Compliance initiative results: workplace violence prevention

Overview

From June 1, 2022 to March 31, 2023, the Ministry of Labour, Immigration, Training and Skills Development (MLITSD) conducted a health and safety initiative that focused on workplace violence prevention, including safe transfer and transition of care in health care workplaces.

In the ministry’s continuous effort to reduce workplace violence in health care workplaces, this risk-based campaign was designed in consultation with our health and safety partners:

• to promote and increase compliance with Ontario’s Occupational Health and Safety Act (OHSA) and related regulations
• to provide compliance assistance and raise workplace parties’ awareness of workplace violence hazards and risks posed to workers during the transition and transfer of care recipients within or across the health care system
• to prevent, assess and control identified risks of workplace violence during the transition and transfer of care process and strengthen worker protections
• to support and align with Prevention Works, Ontario's Occupational Health and Safety 5-Year Strategy’s broader OHS system focus on workplace violence prevention and promotion of system resources on work-related mental health (psychological) hazards

Education, outreach and awareness

We began by focusing on education, outreach, and awareness, in partnership with the Public Services Health and Safety Association (PSHSA), to provide training and education to employers. The goal was to help employers comply with the requirements under the OHSA and its regulations prior to focused inspections. To prepare workplace parties, we provided information and compliance assistance resources on the initiative during a webinar with PSHSA in July 2022.

Inspectors also referred workplace parties to our health and safety partners for compliance assistance and training as appropriate during the enforcement phase.

Enforcement phase

We conducted the enforcement phase at workplaces in two parts (between September and October 2022 and then again from January to March 2023) to check that employers were complying with the OHSA and its regulations. During the enforcement phases, inspectors focused on workplace violence prevention to raise awareness about occupational health and safety concerns.These included the provision of information and communicating the risk of workplace violence to workers during transition and transfer of care both between health care settings (for example, from long-term care to acute care) and within health care settings (for example, from one program to another within a hospital).

Inspectors checked for compliance with the OHSA and applicable regulations, such as the Health Care and Residential Facilities Regulation and, as a result, inspectors:

• conducted 404 field visits with 37 support role activities^{footnote i[i]}
• visited 361 workplaces
• issued 255 orders and requirements

Background

The ministry and its health and safety partners have made it a priority to reduce workplace violence and strengthen protection of workers across all health care settings in Ontario. Using a risk-based approach, MLITSD prioritized field visits to healthcare workplaces such as hospitals, long-term care, retirement homes and home-care.

Transition of care occurs when care recipients (patients, residents and/or clients) move across the health care system, such as between different care sectors, settings and locations to receive care and services or undergo tests and treatments.

Transition of care occurs when a care recipient (patient, resident and/or client) is transferred from one care provider to another, for example, moving care recipients from one program area to another within the same organization.

Transition or transfer of care from one setting to another has been identified by the ministry’s health and safety partners as a contributor to worker exposure to hazards, including workplace violence. This is mainly attributed to a lack of structured processes or mechanisms to communicate the health and safety risks when clients transition across or within the health care system.

Together, with its health and safety partners, we continue to promote the alignment of prevention, education, and awareness resources to assist workplace parties with identifying, assessing, and controlling hazards during the transition and transfer of care process.

Full report

Workplace inspection initiatives

Inspection initiatives are part of our compliance strategy. We announce to the sector, in advance, that we will be conducting an initiative, although individual workplaces are not notified in advance. The results of the initiative are typically posted online within 90 days. Inspectors’ findings may impact the number and level of future inspections of individual workplaces.

Inspectors may also refer employers to health and safety associations for compliance assistance and training.

Focus of the initiative

Inspectors checked that:

• employers prepared policies and developed programs addressing workplace violence and harassment
• employers were providing information and instruction to protect the health and safety of workers including information sharing when clients transition across the health care system and pose a health and safety risk to workers
• employers were training workers on their workplace violence policy and programs, including education and training on staff awareness about transition of care and the hazards involved
• employers were providing workers with information and instruction on a risk of workplace violence from a person with a history of violent behaviour including during the transition of care process
• employers were completing risk assessments and putting measures and procedures in place to control risks
• employers had measures and procedures in place on reporting incidents of workplace violence - at workplaces regulated by the Health Care and Residential Facilities Regulation, inspectors checked these were developed in consultation with the workplace’s joint health and safety committee (JHSC) or health and safety representative
• supervisors were advising workers of any potential hazards, such as the risk of workplace violence specific to care transition
• workers could summon immediate assistance when workplace violence occurs or is likely to occur during the transition or transfer of care process

Inspectors took appropriate action if contraventions were found under the OHSA or its regulations. This included the issuance of orders to comply with requirements of the OHSA and regulations made under the OHSA.

Inspection activity summary

Visits to workplaces

• 404 field visits with 37 support role activities
• 361 workplaces visited
• 255 orders and requirements issued for contraventions under the OHSA and its regulations including:
  • 194 orders (76.1%) issued under the Occupational Health and Safety Act
  • 41 orders (16.1%) under O. Reg. 67/93: Health Care and Residential Facilities
  • 12 orders (4.7%) under O. Reg. 297/13: Occupational Health and Safety Awareness Training
  • 8 orders (3.1%) under Reg. 860: Workplace Hazardous Materials Information System WHMIS
• an average of 0.71 orders and requirements issued per workplace visited
• an average of 0.63 orders and requirements issued per field visit
• 95 orders (37.3%) of the total orders issued under the violence and harassment sections 32.0.1 to 32.0.8 of the OHSA related to the employer’s lack of compliance with the workplace violence and harassment provisions
• 16 requirements were issued to employers to provide an inspector with workplace information and documentation

Healthcare sub-sector analysis

Inspectors prioritized their proactive risk-based inspections to workplaces in long-term care, retirement homes, hospitals, and home care sectors. The following table provides the breakdown of field visits and orders by subsector during the initiative from June 1, 2022 to March 31, 2023.

Breakdown of subsector visits and orders issued

Most frequently issued orders

Orders issued under the Occupational Health and Safety Act

The most frequently issued OHSA orders involved employers’ failure to:

• assess the risks of workplace violence that may arise from the nature of the workplace, the type of work or the conditions of work [subsection 32.0.3(1)] - 31 orders or 12.2% of the total orders and requirements issued during the initiative
• review violence and harassment policies as often as is necessary, but at least annually - 18 orders or 7.1% of the total orders and requirements issued during the initiative
• take every precaution reasonable in the circumstances for the protection of a worker [clause 25(2)(h)] - 17 orders or 6.7% of the total orders and requirements issued during the initiative
• reassess the risks of workplace violence as often as is necessary to ensure that the related policy under clause 32.0.1(1)(a) and the related program under subsection 32.0.2(1) continue to protect workers from workplace violence - 9 orders or 3.5% of the total orders and requirements issued during the initiative
• ensure that the equipment, materials and protective devices provided by the employer were maintained in good condition [clause 25(1)(b)] - 9 orders or 3.5% of the total orders and requirements issued during the initiative
• cause a designated member of the JHSC to inspect the physical condition of the workplace at least once a month [subsection 9(26)] - 8 orders or 3.1% of the total orders and requirements issued during the initiative

The most frequently issued orders under the violence and harassment provisions of the Occupational Health and Safety Act

During the initiative, a total of 95 orders were issued under the violence and harassment provisions of OHSA to health care workplaces. Of these, the most frequently issued orders were written under the following sections of the OHSA:

• assessment of risks of violence [s. 32.0.3] - 42 orders or 44.2% of total orders issued. Of these, most of the contraventions involved the employer’s failure to assess the risks of workplace violence that may arise from the nature of the workplace, the type of work or the conditions of work; and failure to reassess the risks of workplace violence to ensure that the workers remain protected.
• policies for violence and harassment [s. 32.0.1] - 29 orders or 30.5% of total orders issued. Of these, most of the contraventions involved the employer’s failure to review the policies as often as is necessary or at least annually; and post them in the workplace.
• program related to harassment [ss. 32.06 (2)] - 8 orders or 8.4% of total orders issued. Of these, most of the contraventions involved the employer’s failure to include measures and procedures for workers to report incidents of workplace harassment to a person other than the employer or supervisor, if the employer or supervisor is the alleged harasser, as well as the employer’s failure to set out how a worker who has allegedly experienced workplace harassment and the alleged harasser will be informed of the results of the investigation and of any corrective action as a result of the investigation.

Orders issued under regulations made under the OHSA

O. Reg.67/93: Health Care and Residential Facilities, applies to certain types of health care facilities including hospitals, long-term care homes and intensive support or group living residences (group homes). A total of 41 orders were issued, most commonly for:

• failure to ensure that, at least annually, measures and procedures for the health and safety of workers are reviewed and revised in light of current knowledge and practice [ss. 9(2))] - 9 orders or 22% of total orders issued under the regulation
• failure to transport, place or store materials, articles, or things so that they will not tip, collapse, or fall [ss. 103(2)] - 6 orders or 14.6% of total orders issued under the regulation
• failure to develop, establish and provide training and educational programs in health and safety measures and procedures for workers that are relevant to his or her work in consultation with and in consideration of the recommendation of the JHSC or health and safety representative [ss. 9(4)] - 5 orders or 12% of total orders issued under the regulation
• failure of the employer, in consultation with and in consideration of the recommendation of the JHSC or health and safety representative, to develop, establish and put into effect measures and procedures for the health and safety of workers [s. 8] - 4 orders 9.8% of total orders issued under the regulation

As part of checking for worker training and appropriate supervision in workplaces, 12 orders were issued under O. Reg. 297/13: Occupational Health and Safety Awareness and Training Regulation for contraventions involving:

• basic occupational health and safety awareness training for workers [s. 1] – 6 orders or 2.4% of total orders issued under the regulation
• basic occupational health and safety awareness training for supervisors [s. 2] – 6 orders or 2.4%

Inspection activity in priority healthcare subsectors

In Homes for Nursing Care (long-term care homes) during the initiative, a total of 147 field visits (36.4%) were made to 133 different long-term care homes and 68 orders (36.4%) were issued. Of these, the most frequently issued order was for failure to assess the risks of workplace violence that may arise from the nature of the workplace, the type of work or the conditions of work [OHSA subsection 32.0.3(1)].

In Homes for Residential Care (retirement homes) during the initiative, a total of 122 field visits (30.2%) were made to 114 different retirement homes and 89 orders were issued. Of these, the most frequently issued orders were for employers’ lack of compliance with OHSA workplace violence provisions. The most common order in retirement was the failure to assess the risks of workplace violence that may arise from the nature of the workplace, the type of work or the conditions of work [OHSA subsection 32.0.3(1)].

In hospitals during the initiative, a total of 67 field visits (16.6%) were made to 51 different hospitals and 51 orders were issued. Of these, the most frequently issued order to hospitals was for failure to ensure that, at least annually, measures and procedures for the health and safety of workers are reviewed and revise in light of current knowledge and practice [O. Reg. 67/93 subsection 9(2)].

In Nursing Services (home and community care) during the initiative, a total of 40 field visits (9.9%) were made to 36 different workplaces and 11 orders were issued. Of these, the most frequently issued order was for failing to assess the risks of workplace violence that may arise from the nature of the workplace, the type of work or the conditions of work [OHSA subsection 32.0.3(1)].

Observations

The results of this initiative indicate that workplace parties need to better assess the risk of violence when there is a change in the nature, type, and condition of work in order to better address the risks of violence during the transition and transfer of care process. It is important that workplaces parties strive to improve measures, procedure, and work practices to reduce the risk of violence during the transition and transfer of care process.

Aggressive and disruptive behaviours by all persons in the workplace (for example, patients, clients, residents, visitors, volunteers, physicians, staff, students and others) may escalate to workplace harassment and workplace violence affecting workers, especially during the transition of care process. This should be taken into consideration when developing the workplace harassment policy and workplace violence policy and program.

Mitigating the risk of workplace violence

Overall, the risk of violence can be mitigated by raising awareness and by employers putting in place mechanisms for identifying, assessing, and controlling hazards related to workplace violence during the transition and transfer of care process.

Employers can mitigate the risks of violence and improve compliance with the OHSA in workplaces by:

• completing risk assessments and putting measures and procedures in place to control risks and improve internal and external transition of care work practices
• reassessing the risks of workplace violence as often as necessary to ensure the policy and related program continue to protect workers from workplace violence
• establishing measures and procedures to control the risks of workplace violence likely to expose a worker to physical injury during the transition and transfer or care processes, specifically, when there is a change in circumstance, nature and condition of the workplace
• putting into place measures and procedures on reporting incidents of workplace violence, these should also explain how the employer will investigate and deal with incidents of violence
• putting into place measures and procedures for workers to report incidents of workplace harassment to a person other than the employer or supervisor, if the employer or supervisor is the alleged harasser

Consultation with the joint health and safety committee (JHSC) or health and safety representative (HSR)

Consultation with the JHSC or HSR helps support a well-functioning internal responsibility system. However, almost half of the orders (20 orders or 49%) issued under the Regulations for Health Care and Residential Facilities were in related to to the employer not fulfilling its general duties to establish written measures and procedures in consultation with the JHSC in the workplace, as outlined in sections 8 and 9.

Conclusion and next steps

Violence against all workers in healthcare is a serious issue and continues to require system-wide attention and action from employers and others in the sector. Ministry inspectors will continue to:

• promote and enforce compliance with the occupational health and safety legislation across healthcare workplaces
• strengthen compliance with the workplace violence and harassment provisions
• look for evidence of a strong internal responsibility system in Ontario’s health care sector by continuing to check that all workplace parties are aware of and adhere to their duties and rights

The prevention of workplace violence requires a strong commitment by employers and senior leadership. Workplace violence prevention should also be a key indicator in the overall performance of the organization as it impacts both worker safety and the quality of care provided to patients, residents and clients within the sector.

The results of the initiative confirm our need to continue to focus on prevention of workplace violence in health and community care workplaces.

Help for employers

Please contact our health and safety partners, including the PSHSA, for more information, resources, and tools.

For more information please contact the Ministry of Labour, Immigration, Training and Skills Development Health & Safety Contact Centre:

Toll-free: 1-877-202-0008

TTY: 1-855-653-9260

Fax: 905-577-1316

webohs@ontario.ca, or visit us at Contact us | ontario.ca. We can provide information about compliance with the OHSA, including where to find information that is relevant to your workplace to assist with compliance and with prevention of workplace violence.