Emergency Care in Victoria

Addressing violence in Victorian health care settings

The Victorian Government is committed to addressing violence in health care settings and reducing violence against hospital staff. Priority areas for the Victorian Government in achieving this commitment include:

• Establishing a simplified mechanism for hospital staff to report violence
• Compelling hospitals and boards to publically report violent incidents
• Introducing consistent code grey and code black security responses
• Auditing security staff in public hospitals
• Considering risk assessments, behavioural contracts, client alert systems, training and post-incident response
• Establishing a $20 million Health Service Violence Prevention Fund to improve hospital and mental health facilities to make them safer for staff, patients and visitors.

The 2012-13 Victorian State Budget allocated $5.8 million over four years to support safety and security and reduce violence in Victorian health services.

Synergies exist between the Government’s commitments and previous work by the Department of Health to improve safety and security in Victorian hospitals. The improving safety and security in Victorian hospitals fact sheet provides a summary of recent initiatives undertaken.

• Improving safety and security in Victorian hospitals fact sheet

The work to support health services to better address violence in the workplace has been informed and shaped by the following inquiries:

• The Parliamentary Inquiry into Violence and Security Arrangements in Victorian Hospitals and, in particular, Emergency Departments (2011) - the Inquiry provided 39 recommendations relating to the prevention and management of violence and aggression in Victorian hospitals, all of which were supported or supported in principle by the Victorian Government.
• The Victorian Auditor-General’s Office (VAGO) performance audit into Occupational Health and Safety Risk in Public Hospitals (2013),
• The Victorian Taskforce on Violence in Nursing (2005)

An advisory committee was established in 2013 to provide advice and oversight of initiatives. Membership of the Improving Hospital Safety and Security Ministerial Advisory Committee includes community representatives and senior representatives from nursing, medical, security, human resources and Victoria Police.

• Improving Hospital Safety and Security Ministerial Advisory Committee - Terms of Reference
• Improving Hospital Safety and Security Ministerial Advisory Committee - Members

There are a range of initiatives being undertaken which include:

• Standardising Code Grey responses across all health services
• Capturing data and reporting incidents of violence
• Strengthening hospital policy and management on safety and security
• Addressing consistency in education and training for clinical and security staff
• Making hospital design safer for staff and patients
• Improving legal protection for health workers
• Enhancing communication with patients and visitors
• Sharing best practice with the sector

Standardising Code Grey responses across all health services

A standardised response to incidents of violence and aggression is key to addressing occupational violence in Victorian hospitals. The development and implementation of a standardised Code Grey response is a key focus across the public health system.

Principles for a standardised Code Grey

• In May 2014, the Department of Health released Code Grey Standards outlining best practice principles and minimum practice standards supporting standardised organisational responses to incidents of clinical aggression across Victorian health services. These standards are based on research conducted by Melbourne Health* and consultation with a range of Victorian health services.
• All health services are required to have a Code Grey response that is separate from a Code Black response. Health services are to review their organisation-wide policies and procedures for managing clinical aggression and align them with best practice.

* Identifying health service information and survey data has been removed from this report.

Capturing data and reporting incidents of violence

The importance of hospital staff recording incidents of violence and potentially violent behaviour is acknowledged.  Hospitals are encouraged to support and train their staff to report such incidents on standardised reporting systems.

Victorian Health Incident Management System

• The Department monitors the implementation of the Victorian Health Incident Management System (VHIMS). This is a system for collection and review of state-wide incident information including occupational health and safety incident types (inclusive of occupational violence).
• VHIMS enables the monitoring and analysis of incidents and trends in clinical incidents, including incidents related to violence against nurses in the workplace.
• The Department is currently working with health services to improve the reporting interface for occupational health and safety incidents in VHIMS. This work will make local data collection easier for health services and support the examination of trends in system wide aggregate data for a better understanding of both reporting practices and incidents. A trial purpose-built reporting interface has been reviewed by 18 health services across Victoria and this work will continue in 2015.
• The Department has provided a series of e-learning packages that provide information on incident management principles and processes, promotes open disclosure in health care, and enables health services to use rigorous methodologies to determine root causes of local violence.

Strengthening hospital policy and management on safety and security

Hospital executives and management are required to promote policies endorsing the message that violence against health workers will be proactively addressed.  These policies aim to encourage a culture of reporting violent behaviour and incidents.

Victorian Health Policy and Funding Guidelines

• A key change to the Victorian Health Policy and Funding Guidelines 2014-15 is the focus on staff safety in Victorian health services.
• All health services are required to develop strategies to ensure they meet the recommendations arising from the 2011 Inquiry.
• All health services are also required to report to the department on their progress on meeting the Inquiry recommendations at performance meetings with the Department of Health and Human Services and through written reports.

Addressing consistency in education and training for clinical and security staff

All hospitals currently provide various in-house induction and training to medical, nursing, allied health and security staff, and this may include violence and aggression training.

Standardised training on violence and aggression

• There are a range of training programs currently available for clinical staff to support the prevention and management of violence and aggression.
• The quality and effectiveness of this training will be supported with the release of a training guide for clinical and security staff in 2015. The aim of this guide is to assist health services by informing local training programs and enabling a consistent level of training for all staff whose role involves contact with patients and the broader public.

Making hospital design safer for staff and patients

Hospital management should utilise the principles of Crime Prevention through Environmental Design (CPTED) in designing and fitting out new and existing emergency departments, including waiting rooms and triage areas.

Design Guidelines for Hospitals and Day Procedure Centres

• The Department of Health’s Design Guidelines for Hospitals and Day Procedure Centres establishes the minimum acceptable standards for design and construction with due regard for safety, privacy and dignity of patients, staff and visitors. These guidelines incorporate the principles of CPTED.
• The Australasian Health Facility Guidelines have recently been updated and provide Australian health facilities with a common set of guidelines and specifications for the base elements of these health facilities.

Effective security systems in Victorian public hospitals

• From 2012-13 to 2014-15, the Department of Health and Human Services has provided $2.7 million to Victoria’s 40 public emergency departments and Victoria’s 57 rural urgent care centres to further support all Victorian public emergency departments in providing effective security systems, training and capital upgrades to improve the safety and security of all staff, patients and visitors.

Rural capital support fund

• The 2011/12 State Budget provided funding of $56 million for the implementation of a Rural Capital Support Fund (RCSF).  This fund aims to strengthen and sustain existing rural and regional health services through the upgrade of their local facilities. The RCSF is being delivered as a grants program over four years from 2011 to 2014.
• The RCSF enhances the quality and amenity of rural and regional health services.  It also allows health services to respond to local priorities and maintain and enhance their service delivery capacity.

Safety of Women in Mental Health Care Initiative

• The Safety of Women in Mental Health Care Initiative supports modifications in mental health inpatient services to improve the safety, security, and comfort of women in mental health care.
• Modifications funded under this initiative include the creation of female only corridors or wings and improved facility safety with lockable bedrooms.
• The Victorian Government committed capital funding of up to $2 million in 2013-14 and 2014-15 under the Safety of Women in Mental Health Care Initiative

Improving the patient experience for older people

• It is recognised that the physical environment of health services can impact on patient experience and health outcomes. The Improving the environment for older people in Victorian emergency departments report supports the delivery of high-quality, person-centred care for older people in the ED.

Improving legal protection for health workers

In 2014 two pieces of legislation were introduced that reinforce the message that violence towards health workers acting in accordance with their professional duties is unacceptable:

• The Sentencing Amendment (Assaults on Emergency Workers) Act 2014 creates a statutory minimum sentence for assaults on emergency workers. This legislation applies to any offender who attacks a nurse, doctor or other staff member who delivers emergency care.
• The Justice Legislation Amendment (Confiscation and Other Matters) Act 2014 creates an offence of assaulting a registered health practitioner engaged to provide care.

Enhancing communication with patients and visitors

Positive communication is vital between all health care staff, patients and visitors. Effective communication is particularly important in volatile environments like the ED waiting room where it can support de-escalation and act as a pre-emptive tool to address triggers of aggressive behaviour. Good communication includes providing alternative care options, outlining the standards of behaviour expected within hospitals and other health care settings, providing regular updates of ED waiting times and improved hospital signage and wayfinding.

Communication initiatives

• In 2014, funding for communication initiatives was provided to two Victorian health services to improve communication with patients throughout their ED journey, including introduction of improved signage and technology interfaces in hospital EDs.The Improving communication with patients and visitors in the emergency department factsheet describes the key initiatives undertaken by Ballarat Health Services and the Department of Health and Human Services.
• Ballarat Health Services recently provided a presentation on the progress of their communications project.

Victorian Taskforce on Violence in Nursing
The Victorian Taskforce on Violence in Nursing was asked to identify and review the existing systems, procedures and policies in place in Victorian health services and to recommend strategies to reduce the incidence of violence.

Key resources and information on prevention and management of occupational violence:

• Preventing occupational violence - A policy framework (Department of Health)
• Prevention and Management of Aggression (WorkSafe Victoria)
• A workplace free of violence and bullying: How to deliver the message (Department of Health)

Volunteers in Victorian Emergency Departments
Research has shown that volunteers can make an important contribution to improving patient, carer and staff experiences in Victorian public hospital EDs.  In recognition of the valuable contribution of volunteers in Victorian EDs, the Department of Health funded the Australian Red Cross to prepare the Volunteers in Victorian Emergency Departments (VED) program manual to assist Victorian hospitals to implement, administer and deliver a volunteer program in their own ED.

Improving the patient experience for Aboriginal people
The Improving the patient experience for aboriginal people in the emergency department report supports health services in focusing on cultural safety and the delivery of culturally-sensitive care in the ED.

Sharing best practice with the sector

In 2013 and 2014, the Department of Health and Human Services hosted a statewide forum aimed at supporting health services to address local safety and security concerns. The forums reflected the need for responses at multiple levels to address violence in health care settings, including government, emergency services, health services, hospital departments and individual clinicians.

Presentations from the forums can be accessed on the Past Events page.