Protecting Health Care Workers From Violence
Most of us have seen it happen to a colleague or been on the receiving end of abuse from an upset patient, family member or some other individual. Inevitably, we ask ourselves the following questions:
- What happened and how did it escalate to this level?
- Was it something I did?
- Was it something another physician or caregiver did or didn’t do?
- What signs did I miss?
- How can I be more observant and prepare for this in the future?
I’m talking about workplace violence in health care settings.
Workplace violence is considered any act or threat of physical violence, verbal harassment, intimidation or other disorderly behavior. These actions are often stressful, frustrating and can be physically harmful.
Many state Occupational Safety and Health Administration (OSHA) departments believe that a well-written and implemented workplace violence prevention program, with top-down guidance and staff training can reduce workplace violence.
It is essential that all workers understand the policy and know that all allegations of workplace violence will be investigated and remedied promptly.
Health care workers face an increased risk of work-related assaults stemming from several factors. Some include:
- Patient frustration over service delays.
- Burglaries of drugs or money from health care offices.
- A growing proximity of gang members, addicts, or distraught family members to patients.
- A growing frequency of weapons possession.
- Fluctuations in staffing levels. Some attacks happen when staff is on a meal break or attending to other patients.
- A lack of staff training in recognizing and managing escalating types of violent behavior.
The risk of assault can be minimized or prevented if employers take appropriate precautions. One of the best protections that can be offered to health care workers is for their workplace to establish a zero tolerance policy toward any workplace violence. The policy must cover all workers, patients, clients, visitors and anyone else who may come in contact with personnel of the facility.
Having a zero-tolerance policy can assist staff members with common situations that may arise. Staff should be well-versed in conflict resolution during stressful situations. This will require training. Some of these policies should incorporate:
- A written program for workplace violence, safety and security that should be incorporated into the office safety and health program.
- Clear goals and objectives to prevent workplace violence that should be adaptable to specific situations in each department or location.
- Responsibility for the program with individuals or teams through appropriate training and skills.
- Adequate resources for this effort and the team.
- A patient acknowledgment of “rights and responsibilities” including the facility’s zero-tolerance policy as it relates to verbal or physical abuse towards all staff, patients, or visitors.
A well-prepared workplace violence policy is a crucial and essential component of workplace safety. With this in place, educated staff members can evaluate and recognize potentially threatening situations and feel comfortable knowing they have the tools and the administrative support to professionally take control of a situation, if necessary. Some of these methods also provide employees with adaptable strengths to maintain safe working conditions, improve morale, safety and effectiveness.
The Snow Keeps Falling and the Snow Has Won
This season, municipalities across the northern regions of the United States have been inundated with snow and lots more is coming our way. Our overtime budgets are strapped and for the life of us we can’t seem to find enough salt or sand to help pave the roads throughout our communities.
It’s telling that Punxsutawney Phil not only saw his shadow this year earmarking another six weeks of winter, but that he tried to take a snip at his handler. One might gather he’s as sick and tired of beating back the weather as every snowplow operator across the United States.
Public risk managers are drowning in snowplow vehicular accidents, sheared mailboxes and damage from pockmarked roadways.
We know of the dangers and fear for your safety. We ask that you not call us killjoys, Scrooge or any four-letter words.
For every snow emergency called, there is a resident who claims it was never issued, and that his vehicle was completely engulfed by an unseen snow bank that he hit in the dark of the early morning appears to be everyone’s fault but his own.
Snowy hillsides whose curves are marked by dangerous conditions beckon to be sledded, skied or tobogganed. No amount of signage stops the adventurous, the folks who ignore the signs.
Municipal risk managers get it … truly we do. Yes, we were kids once although many residents now think we were spawned from the devil himself. We once sought that Radio Flyer for the holidays, fastened our mittens tight, and held on for dear life as we hopped on that sled to feel the exhilaration of the wind and the cold.
Problem is, we’ve grown up. We now get those pesky accident reports that claim our snow-covered hillsides are dangerous and cause calamity and injury.
Gone is the innocence of every risk manager’s youth.
I’m sometimes asked if I know the terrain of a hillside marked for “No Sledding.” Really? There are many dangerous hillsides marked with a “No Sledding” moniker. Do residents really expect us to map out the topography, the tree stumps, the divots, the gulleys and know exactly where they might get hurt?
How often have adults, or parents or guardians ignored the signage and said just this once … in the beauty of the snowfall … let’s take that chance?
Don’t. We know of the dangers and fear for your safety. We ask that you not call us killjoys, Scrooge or any four-letter words.
Think of the potential injuries — concussions, broken limbs and a potential loss of life — the next time you say to yourself … just this once, nothing will happen. I used to do this all the time when I was a kid.
Should you take the risk and fail, call 911, but don’t call me the next morning and tell me I should have known there was a tree stump that appeared out of nowhere and hit you in the teeth.
The patience of weather-weary risk managers is slowly waning amidst the claims of those who should have know better, but consciously decided to take a risk. Like Punxsutawney Phil, we wish we could nip back too.
Read all of Marilyn Rivers’ Risk Insider contributions.
2015 General Liability Renewal Outlook
There was a time, not too long ago, when prices for general liability (GL) insurance would fluctuate significantly.
Prices would decrease as new markets offered additional capacity and wanted to gain a foothold by winning business with attractive rates. Conversely, prices could be driven higher by decreases in capacity — caused by either significant losses or departing markets.
This “insurance cycle” was driven mostly by market forces of supply and demand instead of the underlying cost of the risk. The result was unstable markets — challenging buyers, brokers and carriers.
However, as risk managers and their brokers work on 2015 renewals, they’ll undoubtedly recognize that prices are relatively stable. In fact, prices have been stable for the last several years in spite of many events and developments that might have caused fluctuations in the past.
Mark Moitoso discusses general liability pricing and the flattening of the insurance cycle.
Flattening the GL insurance cycle
Any discussion of today’s stable GL market has to start with data and analytics.
These powerful new capabilities offer deeper insight into trends and uncover new information about risks. As a result, buyers, brokers and insurers are increasingly mining data, monitoring trends and building in-house analytical staff.
“The increased focus on analytics is what’s kept pricing fairly stable in the casualty world,” said Mark Moitoso, executive vice president and general manager, National Accounts Casualty at Liberty Mutual Insurance.
With the increased use of analytics, all parties have a better understanding of trends and cost drivers. It’s made buyers, brokers and carriers much more sophisticated and helped pricing reflect actual risk and costs, rather than market cycle.
The stability of the GL market also reflects many new sources of capital that have entered the market over the past few years. In fact, today, there are roughly three times as many insurers competing for a GL risk than three years ago.
Unlike past fluctuations in capacity, this appears to be a fundamental shift in the competitive landscape.
“The current risk environment underscores the value of the insurer, broker and buyer getting together to figure out the exposures they have, and the best ways to manage them, through risk control, claims management and a strategic risk management program.”
— David Perez, executive vice president and general manager, Commercial Insurance Specialty, Liberty Mutual
Dynamic risks lurking
The proliferation of new insurance companies has not been matched by an influx of new underwriting talent.
The result is the potential dilution of existing talent, creating an opportunity for insurers and brokers with talent and expertise to add even greater value to buyers by helping them understand the new and continuing risks impacting GL.
And today’s business environment presents many of these risks:
- Mass torts and class-action lawsuits: Understanding complex cases, exhausting subrogation opportunities, and wrangling with multiple plaintiffs to settle a case requires significant expertise and skill.
- Medical cost inflation: A 2014 PricewaterhouseCoopers report predicts a medical cost inflation rate of 6.8 percent. That’s had an immediate impact in increasing loss costs per commercial auto claim and it will eventually extend to longer-tail casualty businesses like GL.
- Legal costs: Hourly rates as well as award and settlement costs are all increasing.
- Industry and geographic factors: A few examples include the energy sector struggling with growing auto losses and construction companies working in New York state contending with the antiquated New York Labor Law
David Perez outlines the risks general liability buyers and brokers currently face.
Managing GL costs in a flat market
While the flattening of the GL insurance cycle removes a key source of expense volatility for risk managers, emerging risks present many challenges.
With the stable market creating general price parity among insurers, it’s more important than ever to select underwriting partners based on their expertise, experience and claims handling record – in short, their ability to help better manage the total cost of GL.
And the key word is indeed “partners.”
“The current risk environment underscores the value of the insurer, broker and buyer getting together to figure out the exposures they have, and the best ways to manage them — through risk control, claims management and a strategic risk management program,” said David Perez, executive vice president and general manager, Commercial Insurance Specialty at Liberty Mutual.
While analytics and data are key drivers to the underwriting process, the complete picture of a company’s risk profile is never fully painted by numbers alone. This perspective is not universally understood and is a key differentiator between an experienced underwriter and a simple analyst.
“We have the ability to influence underwriting decisions based on experience with the customer, knowledge of that customer, and knowledge of how they handle their own risks — things that aren’t necessarily captured in the analytical environment,” said Moitoso.
Mark Moitoso suggests looking at GL spend like one would look at total cost of risk.
Several other factors are critical in choosing an insurance partner that can help manage the total cost of your GL program:
Clear, concise contracts: The policy contract language often determines the outcome of a GL case. Investing time up-front to strategically address risk transfer through contractual language can control GL claim costs.
“A lot of the efficacy we find in claims is driven by the clear intent that’s delivered by the policy,” said Perez.
Legal cost management: Two other key drivers of GL claim outcomes are settlement and trial. The best GL programs include sophisticated legal management approaches that aggressively contain legal costs while also maximizing success factors.
“Buyers and brokers must understand the value an insurer can provide in managing legal outcomes and spending,” noted Perez. “Explore if and how the insurer evaluates potential providers in light of the specific jurisdiction and injury; reviews legal bills; and offers data-driven tools that help negotiations by tracking the range of settlements for similar cases.”
David Perez on managing legal costs.
Specialized claims approach: Resolving claims quickly and fairly is best accomplished by knowledgeable professionals. Working with an insurer whose claims organization is comprised of professionals with deep expertise in specific industries or risk categories is vital.
“We have the ability to influence underwriting decisions based on experience with the customer, knowledge of that customer, and knowledge of how they handle their own risks, things that aren’t necessarily captured in the analytical environment.”
— Mark Moitoso, executive vice president and general manager, National Accounts Casualty, Liberty Mutual
“When a claim comes in the door, we assess the situation and determine whether it can be handled as a general claim, or whether it’s a complex case,” said Moitoso. “If it’s a complex case, we make sure it goes to the right professional who understands the industry segment and territory. Having that depth and ability to access so many points of expertise and institutional knowledge is a big differentiator for us.”
While the GL insurance market cycle appears to be flattening, basic risk management continues to be essential in managing total GL costs. Close partnership between buyer, broker and insurer is critical to identifying all the GL risks faced by a company and developing a strategic risk management program to effectively mitigate and manage them.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Liberty Mutual Insurance. The editorial staff of Risk & Insurance had no role in its preparation.