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Health workers attacked. Investigations bungled. Will this spur change?

Advocates hope WorkSafeBC’s $355,000 judgment against Northern Health leads to protections.
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Northern Health repeatedly failed to properly investigate cases of violence against health workers in the Fort St. John Hospital and attached Peace Villa.

Northern Health repeatedly failed to properly investigate assaults against staff, WorkSafeBC has found, something unions say highlights a  larger failure to investigate and stop violence against B.C. health-care workers. 

The agency fined Northern  Health $355,000 after it found the authority failed to include key  details in multiple reports on attacks on workers, including what caused  the incidents and what steps were taken to make sure they did not  happen again. 

Northern Health provides health-care services in more than two dozen communities and almost two-thirds of the province. 

The authority said in a statement it faced “administrative challenges” with the way such reports are submitted.

Aman Grewal, the president  of the BC Nurses’ Union, says the fine speaks to a larger problem of  health authorities failing to investigate such assaults properly. That  means the root causes of attacks are not identified, making them more  likely to happen again, she said. 

“The employer just did not  take action to provide a safe workplace for the members,” Grewal said.  “The nurses were reporting, but it wasn’t followed through.”

Health Minister Adrian Dix has acknowledged  assaults on health-care workers are a persistent problem that has  intensified during the COVID-19 pandemic. 

Between 2015 and 2021, violence was the  second most-common reason nurses and health-care assistants submitted  time-loss claims to WorkSafeBC. In late October, Dix announced the  government would hire 320 security staff to protect workers in select  high-risk settings. 

“We remain committed to the prevention of  violence in health-care workplaces and to ensuring the safety of  health-care workers in the province, and government is open to further  solutions,” said an emailed statement to The Tyee attributed to Dix.

But unions contend health authorities  aren’t adequately investigating cases of workplace violence, or doing  enough to stop them. 

Kane Tse, the president of the Health  Sciences Association of BC, said his union flagged those issues as early  as 2014. “Clearly, as evidenced by the recent Northern Health  experience, those deficiencies have not been properly addressed,” Tse  said. 

The investigation into the Northern Health  authority began in May after a long-term care resident at Fort St.  John’s 124-bed Peace Villa assaulted a worker on the job. A partially  redacted report said the worker at the facility, operated by Northern  Health, was later directed to contact WorkSafeBC. 

“It was discussed with the employer that  incidents such as this should be reported to the supervisor/manager and  documented in the provincial databases and then investigated as required  according to the employer-documented procedure,” the WorkSafe report  said. 

The board then asked the health authority  to provide documentation from Peace Villa and the attached Fort St. John  hospital related to workplace violence, including incident  investigations, risk assessments, how they tracked violent incidents and  what training was provided to employees. 

A review of seven investigation reports  found the authority had failed to follow policy. On Nov. 10, WorkSafe  imposed an administrative penalty of $355,244.

“WorkSafeBC examined the employer’s  investigation reports for this and several previous incidents and found  that they all lacked key information such as underlying causes and  corrective actions,” the penalty notice said.

The authority would not make a spokesperson available for an interview.

“Peace Villa has complied with  the initial order and implemented a multitude of corrective actions to  address workplace hazards and prevent worker injuries and illnesses,” it  said in an unattributed written statement. 

“Northern Health may request a review of  the decision by the review division of WorkSafeBC, but a final decision  has not been made.” The authority has 45 days to request a review.

In another statement, the health authority said its rates of violent injury were lower than in the rest of the province.

Neither statement responded to questions about why the required information was not provided to WorkSafe.

“We hope to revisit proposals we had  previously submitted to [WorkSafe] prior and during the pandemic that  will address the administrative challenges we face from the current  system,” Northern Health said. “That proposal included plans to invest  and improve the provincial incident investigation platform to support  our staff in reporting efficiently and generating thorough investigation  reports.”

The Tyee asked further questions about  whether the incidents at Peace Villa in question had been adequately  investigated in Northern Health’s view but did not receive a response.

Currently, health workers across the  province submit reports of workplace injuries through a central call  centre. The Workplace Health Contact Centre began in the Fraser Health  authority in 2007 and gradually grew into the first-contact reporting  hub for workers across B.C. 

While the centre was intended to streamline  the reporting process, workplace safety expert Annalee Yassi says it  has made reporting more intimidating for staff and muddled the  investigation process.

Yassi is a researcher who has studied  workplace violence in health care for several decades. While she noted  she is not familiar with the specific instance at Northern Health, she  said reporting a violent incident can be intimidating, which can be  alleviated by having a clear understanding of who reports will go to,  who will investigate and how issues may be resolved.

A centralized system “creates room for  error because people in a call centre don’t have the context or an  intimate connection with the issues facing a particular health authority  or facility,” said Yassi, a professor at the University of British  Columbia school of population and public health, in an interview. 

“Reporting to a person they know or a  [occupational safety] manager who can address the issues is more  meaningful to health-care workers.”

And when proper action isn’t taken, she  says, it discourages staff from reporting future incidents, especially  if they fear being blamed. This chilling effect increases the likelihood  of violence repeating or worsening.

In general, “rural and remote areas have it  particularly bad because there are few employers for trained health  workers and also nowhere else for patients who are violent to go after  an incident,” said Yassi, noting this is especially the case for  patients prone to violence due to medical conditions like dementia.

Yassi heads up a World Health Organization  collaboration centre on workplace violence and says the problems exist  in every country. The COVID-19 pandemic, increasing patient needs and  low staffing have created what she calls a “perfect storm” for violence  around the world.

But research shows proper training can help  make workers feel safer and reduce stress and burnout, Yassi noted. And  she says adequate staffing is also key for workers to handle  challenging interactions as teams, reducing the risk of violence. “When  there’s enough staff, situations can be handled with more care.”

The Health Sciences Association also wants  more training on violence prevention and response for staff and the  hiring of more occupational health and safety staff to ensure reports  are investigated and issues are addressed.

SWITCH BC, a new occupational health and  safety organization for health-care workers created by the provincial  government in 2020, is an important step, the HSA’s Tse said, but the  province hasn’t done enough.

In a statement, Tse said WorkSafeBC should  increase financial penalties for employers who don’t follow regulatory  requirements on investigating and addressing safety concerns.

The fines levied against Northern Health  could be a wakeup call, Yassi said, noting that they also funnel money  from health services in a way that could be counter-productive.

In a followup email, Yassi expressed optimism at how the province is responding to violence against health-care workers.

But health authorities and local facilities  need the resources to support a strong response, she said. “It would be  a mistake if some pro forma process gets put into place that doesn’t  get at the root of the problems.”

In the meantime, the BCNU’s Grewal has  asked the provincial government to audit each occupational health and  safety report submitted by Northern Health over the past year.

Dix declined to respond to that request,  saying it would be inappropriate as the BCNU and the provincial  government are bargaining a new collective agreement.

Tse said he hopes to see WorkSafe take a tougher stand on such cases.

“Sadly, in the absence of real action by  health authorities, it takes big penalties to get results on safety, and  we hope WorkSafeBC will increase the pressure on employers who don’t  follow their regulatory requirement in investigating and remediating  concerns in a timely and effective manner.”