Conflict and violence at work affects healthcare – hospitals not being immune from society’s ills. That’s according to a good practice guide for employers of security personnel in healthcare settings, titled ‘Physical intervention – reducing risk’. Some factors are common to society; some peculiar to healthcare.
Mark Rowe reports.
As elsewhere, at times it will be lawful, and necessary for security officers to use physical intervention skills, to protect themselves, and others. As the guide adds: “Physical intervention however carries risk of injury to staff and the individuals they are dealing with and can result in a restraint-related death.” Bill Fox of trainers Maybo chaired a group behind the guidance. Among members were Christopher John of the NHS Security Management Service; Dr Brodie Paterson of the University of Stirling, featured in our June 2010 issue; Gemma Quirke of guarding contractor Wilson James; NAHS stalwarts Nick van der Bijl, Simon Whitehorn, Mark Dunnett, Peter Finch, Diane Lee, association president David Sowter, and Des Green; Noel Walsh of solicitors Weightmans; the SIA’s training competency man Tony Holyland; and Trevel Henry, director of the ICM (Institute of Conflict Management). Bill Fox paid tribute to expert witness Peter Boatman, who died in 2010.
Clinician in charge
What’s particular to healthcare is that a clinician should be in charge of the intervention. Besides a security officer holding someone, ‘manually’, a chemical may be administered, or intervention may be ‘mechanical’ – locking someone in. The document stresses: “It is vitally important that security officers are trained, understand their organisational policies and why it is often safer not to physically intervene.” Our November issue featured the training offered by the SMS to NHS trusts for security officers or others selected for the task to deal with nuisance behaviour under sections 119 and 120 of the Criminal Justice Act 2008. According to the guidance, the s120 power of removal ‘should only be considered as a last resort’. As the document notes, officers have to watch for vulnerable people (who might need treatment, not being ejected). The document stressed laws around mental health – does the person you are thinking of intervening against know what they are doing – do they have ‘mental capacity’? And even incapacitated people have human rights. All that said, the guidance stresses risk management. The guidance stresses ‘prevention rather than intervention’, but accepts that many factors may affect a situation, some out of staff control, and physical intervention may be necessary where significant risk of assault remains.
Five whys
On how to reduce risk, the guidance advises: “It is often the case that front line staff will suggest simple, creative and cost effective solutions to the problems they are facing.” For instance, staff should identify the root cause of an incident – the document suggests the ‘five whys’ approach. Why have incidents increased? (Friday night fights in town?) Why did these incidents occur? (Because friends of injured in A&E for treatment went on being violent?) Why were they allowd in? (Because the hospital security staff were not told by police or ambulance crews that an aggressive group was heading for A&E?) Why did they become so aggressive? (Because their friends were hurt, they were under the influence of alcohol, or security guards were not inside A&E?) Why were security staff not warned in advance? (For lack of communication protocols with police and ambulance?)
Report and learn
The guidance stresses the need to report and learn from incidents: “Incident reports will inform the ongoing risk assessment process and may also provide added protection for staff and the employer in any subsequent legal action. Incidents are commonly under-reported.” Staff beliefs that violence comes with the job or that reporting is a waste of time need to be challenged. The training has to be relevant, the guidance says. “It should identify and address common risks, such as preventing assaults related to a patient’s clinical condition and not just focus on malicious threats from patients and visitors as ‘breakaway’ training traditionally has. This may require teaching of different strategies, as skills that can contain a confused patient may not be appropriate or effective when applied to an individual that is able and intent on harming themselves or others, and vice versa.” The document warns that you should not assume that SIA-badged officers, though trained in conflict management, have enough training for a hospital. And physical skills can fade over time – with ‘potentially serious consequences’ – so refreshers may be needed. As for use of force, the guidance says: “In clinical settings staff often operate within common law out of necessity to prevent a patient coming to harm … staff should work closely with clinical colleagues and consider the best interests of the patient and staff safety.” The guidance does not set training standards or recommend ways of doing physical intervention or the trainers. As the document admits, there’s much debate about which sorts of physical intervention training are effective.
