Workplace Violence and Harassment

Healthcare workers, including midwives, have been identified as a group particularly at risk (1) for workplace violence. All workplaces, including midwifery practices, have a legal obligation to put systems into place to prevent and manage incidents of violence and harassment in the workplace, regardless of the source. 
Violence may include threatening behaviour, verbal or written threats (including on social media), harassment, bullying, psychological abuse, verbal abuse and physical attacks. Violence can occur in any setting where a midwife or other worker is interacting with clients, such as a client's home, the midwifery clinic, hospitals, birth centres or other community settings.  It may arise from work relationships (e.g. a client or their partner) or from personal relationships that spill into the workplace.

AOM On Call supports midwives and midwifery practices in developing safety plans for when a client, a client’s partner, a midwife’s partner (2), or family members pose a risk of violence. Midwives can contact AOM On Call for support in developing a safety plan. Additionally, there are several actions that practice groups can take to assess, reduce and respond to the risk of violence in the workplace.

Assess the Risk and Develop a Culture of Safety
  • Organizations, including midwifery practice groups, must develop a workplace violence policy and program, to both prevent and manage incidents of violence, including sexual harassment.  They are required to review their workplace violence program and assessments at least annually, or more frequently if necessary.
  • Complete a Workplace Violence Survey (see AOM template under Midwives Safety) to proactively identify, prevent and manage incidents of physical, verbal and emotional violence and harassment in the work setting, including the risk of domestic violence spilling into the workplace. 
  • Proactively discuss how the practice handles abusive behaviour or possibly discriminatory requests to change midwives. Some practice groups may be able to accommodate a request to change midwives when the request is for reasons of cultural or personal safety and/or from clients with a history of trauma, as this is unlikely to be deemed harassment under the new law. However, a practice may decide not to accommodate requests that it deems are discriminatory towards a particular midwife or group of midwives.
  • Develop a system to track places and activities where violence has been identified as a problem. All incidents, including minor incidents and incidents in which the potential for violence is present, should be reported to the person responsible for tracking them (e.g. the practice’s designated health and safety lead).
  • Adapt an Anti-Harassment and Anti-Violence Policy (see AOM template under Midwives Safety) to establish guidelines for assessing, preventing, investigating and managing violent workplace behaviours and to comply with the Occupational Health and Safety Act, which includes protecting workers from domestic violence that spills into the workplace.  Reporting procedures must include an alternative process in the event that the usually designated person is the one alleged to be harassing a worker. This could be another partner, another practice group or a private third party who is qualified to perform this type of investigation.  If a complainant does not believe that their complaint has been dealt with fairly, they can file a report directly with the Ministry of Labour, which has the power to hire an impartial investigator to investigate and produce a report at the workplace’s expense.
  • Develop and promote a protocol or code of conduct that clearly states that the practice group will not tolerate any forms of violence, and post this code of conduct in a visible location. The AOM has developed an anti-violence and harassment poster for practice groups that can be used for this purpose. For access, please e-mail anna.ianovskaia@aom.on.ca.
  • Support midwives, students and staff in understanding how to recognize potentially violent situations, (3) and warning signs of domestic abuse. Support midwives in understanding the hospital, birth centre and practice group’s policies on workplace violence and the practice’s planned response to violent and potentially violent incidents. Additionally, workers may wish to complete training on diffusing potentially violent situations (4) and interpersonal and communications skills to prevent or diffuse workplace conflict. 
Be Prepared

If the practice has considered potential risks of violence in advance, it will be better prepared to quickly address them if they occur. Developing a safety plan can help mitigate violent workplace incidents and threats of violence. Generally used in cases of intimate partner violence, a safety plan consists of security measures to minimize workplace danger and identify a process of action to increase workplace safety when a worker is experiencing, or is in danger of experiencing, violence. A safety plan should be individualized and developed in collaboration with the person at risk of violence; it also needs to evolve as the situation changes. 

A safety plan may address the following:

  • Consider the physical set-up of clinic space to maximize worker safety. For example, set up clinic rooms so the midwife is always seated closer to the door to mitigate the risk of being trapped in a room with an abusive or violent person. If possible, orient the reception desk so there are two ways to exit the clinic.
  • Investigate how well-lit and visible worker parking spaces are, especially at night. If possible, make changes to the physical parking space to maximize worker safety, or enlist someone to escort workers to the parking space (e.g. security personnel at the hospital). Review safe travel and driving procedures (3) and customize them for specific communities and situations.
  • Implement a safety system for when a midwife or staff member is working alone at the clinic or at a client’s home. Ensure that workers are alone only when absolutely necessary, and establish a buddy system so another staff member knows where the worker is and when they are expected to finish their work. Midwives and staff should be aware of how to use a cellphone panic button when they feel threatened or unsafe.
  • Encourage midwives to become familiar with the area around their clients’ homes and plan the safest route to and from clients’ homes. Remind midwives that they should leave a client’s home immediately if threatened with violence.
  • Establish a practice-wide system for tracking and documenting violent or potentially threatening incidents (e.g. emails, calls).
  • Ensure that the practice group’s Workplace Violence Policy (see AOM template under Midwives Safety) includes criteria to prevent visits to homes where there is a likelihood of violent or dangerous behaviour as assessed by the midwife.

  • Develop internal code word(s) at the practice so workers can discreetly communicate the need for assistance when necessary. For example, workers at a legal aid clinic use their internal phone announcement to ask someone to bring “the pink folder,” signaling that they are unsafe and need help.

When a worker is experiencing intimate partner violence (1) or a specific threat of violence, consider the following in addition to the above:

  • Download the template Workplace Violence Safety Plan (under midwives’ safety). Be sure to tailor the template to reflect best practices and practice group/community-specific considerations before use.
  • Screen calls and visitors for the worker. For example, lock the clinic’s front door and direct all visitors to knock or call to enter. 
  • Set up a buddy system for the worker to notify someone when they arrive and leave each home visit; consider having two workers attend each home visit or labour assessment. 
  • If a midwife is experiencing intimate partner violence or domestic violence that might spill into the workplace, consider how to protect clients from that risk. For example, transferring care to another midwife, or only offering care at the clinic or hospital during regular business hours. 
  • Provide the worker with information on appropriate resources (e.g. legal services, counselling, community resources, LifeWorks) and offer them time to deal with legal or other issues. Determine if the police should be notified. Inform any other workplaces, such as the hospital or birth centre administration and/or security, to implement their safety procedures.
  • Obtain contact information for someone the worker trusts (e.g. a family member or close friend) in the event that the midwife is unexpectedly absent and cannot be reached.
  • Consider reducing the worker’s visibility and public profile (e.g. remove their name or photo from the practice’s website and social media).

For questions or support, contact the AOM On Call service.

Additional Resources

References

1.    International Labour Organization, International Council of Nurses, World Health Organization and Public Services International. Framework Guidelines for Addressing Workplace Violence in the Healthcare Sector. [Internet] Geneva. 2002. [cited 2017 Jul 7] Available from: http://who.int/violence_injury_prevention/violence/interpersonal/en/WVguidelinesEN.pdf?ua=1&ua=1 

2.    Health & Safety Ontario, Public Services Health & Safety Association (PSHSA). Domestic Violence Fast Facts. [Internet] Toronto. 2010. [cited 2017 Jul 6] Available from: http://www.pshsa.ca/wp-content/uploads/2013/01/domestic_violence.pdf

3.    Health & Safety Ontario, Public Services Health & Safety Association (PSHSA). Assessing Violence in the Community:  A Handbook for the Workplace. [Internet] Toronto. 2017. [cited 2017 Jul 11] Available from: http://www.pshsa.ca/wp-content/uploads/2017/06/VDVMNAEN0417-Assessing-Violence-in-the-Community-A-Handbook-for-the-Workplace-V2.3-05.01.2017.pdf

4.    Health & Safety Ontario, Public Services Health & Safety Association (PSHSA). Community Care Workplace Violence Course. [Internet] Toronto. 2018. [cited 2017 Jul 7] Available from: http://www.pshsa.ca/product/community-care-workplace-violence/

5.    Canadian Labour Congress. Safety Planning. [Internet]. [location unknown] 2015. Accessed on July 6, 2017. Available from: http://canadianlabour.ca/safety-planning

6.    Government of Ontario. Preventing workplace violence in the health care sector. [Internet]. [location unknown] 2017. [cited 2017 Jul 5] Available from: https://www.ontario.ca/page/preventing-workplace-violence-health-care-sector

7.    Ontario Safety Association for Community and Healthcare. Health and Safety in the Homecare Environment. 2 ed. [Internet]. Jan 2003. [cited 2017 Jul 10] Available from: http://www.osach.ca/SG/Product/lap_301.pdf

8.    Western Centre for Research & Education on Violence Against Women & Children. Individualized Safety Plan Template. [Internet] London, ON. 2018. [cited 2017 Jul 6] Available from: http://makeitourbusiness.ca/guidelines/individualized-safety-plan-template-0. 

9.    Occupational Health & Safety Agency for Healthcare in British Columbia (OHSAH), Workers Compensation Board of British Columbia (WorkSafe BC). Home and Community Healthcare Worker Handbook.  [Internet] British Columbia. 2006. [cited 2017 Jul 11] Available from: http://www.phsa.ca/Documents/Occupational-Health-Safety/HandbookHomeandCommunityHealthcareWorkersHandbook.pdf