Addressing violence and aggression
What is your job at Barts Health?
Associate Director for Culture Change and my main responsibilities are around individual and team development. At the moment I am leading on projects like Super T across the Trust, the national staff survey and am also working on our violence and aggression workstreams with Valerie Swaby, Asha Wimmer and Stewart Russell.
How long have you worked at Barts Health?
I have been here for 6 years, almost 7! I joined during the merger.
Why is violence and aggression an issue within the Trust?
Sadly we have seen a gradual increase of staff reporting incidents of violence and aggression within the staff survey, particularly from patients and visitors demonstrating this type of behaviour towards them. I noticed that at The Royal London Hospital I had 7 referrals from teams wanting to talk to me about this issue, and with Newham Hospital having launched their Respect campaign in 2016/2017 following staff survey survey results it became clear that a new approach was needed.
I went to these teams to hear their stories and was shocked by what they were telling me. One nurse told me that her colleagues during the London Bridge attack of last summer and its aftermath, was walking down Whitechapel road and had her headscarf pulled from her head. Another nurse had threats of acid attacks, and a doctor had sadly been physically struck by a patient.
Having heard these stories I knew we needed to revamp our approach, and our policy on violence & aggression was outdated. Traditionally this policy was led by security. However research into what other Trusts are doing showed us that their policies were clinically led. Many were using a model of clinician, nurse and security working in partnership to deliver best practice. We are working on developing a similar approach here at Barts Health, and to deliver train the trainer to staff so we can embed a sustainable approach to this issue.
Our colleagues at ELFT have done fantastic work which we drew from, as well as looking at the work undertaken at the Evelina Children’s Hospital and Transport for London. We have had three collaborative meetings, as well as a peer review where colleagues from Kings College Hospital, ELFT, Newcastle, Royal Free came to review our current practice. Their feedback has been really valuable in helping us determine next steps.
What improvements are being made to support staff with violence and aggression at work?
As well as reviewing and updating our policy, we have been awarded £27,000 by Health Education England to invest in training for staff. We are in the process of finding the best training courses to ensure we meet the unique needs of Barts Health.
In our collaborative meetings we have been working closely with ACCU and the Emergency Department at The Royal London Hospital, who have been doing amazing work internally to educate staff and combat these issues. St Bartholomew’s Hospital and Whipps Cross have also rolled out the Respect poster campaign.
External support is also important to us, and we have invited organisations such as Transport for London to come in and share their learning and approach with us. They have focused on campaigns with a psychological connection rather than enforcing zero tolerance messaging, and these have had huge success. Taking elements from campaigns that have proven successful elsewhere is going to help us shape the best possible framework for our own staff.
We are also exploring what work we can do with Estates & Facilities to better our environment for staff and patients. There is evidence that changes such as wall colour, the furnishings and even using mirrors in reception areas so that people can see themselves and their reactions make a difference to behaviour. Particularly in wards at The Royal London that are so vast, people can often not see around corners - so could we have mirrors at certain angle to combat this problem? Trialling improvements like these are certainly on the agenda.
What impact does violent and aggressive behaviour have on people at work?
The research is very clear that this behaviour impacts both the recruitment and retention of staff, and also on sickness and absence. We know that in ACCU at The Royal London Hospital since work has been undertaken to improve these areas on concerns that their retention numbers have gone up and they have also seen a steady rise in recruitment.
If staff have suffered violence and aggression at work, what support mechanisms are in place?
I would encourage all staff to Datix these incidents so there is a clear record of events, and also to then access our occupational health service. The Royal London’s Senior Leadership Team have also now agreed that should they be notified of an event, that a member of this team will personally call the staff involved to discuss further. Regular contact with staff following a behavioural event is so important.
Individuals should be encouraged to contact occupational health, or a trusted colleague, to discuss the incident and help develop the understand as to what is normal behaviour, what is not to be tolerated, and how best to manage these incidents in future. I think that at Barts Health we have tolerated this behaviour for so long that the unacceptable has become acceptable, and this needs to change. No one should come to work scared.
There is a huge opportunity to make our staff feel safe and secure at work, and should anything happen that they feel thoroughly supported.
What other work is going on across the Trust to address this issue?
Caroline Alexander (Chief Nursing Officer), Alistair Chesser (Chief Medical Officer) and Andy Bowman (Director of Estates and Facilities) are the triumvirate sponsoring this work. Using this triumvirate model at each site is going to be essential in embedding the changes we make at a corporate level, and to ensure the individual needs of each hospital are met. A systemic approach like this is going to allow us to confidently make changes and work towards best practice.
We will also continue to facilitate external peer reviews of our work, so that people with no connection to the site or our work can actually walk the patient journey and understand what might cause violent or aggressive behaviour to occur. Feedback like this will ensure we consider every possible area for improvement.
What other resources would you direct staff to if they want more support?
We do have psychologists at each site who have been brilliant at helping teams and individuals. If there has been an issue, they have helped provide assistance to the multidisciplinary team in understanding the incident and supporting staff afterwards. If staff are experiencing behavioural issues from other staff, we do also have trained mediators in the Trust who can help facilitate a conversation if there is conflict.
Also, don’t be afraid to ask us for support or suggest changes! The Emergency Department at The Royal Hospital got in touch to say that they might benefit from a therapy dog, so after a quick call to Nancy Whiskin (Head of Volunteering) - they now have one! Please do encourage your colleagues to get in touch with me or the Organisation Development team at any time.
If you want to get involved with the wider collaborative work and the changes we are making Trust wide, please contact myself, Valerie Swaby or Stewart Russell
Thank you for reading,
Geraldine Cunningham, associate director for culture change