Evaluation by OVAS prevention activity

Limited data provided some light on the OVAS prevention programme in 2012. BN123 Health deserves admiration to introduce an OVAS prevention training programme in their management system to create awareness of the staff on occupational violence and to develop skill of the work force to face the problem. But the following points find some sluggish response to the dynamic OVAS environment and this is not much different than other health facilities in Australia, particularly in Victoria.

To manage a dynamic environment, the responsible officer or team should have a real-time information gathering system. Data entry on OVAS incidence is not a real-time event. After submission of a report by floor level staff an assigned supervisor enters data in text format in reporting software RSKSOFT. On request the training officer of MSVT gets a fixed format report.

Interviews with trainers revealed that there is no regular analysis of the data (OVAS incidence, cause and effect, consequences of OVAS to employee and to client service during or after exposure). Trainers said, “Training officer receives report from RSKSOFT in a fixed format more like a summary sheet”. Such a report is less interactive to analyse the impact of training to a specific work area, as it does not have an option to re-arrange the data to collect further information like impact of training (number of staff trained versus the incidence rate in a particular area). Such a fixed format report also has limitations to follow-up the consequence of incidence to employee, client and service delivery perspective. This could be considered as a limitation in management of the OVAS situation at BN123 Health.

Another limitation of my study is that it couldn’t reveal whether trainers or training officer have regular meetings (monthly or yearly) with the top management (like CEO, deputy CEO or OHS manager), to discuss the strategy (like learning objective, delivery mode, curriculum development, resource allocation and outcome of the training on OVAS incidence). No evidence was available in that line, like any meeting minutes or reports with top management to discuss any review.

Further interviews with the trainers, review of the RSKSOFT report and review of the Annual Report of BN123 Health identified that BN123 Health has more focus on Clinical safety than on OVAS in Work Health and Safety. The modules of RSKSOFT used by BN123 Health are more supportive in that direction (patient safety).

109 The data analysis and report generated by RSKSOFT is not regularly shared with the training officer in charge. According to the ‘management of RSKSOFT software package’ the ability to access and distribute the report generated by this software depends on the number of modules purchased by the hospital. The purchase of more modules depends on the priority setting by hospital management.

Trainees working at the emergency department mentioned that their performance (like isolating the aggressive clients) is intervened by clinical professionals (like doctors) considering it as inhumane.

Neither the trainers nor the trainees mentioned any arrangement of post-incident professional counselling to support the victims (staff) to reduce stress and maintain quality of service.

Also, there is not much awareness about MSVT among all staff of BN123 Health except some facilities like aged care, community care.

The enrolment process allows anyone of the permanent workforce to enrol. There is no priority setting depending on the length of service or task in the organisation. There is no encouragement for doctors and other specialists to enrol in the course. Most possibly none of those professional groups are even aware of the existence of this MSVT.

Code Grey Incidences in Hospitals of Victoria, 2012-2014 (Figure 2), demonstrates the increasing trend of OVAS in Victorian Health Services. OVAS is not limited to nursing staff, it can affect anyone in hospital including doctors and specialists and even GPs (Hills, 2012; Parker, 2017; Rowe, 2007). Newspaper articles describe attacks on a Cardiologist punched to death (in 2017), stabbing of a Neurosurgeon (in 17 December 2014) and, stabbing of a female Psychiatrist (in 2009), all in hospital premises in Melbourne (see Appendix 21). So, there is no reason why those professionals could not be included in the MSVT trainee list.

Focus of WHSMS in this hospital in relation to OVAS prevention is limited as suggested by the reporting mechanism. Real-time information generation is not there, modules of RSKSOFT used by this hospital are more to support clinical safety rather than analysis of OVAS risks (Appendix 20.2)

Reviewing the causes of OVAS (in Chapter 2.1.3.B) it is important that the training content should highlight the following issues: enough work space to ensure safe distance from aggressors, reducing isolation, reducing blind spots, providing instructions to clients and their family or friends to avoid violence, supervising floor level staff in performing MSVT skills, random review of staff wellbeing to minimise the risk of poor service delivery impacted by OVAS on staff performance, follow up of indirect evidence of that like unusual leave of absence, frequent medical consultation, general

110 reluctance of staff to avoid working in a particular area. This is not found in MSVT (Table 9 and Chapter 4.2.1.B. ‘Content of training’).

My study couldn’t find any committee to review the curriculum of the training. Interviews of the trainers suggest some components were taken from the old plan that used to serve the forensic psychiatric unit and some by the education unit to develop the best learning tools and some by the work health and safety management to incorporate the regulations, compliance issues and quality control.

Weakness in the commitment of the top management is evidenced by: the change in leadership from higher ranking clinical (Psychiatry) unit to a comparatively lower ranking department, not opening easy access to data and its analysis by trainers, not appointing enough quality trainers, not performing regular evaluation by checking goal and outcome or doing any analysis like cost benefit analysis or return of investment (ROI) or others. Also, trainers’ professional or skill development aspect is absent.

Trainers are concerned that the remuneration system downgrades them from previous years, even though they have the potential to increase the income of BN123 Health by consultancy services to other organisations. The trainers are confident that more human resource would allow them to conduct research and develop workplace specific training, which would improve the quality of the service within BN123 Health.