A simple risk assessment which can be
done by anybody in just two minutes is a useful tool to help prevent violence
in the workplace, by Walter Brennan
Violence in the workplace continues
to be a major problem for organisations.
Left unaddressed, violence damages people and morale, increases
sickness rates, tarnishes the organisation’s commercial profile and costs
millions of pounds in terms of replacement costs or increasing litigation under
health and safety legislation.
The 1992 Management of Health and Safety at Work Regulations
highlight the need for employers to identify hazards in the workplace and
assess the risk1.
Violence was classified as a hazard under the Reporting of
Injuries, Dangerous Disease Occurrence Regulations (Riddor 1995)2, which came
into effect on 1 April 1996. This is significant because it finally identified
violence as a notifiable hazard.
For many years mental health professionals have endeavoured to
predict the likelihood of a person being violent. Clinicians tend to be
ascribed the "expertise" necessary to make such predictions, but this
has yet to be tested and demonstrated empirically. Monahan (1981) indicated
that professionals who aim to predict
the likelihood of violence only have a success rate of 40 per cent3.
There have been some impressive risk assessment models based on
a combination of actuarial and clinical issues. The problem, however, is that
many of these improved tools are either extremely time-consuming or technical
or both.
Furthermore, many of the existing health and safety risk
assessment tools available are either designed specifically for inanimate types
of hazard, for example spillages, or manual handling.
Despite the legal requirement to carry out risk assessment, a number
of surveys conducted over the past 12 months reveal some startling, but not
surprising facts: staff working with potentially and actually violent people
were not carrying out risk assessment in relation to violence4.
A survey showed that:
– 60 per cent of social workers (n=55),
– 45 per cent of accident and emergency nurses (n=71),
– 72 per cent of retail workers (n=31), and
– 89 per cent of personnel staff (n=19)
had absolutely nothing in place in terms of risk assessment for
violence.
This led to an attempt to devise a risk assessment device that
could be used in a number of environments by different staff.
Planning
Because different people may express different behaviours in
different situations, it was felt important to explore the link between the
person and the situation.The assessment had to have the following features:
– Be easy to use
– Be free from jargon
– Be quick
– Not need a clinical background
– Be easy to access
– Be simple to score
– Fit on one page of A4
– Aim to combine clinical with health and safety issues
Use of the tool
This risk assessment questionnaire has been adopted by three
hospitals, two schools, one local authority and is at present being piloted by
a hospital in London and two retailers in Nottingham.
Conclusion
This simple risk assessment tool is intended to be used by a
variety of disciplines at first point of contact with clients, members of the
public and even employees.
A more comprehensive assessment can follow on from this
two-minute exercise going into more detail about the person and exploring wider
aspects of the human condition.
Walter Brennan is a freelance
training consultant, who has worked with the Department of Health on its Zero
Tolerance campaign
References
1. Health and Safety Commission (1992) Management of Health and
Safety at Work: Approved code of practice. Management of Health and Safety
Regulations. London: HMSO.
2. Health & Safety Executive (1996) A Guide to the
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995.
London: HMSO.
3. Monahan J (1981) The Clinical Prediction of Violent
Behaviour, 627-628. Washington DC: Government Printing Office, and Rockville
MD: NIMH
4. Brennan W (1999) Risk Assessment, Violence and Dangerousness
in the Workplace: Nursing and Residential Care, 1 (3): 159-163.
Brennan’s two-minute risk assessment of violence
1: Do you know the person?
Yes = 5 No = 10
The best predictor of future behaviour is past behaviour.
2: If yes, does the person have a known history of violence?
Yes =10 No = 0 Don’t know = 10
If a person has a known history of violence, then this must be acknowledged.
Of course a person may have been violent as a result of a set of unique and
exceptional circumstances and these circumstances may never re-occur. Nevertheless,
if known, a history of violence needs to be acknowledged. What is of more
significance is the score attached to the "don’t know" response. If
we are not aware of any history of violence, we may assume the person not to be
violent. This is not good practice. Until you have evidence that the person is
not violent, then the default should always be, "If you are not sure,
assume the worse".
3: Has the person become verbally abusive or suddenly become quiet?
Yes = 10 No = 0
If there is a noticeable change in someone’s behaviour, this should cause
alarm, as such changes are indicative of unpredictable behaviour.
Unpredictability should prompt caution. Verbal abuse is often a precursor to
physical violence.
4: Has the person said he/she intends to become violent towards you or a
colleague?
Yes = 10 No = 0
As obvious as it seems, many employees who deal with threats of violence on
a daily basis can become "immune" to the incident whereby the person,
after threatening violence, then executes it, prompting "surprise"
from the victims or statements such as, "I didn’t think he/she would
attack me".
5: Does the person have or appear to have a mental health problem?
Yes = 10 No = 0
Mental health problems are often erroneously associated with violence. However,
research suggests that a person who is unknown and who may be expressing
bizarre behaviours or responding to hallucinations may be unpredictable and a
source of anxiety.
6: Is the person under or appear to be under the influence of drugs or
alcohol?
Yes = 10 No = 0
There have been numerous pieces of research aimed at exploring the links
between alcohol and drugs and violence. One of the most common reactions to
alcohol and drugs is disinhibition.
7: Is the person’s body language hostile or aggressive?
Yes = 10 No = 0
8: Is the task being undertaken likely to cause the person to become
angry, for example, are you giving bad news? Are you doing something the person
may find painful or distressing?
Yes = 10 No = 0
One of the most common triggers of violence in the workplace is the use of
words such as "No", in other words – not giving someone what he or
she wants. This is a situational factor that needs to be taken into
consideration.
9: Are there the correct number of staff on duty and available to manage
a violent situation should it arise?
Yes = 5 No = 10
The idea of this risk assessment is to balance the risk of violence against
the safe systems of work in place, which can minimise or even eliminate the
risk of violence.
Note that the correct number of staff might be two or three. This number may
be more effective in dealing with a situation than say, five or six staff.
10: Does your unit provide safety first for staff?
CCTV = 9 personal alarm system = 9 Training in aggression management = 5
No = 10
It is important to understand that having no safety systems in place
attracts a score of 10. Personal alarm system or close circuit TV are only 1
point less each. Training in aggression management scores 5.
11: Do staff feel comfortable about the situation?
Yes = 5 No = 10
This is about intuition or "gut feelings". Although somewhat
unscientific, many victims of violence have in retrospect articulated views
that something was not right. Intuition does have a role and should not be
dismissed as crude or primitive.
Add up the scores:
13 – 34 = low risk of violence.
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35 – 84 = medium to high risk of violence.
85 – 110 = high risk of violence.
