Transcript Managing the Problem Employee

Myths, Realities, and Effective
Practice in Addressing Violence in
the Workplace
Ronald Schouten, MD, JD
Associate Professor of Psychiatry, Harvard Medical School
Director, Law & Psychiatry Service, Massachusetts General Hospital
President, KeyPeople Resources, Inc.
©2007 Ronald Schouten, MD, JD
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It’s Been a Bad April
•
Apr 2, 2007 1:15 pm US/Pacific
2 Dead In University Of Washington Shooting
• Official: UW didn't follow policy in staffer's death
By Associated Press Apr 06, 2007 - 11:43:27 pm
PDTSEATTLE -- A woman staffer who died in a murdersuicide at her University of Washington office could have
been moved to a different building or assigned heavier
police patrols had officials followed school policies, an
administrator says.
• Sheriff: Michigan office shooting kills 1, injures 2
POSTED: 6:52 a.m. EDT, April 10, 2007
2
April 16, 2007
Gunman, 32 others killed in Va.
shooting
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Copy Cats and More
• Bomb Threats Plague Central Florida Schools
POSTED: 11:43 am EDT April 21, 2007
• Gunman Kills NASA Worker and Himself
UPDATED: 12:09 pm EDT April 21, 2007Gunman
Published: April 21, 2007
HOUSTON, April 20 — A contract worker brandishing a revolver took
control of part of a Johnson Space Center building on Friday
afternoon, and killed a hostage and then himself after a standoff with
the police.
April 21, 2007, 9:33PM
Police: Poor review set off NASA gunman
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The Faces of Workplace Violence
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The Faces of Workplace Violence
Rebecca Griego
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Agenda
• The impact of workplace trauma
• What we know (and don’t know) about
workplace violence, victims, and
perpetrators
• Approaches to prevention, threat
assessment, and management of high risk
situations
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Scope of Our Discussion
• The workplace/school distinction
• Physical aggression or threats of physical
harm
• Bullying and harassment as behaviors lying
on a continuum leading up to physical
aggression or threats
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The Impact of Threats and Violent
Acts at Work
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Legal/Administrative Implications
• OSHA General Duty Clause Sec. 5 (a)(1): civil &
criminal penalties; evidence in civil claims
• Workers’ compensation claims
– If violence is work related
– Stress/psychiatric claims
– Injury based claims
• Negligence claims
– Hire
– Retention
– Supervision
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Legal/Administrative Implications
• Disability discrimination claims, e.g. university
cases
• Defamation, invasion of privacy
• HIPAA and other breach of confidentiality claims
• Potential liability for failing to have a disaster
plan:
– OSHA requirements
– Failing to plan is planning to fail: liability for poor or
absent disaster planning
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The Impact of Threats and Violent
Acts at Work
• General
– Physical injury
– Psychological impact
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New symptoms
Exacerbation of pre-existing conditions
Disruption of assumed sense of safety
Suspicion and loss of cohesion
Decreased productivity
• Northwestern Life Study (1993)
– 79% of those attacked at work had subsequent psychological
problems
– 40% experienced disruption of work life
– 28% had a physical injury or became ill
– 15% had no negative effect
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Impact of Hoaxes or Perceived Risks
• Acute Psychological Effects of Suspected
Bioterrorism (Mason & Lyons)
– 13 employees who believed they had been
exposed to anthrax spores
– Definite anxiety symptoms in 45% one week
after the threat was cleared
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The Knowledge Base for Threat
Assessments
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Defining Workplace Violence
• NIOSH: Workplace Violence is any physical
assault, threatening behavior or verbal abuse
occurring in the work setting. It includes, but is
not limited to, beatings, stabbings, suicides,
shootings, rapes, attempted suicides,
psychological trauma, threats such as obscene
phone calls, an intimidating presence, and
harassment of any nature, such as being followed,
sworn at or shouted at.
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Defining Violence
• Targeted violence
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Predatory, planned
Aimed at a specific individual or institution
Includes acts of terrorism, whether or not
politically motivated
• Impulsive violence
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May be specific or nonspecific
Victim may be unintended
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Defining Threats
• Types
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Express or implied
Direct or contingent
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Organization
Self
Others
• To physically harm:
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Threats
• Purposes:
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Self defense
Intimidation
Retaliation
Manipulation/Extortion
Disruption
Promote ideology
Personal satisfaction/entertainment
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Myth vs. Reality
• #1: People “just snap.”
• Reality
– With hindsight, and some investigation, we can
almost always identify a pattern of deteriorating
behavior, threats, etc. leading up to the action.
– Perceptions that the violent behavior is a new
development for the perpetrator are the result of
people either not knowing the perpetrator or not
being aware of what others know.
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Myth vs. Reality
• #2: Violence and threats are irrational
• Reality
– Both tend to be chosen as a means to accomplish an end
when no other methods appear to be available.
– They tend to work, at least in the short term, e.g.
• Disgruntled workers and their effect on management
• “You’d better watch it.”
• Terrorism
– They may represent rational decisions made on the basis
of irrational beliefs
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Myth vs. Reality
• #3: Workplace violence has been growing in
frequency since the early 1990s
• Reality
– A total of 564 workplace homicides was recorded in
2005 (up from 559 in 2004).
– However, workplace suicides were sharply lower in
2005, dropping 14 percent to a series low of 177
fatalities.
– Total workplace homicides of all types have dropped
approximately 50% since 1994.
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#3 (cont’d)
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Myth vs. Reality
• #4: Current and former co-workers pose the
greatest risk of workplace violence
• Reality
– Since data have been gathered, the majority of
workplace homicides have been committed by
outsiders engaged in attempted robbery or other
crime. (Type I)
– Current and former co-workers (Type III) have
consistently been responsible for 5-13%
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The Four Types
of Workplace Violence
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% of homicides
Type I: Criminal Intent
(~75%)
Type II: Customer/Client
(~5%)
Type III: Worker on worker (~12%)
Type IV: Personal relationship (~8%)
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Non-fatal Assaults
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The OSHA problem: under-reporting
1993-1999: (BJS; Mark Lies, Esq., Seyfarth Shaw 2005)
– 94% of workplace violence incidents involved simple
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–
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or aggravated assaults
52% of workplace violence victims failed to report the
crime to the police
Women less likely to report than men
1999: 27% of employees who were physically assaulted
in the workplace failed to report to anyone
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Myth vs. Reality
• #5: Research studies have established profiles of
perpetrators of violence at work and school.
• Reality
– There have been no scientific studies of workplace
homicide perpetrators
– US Secret Service Studies of school shooters and
presidential assassins have shown that there is no
definitive profile
– For any low incidence phenomenon, like workplace
violence or suicide, even very sensitive tests result in an
unacceptably high rate of false positives, i.e. overprediction.
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The Mad Bomber and the Origins of
Profiling
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The Olympic Park Bombing
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#5 (cont’d)
• Profiles have the problem of both false
positives (over predicting who may be
violent) and false negatives (missing those
who do not fit the profile but are at risk.
• Empirically-based research has identified
risk factors for non-fatal violence.
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Myth vs. Reality
• #6: There are no profiles, so we can’t assess
risk.
• Reality
– Those who do act often share common
characteristics, although the same characteristics
may be present in a significant portion of the
population
– Utility of investigating risk factors
• Heightened awareness
• Inform management strategy during an incident
• Determine level of risk, rather than predicting
– Risk factors have been identified
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The Violence Formula
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Violence is the product of :
– Individual variables (personality traits and illness)
– Environmental variables (whether the environment
promotes or dissuades violence)
– Situational variables (acute and chronic stress): FINAL
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Financial
Intoxication
Narcissistic injury
Acute or chronic illness
Losses
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Aggressive and Violent Employees:
Who Are These People?
• One description (Jockin,et al 2001)
– Sample of 489 employed men (32-36) asked about
involvement in workplace aggression and conflict
– Involvement correlated with:
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Past antisocial behavior
Alcohol abuse
Tendency to stress reactions
Aggressiveness
Low self control
– Factors modified by perceived victimization
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Validated Individual Risk Factors for
Perpetrators Include
• Unsatisfied by treatment from supervisor (Baron et al., 1999; Cole et al.,
1997)
• Younger age (Baron et al., 1999; Warren et al., 1999)
• Male sex (Baron et al., 1999; Warren et al., 1999)
• Union membership (Baron et al., 1999)
• Being laid off (Catalano et al., 1993)
• Trait anger (Douglas & Martinko, 2001)
• Thinks revenge is justified (Douglas & Martinko, 2001)
• Tends to blame other people for things (Douglas & Martinko, 2001)
• Previous exposure to aggressive cultures (Douglas & Martinko, 2001)
• History of anti-social behavior (Jockin et al., 2001)
• Alcohol abuse (Jockin et at., 2001)
• History of criminal behavior (Warren et al., 1999)
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Validated Risk Factors for Organizations
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Pay cuts or freezes (Baron & Neuman , 1996)
Use of part-time employees (Baron & Neuman , 1996)
Changes in management (Baron & Neuman , 1996)
Increased diversity in workforce (Baron & Neuman , 1996)
Computer monitoring of employee-performance (Baron & Neuman, 1996)
Reengineering (Baron & Neuman, 1996)
Budget cuts (Baron & Neuman, 1996)
Deteriorating physical workplace environment (Baron & Neuman, 1996)
Workplace located in city (Baron et al., 1999)
Employment in the industry is unexpectedly low (Catalano et al., 1993)
Organization faces low work-group harmony (Cole et al., 1997)
Conducting terminations with more than one employer present (Karl & Hancock,
1999)
Conducting terminations on a Monday or Tuesday (Karl & Hancock, 1999)
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Myth vs. Reality
• #7: Mental illness is the most significant
risk factor for violence
• Reality
– Absent active psychotic symptoms, the risk of
violence for mentally ill individuals (excluding
substance abuse) is no higher than for
demographically similar members of the same
community who have never been treated
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#7 (cont’d)
• Individuals most at risk
– Psychotic disorders
– History of Oppositional Defiant Disorder as
children, Antisocial Personality Disorder as
adults
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#7 (cont’d)
• Psychotic symptoms most related to
violence: threat/control override
symptoms
– Symptoms which involve overriding of
internal self-controls by external factors
– Symptoms which imply a specific threat
of harm from others: How often have you
felt that there were people who wished to
do you harm?
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#7 (cont’d)
Substance Abuse as a Risk Factor
Self report of violence in previous year:
DX
%
None
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OCD
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Bipolar/mania
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Panic disorder
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Major depression
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Schizophrenia
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Cannabis use/dependence
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Alcohol use/dependence
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Other use/dependence
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The Role of Anger
• As part of a disorder
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Anger attacks and depression
Anger and psychosis
Anger and personality disorders
• As a personality trait
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Myth vs. Reality
• #8: The main issue in threat assessment is
on whether an actual threat has been made
• Reality
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Those who act often never threaten the subject
Those who threaten often do not act
Those who act may issue threats to third parties
Important to distinguish targeted violence vs.
impulsive violence
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Myth vs. Reality
• #9: “It will never happen to us.” vs. “It will
definitely happen to us.”
• Realities of risk perception
– Probability neglect:
• When strong emotions are involved, people focus on the
severity of the outcome, rather than the probability that the
outcome will occur
• We tend to overestimate the likelihood of low probability
events, and underestimate the likelihood of higher probability
events
– Risk appreciation factors
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Availability of an example
Identification with the victims
Nearness to the event
Nature of the trauma
Perception that the risk can be reduced
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Myth vs. Reality
• #10: These situations are best handled by a single
person.
• Reality
– These are complicated problems; no two are exactly
alike
– No one field has the requisite knowledge and insight to
sort these all out
– Information, the decision making process, and
organization are key
– Team approach provides the highest yield
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Effective Strategies in Assessing and
Managing Threats and Violence
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Risk Assessment and Management
• Many moving parts to the problem
• Focus on behavior rather than diagnosis
• It’s a clinical management problem that requires
– Obtaining as accurate a history as possible
– Assessment of risk factors
– An understanding of how to modify the risk factors to
decrease the risk of harm to individuals (including the
subject of concern) and the organization
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Effective Strategies
• Workplace violence and crisis management
policies in every organization
• Threat management teams
– Outside consultation available as needed
– Incident Command System model
• Liaison with local law enforcement
• Published resources
– ASIS International (2005): Workplace Violence
Prevention and Response Guideline
– ATAP (2005): Violence Risk Assessment Guideline
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Early Interventions to Head Off
Problems
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Detecting conflict
Conflict resolution strategies
Stress management
Does this employee need help?
– Talk to them
– Clinical referrals, e.g. EAP, company physician
– Expectations for the clinical referral
Fitness for duty evaluations
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Counseling the Problem Employee
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Be aware of, but don’t anticipate, the worst.
Empathy
Respect: humiliation as a risk factor
Limit setting
Honesty
Generosity
Flexibility
Privacy
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Response to an Ongoing Event
• Leadership is key
– Visible
– Communications
• Information: specific, actionable, accurate
• Priorities: safety, health, food/water, family
contact
• Managing the perceived threat
– Safety first
– Understanding the motivation of the threat
– Perception of victimization is key
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The Aftermath: Responding to
Victims
• Threat or other perceived danger
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Empathy
Setting limits on demands
Education vis a vis risk perception
Honesty
Generosity
Flexibility
Privacy
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The Aftermath: Responding to
Victims
• Actual violent event
– Physical safety comes first
– Communication
• Employees in touch with families
• Media
• Customers and investors
– Honesty
• What is known
• What was done
• Further follow up
– Arranging for follow-up services
• Internal
• External
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Post-Event Response
• What do people need to avoid long-term
psychological consequences?
– The prevalence of resilience
– Efficacy of community support
– The CISD/M controversy
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Conclusion
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Greatest risk of violence is from outside
The dangers of profiles
Risk assessment as a process
Identification and management requires:
• Policies
• Enforcement
• Awareness of risk factors
• Flexibility
• Willingness to respond
• Ability to respond
• Cooperation
• Recognition that it’s rarely easy
• Team approach
©2007 Ronald Schouten, MD, JD
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