Doing it Differently - Reducing Violence and Aggression:

Our Guest Interview with a Hospital Health and Safety Team Leader

Retired Occupational Health and Safety Team Leader at a large Queensland Hospital and Health Service, Brian Smith, speaks to Maybo’s Mark Wakefield about the hospital’s response to the increasing frequency and severity of incidents of aggressive and violent behaviour against staff, the introduction of Code Grey and the role played by Maybo training.

What was your role?

As Senior Team Leader for Occupational Health and Safety (OH&S), one of my responsibilities was to identify unsafe acts, hazardous incidences, trends or behaviours. Approaching the problem from an OH&S perspective, I identified risks and reviewed existing control measures, assessed hazards, advised and where necessary, assisted in the development of appropriate control measures to either eliminate or mitigate the risk. Following reviews, I provided senior management with trends or indicators which may pose a high risk to staff, patients and others. Occupational violence was assessed as high risk and was placed on our Risk Register.

What was happening in your Hospital?

Although policies, education programmes and auditing and reporting systems were in place to minimise staff exposure to aggressive or violent behaviour, trending evidence revealed that the frequency and severity of incidences were increasing, despite the control measures. This was not unique to our hospital but was a trend in health care environments nationwide, particularly in emergency departments. The level of concern warranted a nationwide review of occupational violence which was undertaken by State Health and Safety Regulators in 2010.

So, what did you do to address these issues? 

We recognised that in addition to the robust systems in place, further improvements to mitigation strategies were required and as part of the review I attended a national occupational violence conference in Melbourne in 2011. One of the guest speakers from St Vincent’s Hospital in Melbourne delivered an overview of their Occupational Violence Prevention (OVP) strategies/procedures and the adoption of the “Code Grey” response to minimise frequency and severity of violence and harm to staff and others. Code Grey is a clinically led team response to planned or unplanned aggressive behaviour before the incident turns violent rather than a security led one (Code Black), responding to potential violence or for example where a nurse maybe being assaulted.

Post conference, our senior management team was briefed and supported the concept of Code Grey as an additional control measure which could minimise or lower the frequency of violence across the organisation.

A specialist team consisting of clinical, nursing, security and OH&S professionals visited St Vincent’s to observe and learn more about the procedure. The team returned and were extremely enthusiastic about how this could improve things for our hospital, particularly within the emergency department. It needed some reshaping and remodelling to suit our particular circumstances and this led to a working group being established which included a review of the current training. The group concluded that the current set of training and capability was not resourced adequately to deliver the required training prior to implementation of a pilot within the emergency department. To address this, an external company was sourced that was suitably qualified to conduct Code Grey training for the emergency department, security and support staff who may form part of the Code Grey response team.

How did you hear about Maybo?

Maybo was one of the preferred providers for Queensland Health. Following positive feedback from colleagues who had already used their services Maybo was approached to work with us to provide the specific, evidenced based training required. Maybo was also willing to run a pilot to secure engagement from all staff.

So, was there some resistance?

Initially yes. Many thought they already possessed the necessary skills and couldn’t see a reason to change. Maybo’s Lorraine Harvey presented the pilot to a diverse group of staff including managers, doctors, nurses, security staff and police officers and at that point people started to see how things could be managed differently. It was mainly Lorraine’s ability to communicate the programme that helped change people’s attitudes.

Was it only the conflict management skills that were taken on board?

That was the starting point, we already had a physical intervention module within the current suite of occupational violence protection that we used and Maybo’s conflict management could sit alongside this. However, during the course of the training, Maybo’s managing director, Neil Warwick identified some shortcomings in our in-house training. We only train selected staff to take patients and others to the ground face down, there were no holds for restraining in a seated position or for placing/restraining a non-compliant person on a bed to allow for safe clinical assessment/intervention. This led to a more in depth look into Maybo’s training offerings.

In relation to the laws around the use of force, Neil was also able to provide staff with a good understanding of their legal rights and responsibilities and according to the feedback, has given staff more confidence in what they are able and allowed to do. This meant that where necessary, instead of avoiding a situation staff were more willing to manage it, knowing that they are acting within the law and with due respect to the dignity, safety and better clinical management to the patient and staff involved.

What changes did you notice after the Code Grey implementation?

The hospital has not yet fully implemented those changes and although some staff have been trained, Code Grey is not yet officially up and running. However, the hospital has already started to see a difference in the way that situations are being handled and the early data looks good.

There has been a drop in the number of violent events in the emergency department, although it is too early to conclusively contribute the downturn due to the different approaches by the staff post training. The pilot, when fully implemented will provide the tangible evidence. The conflict management, language and skills around awareness of situations, risk reduction strategies that can be used and the de-escalation strategies introduced to the staff by Lorraine have already taken hold.

The police are fully supportive of the Code Grey response particularly regarding planned responses and they are actively calling forward to the emergency department staff when they are bringing in a “potential Code Grey patient” to allow for the response team to prepare. The Police now also have a better understanding of how important their support is as part of the team if required, as this contributes to lower re-calls back to the hospital, often on the same patient and allows for more operational time. The Police are remaining onsite until the staff have full control of the situation.

Why is that?

One reason is that the training demonstrated the necessity to maintain control and work together as a team. The other benefit has been the reduction in call backs that are being made to the Police who in the past, due to workload, would at times leave the hospital before a patient was settled but would inevitably have to return when a Code Black was called to assist the staff. Now they operate with the understanding that dealing with the situation at a lower level is better all round and enables them to do their job more effectively out on the streets rather that in hospital wards.

Has there been an effect in other areas of the Hospital?

The benefits of implementing these strategies across other wards are evident. The patients with Dementia will certainly benefit. In the past there have been incidents of prolonged restraints and assaults on this ward, which can be particularly risky with elderly patients.  The mental health wards will also benefit; particularly as they work under very specific legislation. Any ward that experiences the use of a Code Black response will benefit from this specific training. The Hospital and Health Sevice has a number of rural hospitals that operate with low numbers of staff that may also benefit from this set of skills and training. There may need to be some adaptations to take care of the different circumstances under which they work but overall I can see there will be positive outcomes.

 What would be your overall impression of Maybo and Code Grey?

I and those who attended the training were very impressed with Maybo’s approach.  They adapted their training to meet our needs and the delivery was without doubt one of the most professional, interactive, relaxed yet controlled sessions of this nature that I have experienced in forty years as a trainer and facilitator.

Lorraine and Neil are exceptional operators and quickly read the audience and for Lorraine to maintain the focus and interests of the attendees throughout the sessions was exceptional, given that they were dealing with clinical/medical professionals, security and support staff. 

I would recommend Maybo to any organisation that may be exposed to occupational violence and need training in conflict management and control of potentially violent people, inclusive of physical intervention methods in the workplace. In particular anywhere where health care facilities or services operate in an environment that can be threatening due to the potentially hazardous behaviours of patients or others.

Brian Smith

Ex Senior Team Leader OH&S (Retired)

If you would like to talk to us about Code Grey training or tailored conflict management and physical interventions training for your staff, please get in touch.








































Posted by Maybo on October 19, 2015


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