Managing disruptive patients in health care: Necessary solutions to a difficult problem

Abstract

VA's system was considered effective by system owners and users may be effective at reducing assaulted-related injuries.

Managing Federal Workers' Compensation Injuries and Costs

“…12 Nevertheless, workers' compensation costs continued to increase. 13 The VHA conducted a second national assessment to identify obstacles and system weaknesses. In response, it developed specific performance improvement projects, in various administrative regions, to test specific hypotheses, evaluate specific interventions, and characterize obstacles to roll-out.…”

“…Targeted injury prevention programs were developed and implemented that effectively decreased the injury incidence rate. 12,13 The VHA efforts at integrating workers' compensation programs into its general safety activities and the occupational health program occurred in the context of growing interest at the departmental level. Initial pilot efforts in DVA were undertaken without involving the management chain in VHA.…”

“…The VHA developed critical education and training and novel infrastructure to intervene in patient-on-provider assaults. 13 In the area of sharps injuries, the VHA implemented senior management performance metrics that focused on obtaining safer devices that had little effect on reducing injuries. Finally, in the area of cumulative trauma disorders, VHA implemented its electronic medical record in 2001 and saw a fourfold increase in carpal tunnel syndrome and other upperextremity problems and then implemented VHA-wide training on office ergonomics for all staff.…”

Workplace violence: A call for action

“…While denial of care is not appropriate in some cases, organizational leaders should track these perpetrators such that appropriate staffing and other personnel can be summoned when the patients seek future health care services and can be referred to programs to help them manage their aggression. The Veterans Health Administration, in an effort to manage WPV, enacted a tracking system for patients threatening providers [21] . While banning care is not legally and morally possible in some U.S. health care settings, tracking offenders allows for readjustments of location and timing as to when these patients can receive care, as well as having the appropriate personnel present to manage potentially violent incidents.…”

Workplace Violence Prevention: Improving Front-Line Health-Care Worker and Patient Safety

“…Work organization factors identified as contributing to an environment in which violence can flourish including inadequate staffing, long patient waiting times, poor safety culture [15], and a lack of staff empowerment and shared governance.…”