Workplace Violence Prevention: Flagging Practices and Challenges in Hospitals

Abstract

Background: Flagging is a standardized way to communicate the risk of patient violence to workers. We add to the limited body of research on flagging by describing hospitals’ approaches to and challenges with flagging patients with a history of violent behavior. Methods: We used a qualitative case study approach of hospitals in Ontario, Canada and their patient flagging practices. Key informants and our advisory committee identified 11 hospitals to invite to participate. Hospitals assisted in recruiting frontline clinical and allied health workers and managers to an interview or focus group. A document analysis of hospitals’ flagging policies and related documents was conducted. Thematic analysis was used to analyze interview and focus group data. Findings: Five hospitals participated. Of the five hospitals, four had a flagging policy where frontline clinical workers ( n = 58), frontline allied health workers ( n = 31), and managers ( n = 42) participated in an interview ( n = 43) or focus group ( n = 15). Participants described three challenges: patient stigmatization, patient privacy, and gaps in policy and procedures. Conclusion/Application to practice: Flagging patients with a history of violent behavior is one intervention that hospitals use to keep workers safe. While violence prevention was important to study participants, a number of factors can affect implementation of a flagging policy. Study findings suggest that hospital leadership should mitigate patient stigmatization (real and perceived) and perception of patient rights infringement by educating all managers and frontline workers on the purpose of flagging and the relationship between occupational health and safety and privacy regulations. Leadership should also actively involve frontline workers who are the most knowledgeable about how policies work in practice.

The importance and feasibility of hospital interventions to prevent and manage patient aggression and violence against physicians in China: a Delphi study

“…Risk assessment advocates claim that risk assessments can be employed by hospitals to safeguard physicians and to reduce the incidence of violence [ 19 , 35 , 37 ]. However, its opponents are concerned that applying policies and procedures that flag individuals would lead to patient stigmatization and damage patient privacy [ 38 , 39 ]. Although implementation of patient risk assessments is controversial, some countries have adopted practical measures to flag patient based on risk assessment.…”

Violent Event Severity Tool for Reporting Violent Incidents

“…These include screening and flagging potentially violent patients, activating behavior response teams, staff education and training, and postassault debriefing. [14][15][16] A Cochrane review of staff education and training studies showed no significant direct effects on the incidence of patient violence, although educational programs may have improved knowledge and attitudes among healthcare workers. 17 Another Cochrane review that included interventional studies from 2 psychiatric units and an emergency department showed that regular violence-risk assessments reduced aggression against healthcare workers.…”

“…Various strategies have been recommended to prevent and manage violent behaviors. These include screening and flagging potentially violent patients, activating behavior response teams, staff education and training, and postassault debriefing 14-16 . A Cochrane review of staff education and training studies showed no significant direct effects on the incidence of patient violence, although educational programs may have improved knowledge and attitudes among healthcare workers 17 .…”

The Use of Graphic Facilitation to Support Adherence to OCAP® Principles in Research With Indigenous Communities

“…Researchers are also being asked to develop visuals of their work - like co-author E.M.F. who was invited by a journal to create a visual abstract of her research for promotion on the journal’s social media platforms (Ferron et al, 2021).…”