Part 1 of this essay examined the general nature of violence in the workplace. It noted the major types of crimes in the workplace, the various types of patient assailants, the theories that seek to explain such violent behavior, and the various physical and psychological impacts such violence has on staff victims. Part 2 examines how this information can be put to good use in developing sound risk management strategies to reduce the risk of such workplace violence and to restore the organization to normal productivity in the aftermath of such incidents.
Workplace risk management strategies are best considered as a threefold approach: Pre-incident training to deter violent behavior; organizational stress management, and crisis counseling to assist staff victims. These strategies enhance morale and restore productivity in the organization and may be modified and tapered to meet the needs of any given organization.
Pre-incident training is directed toward securing and maintaining safety at the facility. It includes controlled access, on-going surveillance, and employee self-defense, where indicated (1). The goal of these tools is to create a physical environment and an educated work force so that the ability for the potential assailants to commit violent acts successfully is reduced and the probability of such assailants being apprehended is increased.
Controlled access concerns itself with who is in the worksite and why these individuals are present. Crime prevention through environmental design (CPTED) is a helpful place to begin to field sound risk management strategies (2). CPTED includes having shrubs at the worksite low and away from the building so that no assailant has a place to hide. Windows in the worksite should be clear of any visual obstructions (e.g., signs advertising goods on sale), so that employees can see out and police and passersby can see in. The worksite should be well-lighted, as this has been shown to be associated with reduced crime. This includes internal corridors and hallways, bathroom, parking lots, and garages.
Next, every facility should avail itself of the various means of target hardening. Locks, fences, cameras, ceiling mirrors, and swipe keys for employees have been shown to reduce risk. Organizations that deal with the public in cash transactions should limit the amount of available cash, conspicuously post this limitation, and have additional employees onsite during heavily trafficked, high-risk periods.
Finally, organizations with the potential for repeated exposure to violence (e.g., police, paramedics, health care providers) should consider maintaining a call-log (3). Research has demonstrated that apparent random acts of violence are not random when looked at in the aggregate but follow a temporal pattern. Rapes appear to occur most commonly between 8:00 p.m. and 4:00 a.m. on Sunday evenings. Most youth violence begins after 3:00 p.m. Psychiatric patient assaults occur most frequently between 7:00 a.m. and 9:00 a.m. on weekdays, when ward activity is high. The call-log is helpful in identifying the types of violence, the type of assailants, and the most frequent high-risk periods. Log information is a risk management strategy in that it permits the deploying of resources at critical times and the deployment of resources is often enough to deter would-be assailants in its own right.
Once the organization is open for business, the workforce needs to be aware of any customers or visitors that may pose a risk. Helpful steps in this area include identification badges with pictures for employees in one color and large identification badges in a different color for visitors to the worksite, such as sales people, repair personnel, and the like. Employees also need some way of communicating danger quickly, such as panic buttons under desks or some code word over the intercom, to summon help. For example, “Mr. Blue to room 520″ to summon in-house security or to call local police. A third helpful strategy is to have employees work in teams so that no one is alone in stairwells, isolated corridors, elevators, and parking areas both day and night.
Employees should be educated in office or worksite safety. If the employee sits at a desk in an office, the desk should be not in the center of the room but against the wall near an exit door. The desk chair should be on wheels for quick escape, if need be. Wall hangings should be securely fastened to the walls and not hung on wire. Employees should not have glass lamps or ashtrays in offices nor any brick-a-brac, such as staplers, that could be used as potential weapons. Such items should be kept in a drawer and not left on the desk top.
Some employee groups such as paramedics, health care providers, and retail service delivery personnel, may need to be trained in some acceptable system of self-defense, especially if they are subject to repeated contact with potentially violent persons. Employees should be trained to identify the early warning signs of potential loss of control. These may be observed in an individual’s appearance and/or behaviors. Disorganization in dress or appearance, tense facial expression, glazed eyes, and inappropriate use of sun glasses are examples of appearance warning signs. Similarly, severe pacing, verbally hostile speech, suggestions of substance abuse, verbal threats to specific persons, and threat of weapons are all behavioral signs of tenuous control. Security should be alerted. Finally, employees should be trained immediately to leave what may be a crime scene that they have come upon and to summon help immediately, as the crime may still be in progress. Employees should also be trained not to disturb what may be a crime scene, if it is at all possible.
There are some professions where employees are required to provide services fairly regularly to persons who are violent or potentially violent at the time of service. Police, paramedics, health care, and social-services providers are common examples. For these employee groups, there are some basic guidelines to providing these services in a manner that reduces the risk of violence and enhances the safety of the patient/ client/suspect, any family or civilian bystanders, and the service providers themselves. Guidelines for at-risk situations include being aware of any medical/psychiatric illness related to the call for assistance; doing scene surveillance, when arriving onsite; being aware of old brain stem functioning (reduced cognitive functioning in service recipient due to severe stress); being alert for the early warning signs of loss of control; and so forth (3).
Organizational Stress Management
Managers and employees are most productive in low-stress environments, where attention and concentration to the task at hand are enhanced. Although it is true that modest increases in anxiety may enhance performance for a short period of time, these small, sustained increases and any substantial increases over time disrupt employee productivity, result in maladaptive work, and lower morale. Simple, cost-effective risk management strategies may result in better organizational productivity, and, equally important to the issue of work place violence, better presence of mind and problem-solving, should a critical incident erupt. The strategies below that are selected should reflect the size and fiscal resources of the organization.
Some interventions require minimal cost. These include organizational polices that preclude having personal weapons at work, substance use during the work day, and the prohibition of violent threats. In the latter case, an organization of any appreciable size should have a formal threat response team. Such teams are usually composed of members of management, unions, human resources, and the legal department. When a threat of any nature (even in jest) is made, the treat team investigates the incident and enacts a penalty in proportion to the offense on the employee who made the threat
A common stress at work in today’s age of down-sizings, closures, and buyouts is unclear job descriptions. When organizations merge or employees are laid off and not replaced the remaining work force must pick up all of the work. Unclear priorities, unclear mission statements, and overlapping lines of authority result in employee confusion, lowered productivity, and increased stress. It is the increased stress that can also impede managing a violent incident with minimal impact, should one occur.
Research has identified the characteristics of people who cope well with stress and are productive (4). These characteristics include reasonable mastery; commitment to a meaningful task; the healthy lifestyle practices of sound diet, aerobic exercise, and relaxation periods; caring attachments to others; a sense of humor; and concern for the welfare of others. These characteristics stand the individual in good stead in regards to work-related stress and violent traumatic stress. Organizations would do well to hire employees with these skills and support a training program to teach these skills to current employees who may not have them. It is a sound decision from the perspective of productivity as well as an additional, cost-effective risk management strategy. Other training programs an organization might want to consider to reduce the risks of workplace violence could include programs or workshops on cultural diversity, sexual harassment, substance abuse, anger management, and verbal-conflict resolution skills.
The goal of organizational stress management strategies is to create a more stable workforce that will remain productive and exhibit adaptive coping behaviors in the face of violence from an external threat or a coworker.
Post-incident Crisis Counseling
Regardless of an organization’s best efforts in pre-incident and organizational stress management initiatives to reduce the risk of violence, such violent episodes may occur. Aside from any medical, legal, structural, or productivity losses, such violence can exact a grim toll on manager or employee direct victims and on other employees who may have witnessed such victimization. The resultant psychological trauma is highly distressing. As we stated in part 1 of this essay, traumatic events may result in disruptions in the domains of good health: reasonable mastery, caring attachments, and a meaningful purpose in life. These disruptions may also be accompanied by the physical, intrusive, and avoidant symptoms of psychological trauma. As has been discussed in part 1, if left untreated for thirty days, posttraumatic stress disorder will follow and, if again left untreated, will persist until the victim’s death.
For organizations where such work place incidents are highly infrequent, hiring outside psychological trauma consultants to assist all employee victims after a critical incident is a sensible option. However, if violence is a frequent visitor to the workplace, such as in police, paramedic, health care, social service provider, and school systems, it may be cost-effective for the organization to create and field its own in-house program.
The most widely researched crisis intervention program in the published literature to address the psychological sequellae in the aftermath of violence is the Assaulted Staff Action Program (ASAP) (5,6). ASAP is voluntary, system-wide, peer help, crisis intervention program to assist employee victims with the psychological aftermath of violent events. When a critical incident occurs, an ASAP team member responds to the victim and offers ASAP services. If the service is accepted, the staff victim is assured of confidentiality and the ASAP team members gather the facts of what has happened. Next, the ASAP member works to address the impact of the traumatic event by restoring mastery, attachments, and a meaningful purpose as well as assessing for the presence of any physical, intrusive or avoidant trauma symptoms. The same ASAP team member then makes arrangements to contact the employee victim after three and again after ten days to provide continuity of care in assessing the need for any additional ASAP services (5).
ASAP teams offer a variety of services as victim needs dictate. There is individual crisis counseling as described above. ASAP teams also offer group crisis counseling, when a group of employees has been impacted by a single incident; a staff victims’ support group for staff victims with continuing psychological distress; employee victim family crisis counseling, when spouses or children are also overwhelmed by what has happened; and private referrals to therapists specially trained in counseling trauma victims for those employee victims with longer-term needs. In twenty-two years of continuous service there have been 40 ASAP teams in seven states with over 1,700 ASAP team members who have provided needed counseling efficaciously to over 4,500 employee victims of workplace violence (6). ASAP has been chosen as a best practice by the federal governments of Canada and the United States. ASAP programs pay for themselves in reduced medical and legal expenses and sustained productivity.
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These two parts of this essay on workplace violence have reviewed the types of crimes and assailants and their psychological impact on employee victims. The essay has also outlined pre-incident, organizational stress management, and post-incident counseling as important efficacious, cost-effective risk management strategies for enhancing workplace safety. These suggestions are to no end if senior management subscribes to the cultural denial: “It can’t happen here.” It can happen to any organization and any employee at any time. Better to seize the moment and implement these minimal-cost procedures in advance. High worker productivity is expected but safety is not optional.
1. Flannery R. B. Jr. Violence in the Workplace. New York: American Mental Health Foundation, 2012.
2. Crowe, T. D. Crime Prevention through Environmental Design: Application of Architectural Design and Space Management Concepts. Stoneham, MA: Butterworth-Heineman, 1991.
3. Flannery R. B. Jr. The Violent Person: Professional Risk Management Strategies for Safety and Care. New York: American Mental Health Foundation, 2009.
4. Flannery R. B. Jr. Becoming Stress-Resistant through the Project SMART Program. New York: American Mental Health Foundation, 2012.
5. Flannery R. B. Jr. The Assaulted Staff Action Program: Coping with the Psychological Aftermath of Violence. New York: American Mental Health Foundation, 2012.
6. Flannery, R. B., Jr., LeVitre, V., Rego, S., and Walker, A. P. “Characteristics of staff victims of psychiatric patient assaults: Twenty-year analysis of the Assaulted Staff Action Program (ASAP).” Psychiatric Quarterly, 2011, 82, 85-93.
Dr. Raymond B. Flannery, Jr., Ph.D. FAPM, is an internationally recognized scholar and lecturer on the topics of violence, victimization, and stress management. Dr. Flannery is available for lectures and workshops for all types of groups, and may be reached at the American Mental Health Foundation. Elomke [at] americanmentalhealthfoundation [dot] org or 212-737-9027 (phone and fax)