Staff Training

Protection against violence and aggression cannot be achieved and maintained by the provision of staff training alone.

It is usually best to ensure management controls (i.e. Policies, Risk Assessment, Behaviour Plans, Reporting Systems, Safe Practice Guidance and Instructions and Crisis Procedures) are established – before deciding on the content of the training to be provided.

Is Staff Training necessary?

In some circumstances, adequate Guidance, Instruction and Supervision may mean that staff do not need any extra training.

However, in many cases staff training would be considered an essential, reasonable step and a failure to provide it would constitute negligence on the part of the employer, as well as, an offence under the Health & Safety at Work legislation.

For example, training that helps to reduce the risks of becoming a victim of violent assault or to avoid becoming the perpetrator of an unlawful assault may be considered a must for all employees whose workplace, role (or occupation) is, or can be, associated with:

• A high risk of assaults on staff
• Responsibility for physically controlling people

What training do Staff need?

Staff Training needs will be identified from the Workplace Risk Assessment process, which should take into account the nature of the work processes being conducted, any history of incidents, the environment, the characteristics of the client group, working practice and procedures, the individual capabilities of each employee AND the kind of role in the safety arrangements that they are expected to play.

What might a Staff Training Programme include?

All employees need to know and understand:

a) The nature and extent of the risks being faced (whether from internal bullying or aggression from service recipients).

b) The employer’s policies, safety arrangements and safe practice procedures (and the reasoning underpinning them).

c) Common Law Duty of Care to self and others and statutory Health & Safety responsibilities.

d) Section 44. Employment Rights Act 1996.

e) Human Rights Act 1998.

f) The law in relation to the use of force.

g) What to report, when to report and who to report to.

h) The characteristics (and sensitivities) of the particular client group being serviced.

i) Warning & Danger signs – so as to be able to anticipate problems and recognise trouble brewing.

j) How best to behave if someone becomes aggressive – including avoiding “triggers”.

k) How best to respond to verbal abuse and threats of assault.

l) The importance of always maintaining a safe distance and an egress route.

m) How to summon support (verbally, by telephone, by radio, by panic alarm).

n) Where and when to go and be safe.

o) The availability of professional counselling in the event of victimisation to help to minimise the impact and protect against Post Traumatic Stress

Some employees will need more specialised training

Each employee needs only to be able and competent to carry out their particular role in the safety arrangements. However, where an employee’s duties include a specific responsibility that brings a risk of violence, they will need training in how to perform their task safely.

For example: Those employees (supervisors and junior managers) who have been assigned the role of ‘resolving conflicts’ may benefit from training in:

• How to communicate effectively with people whose ability to comprehend their situation is limited
• How to de-escalate and defuse anger, hostility and aggression
• What to do in the event these strategies fail or would not be of any practical benefit (e.g. the person attacks or is behaving in such a dangerous way they need to be physically restrained.)

Employees assigned to carry out “emergency procedures” for “serious and imminent danger” from violence will be likely to need training in how to practically carry out the procedures – including how to approach, intervene, hold and restrain people safely.

People who work away from the workplace or isolated from the immediate support of others may benefit from Lone-Worker training in how to reduce the risks of violence.

Employees who have been the victim of a work related assault will (statistically) be more likely to be attacked again in the future. Training in how to reduce the particular risks they face may be regarded as essential for them.

How long should training courses be?

To be worthwhile, the duration of training needs to be long enough for all the trainees to achieve the learning objectives.

Do staff in your workplace need Restraint Training?

Every employer would like to say “no”, but the reality is the potential exists in every single workplace for an incident to happen which presents a need for a person’s physical restraint!

For example, a fight breaks out between colleagues, or where an employee reaches the end of their tether, goes berserk and smashes up property.

Consequently, all workplaces need to have basic “crisis arrangements” in place. At the very least, these should include comprehensive advice to employees on what action to take and, in particular, avoiding the death from asphyxia of the person who needs to be restrained.

The Courts now recognise the need for some employees working in certain occupations to have training in Physical Restraint. Where a risk of danger is known to exist either from violent people (including young children) or from other people whose conduct if not physically restrained (e.g. mentally ill patients), an employer may well be considered negligent if they don’t provide employees with training in how to carry out their ‘duty’ assignment to minimise the risks’ safely.

What standard of training do staff have to have?

The Management of Health and Safety at Work Regulations requires employers to provide all employees with suitable training to a standard “commensurate with the level of risk being faced”.

Each workplace will be different.

What would indicate that the legal standard had been achieved?

There isn’t an Officially Approved National Standard of Training to deal with violence at work.

However, where a consensus exists amongst the staff facing the risks that the safety provisions (including staff training) are adequate AND the facts (not necessarily the records kept) support this opinion the circumstances will indicate that the ‘legal standard’ will have been met.

So, staff opinion on the adequacy of any training provided is a crucial factor that cannot be ignored!

Note: Even if the staff are prepared to testify that the arrangements and training programme are adequate enough – if the history of the workplace reveals that incidents of serious harm have been occurring and there are reasons to believe more are likely to occur this will indicate a failure to achieve the legal standard.

Is there proof training is effective?

There are few people who would argue that training employees to deal with workplace violence doesn’t help to reduce the incidence and severity of outcome of subsequent events; and a great many ‘ trainees’ would also testify that the ‘training’ they received was key to the successful resolution of post training conflicts they had to deal with.

However, unfortunately, efforts to counter violence at work have to a large degree been addressed in an unsystematic, ad hoc fashion. As a result, research into the effectiveness of employee training programmes lack rigorous, large-scale trials. Much of what has been done consists of small, short term, uncontrolled studies where ‘follow-ups’ have been inadequate or absent. Consequently, hardly any ‘hard evidence’ exists to substantiate the effectiveness of training programmes or elements thereof.

HSE Research

In 2004, HSE commissioned the Institute of Work, Health and Organisations at Nottingham University to research how violence management training* provided to UK Healthcare Staff worked at three distinct time points:

(i) before incidents occur (prevention)
(ii) as they unfold (interaction) and
(iii) in the period following an incident (rehabilitation)

The intention of the research was to be able to:

1. Produce an evidence-based evaluation of the effectiveness of current violence and aggression training programmes across a range of healthcare settings.
2. Develop a suite of tools and instructions for duty holders (& HSE Inspectors) to use, covering:
   a. an assessment of training needs and the extent to which available training meets them
   b. the evaluation of training
   c. an analysis of current provision against best-practice standards

The objective was to identify the value of different elements within an overall training approach to the management of violence.

Results:

On 28th March 2006, a document comprising two complementary reports was published on the HSE’s web site.

Part 1, is the Research Report and details the key research findings in answer to two fundamental questions:

1. What impact does violence management training have?
2. What is the broad content and curriculum of the most effective violence management training?

Part 2 of the document is the companion Practitioner Report. This report specifically addresses the issues of how to evaluate training and offers a series of tools to support and guide those with a responsibility or interest in designing, delivering or managing violence management training.

Main findings:

…training given to healthcare staff to deal with violence at work is generally yielding positive, but limited, short-term benefits. (Apparently any benefit of training is largely lost within a matter of months.)

… some poorly thought-out training is having a negative effect, leaving staff feeling more anxious and less capable of coping with the verbal and physical abuse aimed at them.

HSE recommendations:

A national approach to the evaluation of training must be developed and implemented and the criteria against which training is to be evaluated needs to indicate the impact of training on both individual and organisation health. A better understanding of what works to reduce the risks of violence is also needed and a platform to facilitate information sharing would be helpful. (This was a primary function of the NHS Zero Tolerance Zone web site which the NHS SMS dismantled in October 2005.)

What else was confirmed?

Training is not (and must not be regarded as) a ‘stand alone’ solution to workplace related violence.

To download the HSE Research Report, click the link below.
http://www.hse.gov.uk/research/rrhtm/rr440.htm

NOTE: Other research suggests that training in verbal de-escalation can be effective in reducing the number of violent incidents and reducing the severity of outcomes. Phillips & Rudestam (1995) found that staff who were trained in both physical skills AND theoretical aspects of the management of violence reported feeling less fear and aggression towards patients, were involved in fewer assaults and placed higher value on non-violent outcomes to potentially violent situations than either staff who have received theoretical training alone or untrained controls.

How can employers assess the success of their Training Programme?

Employers should always set clear Training Objectives and afterwards consult with Trainees to get direct feedback on the course including whether or not the aims were achieved.

The way to get truthful input is to provide for employees to supply information anonymously.

But, the best and quickest way to assess the success of an anti violence training programme is to get out among the workforce and get a sense of the atmosphere on the “shop floor”.

Are the staff self assured, calm, efficient and composed? Or, are they rushed (overburdened), fretting, tense, agitated and short tempered?

If it is the latter, ask them for their suggestions on how their situation could be improved!

The next step is to support your observations and questioning by comparing absenteeism rates, sickness rates and staff turnover before and after the training and assess whether or not Policy “targets” are being/have been met (e.g to reduce the number of incidents involving physical violence by 25% in a year.)

Assessment by an external, independent party will produce a truer, more unbiased picture than if the exercise is conducted ‘in house’.

If you want to know the real situation – warts and all – (and you should) consider hiring in a professional to carry out your survey. Staff who are granted anonymity will be more likely to ‘open up’ to an independent assessor than to risk the wrath of the management by (‘upsetting the cart’) and complaining to their line manager about safety shortcomings.