What Does OSHA Say About Workplace Violence?

You're listening to the Phil Klein Dental Podcast. We all go to work every day to our dental practices and lots of things are on our mind. But for most of us, the last thing we're thinking about is workplace violence. Thank goodness it doesn't happen very often in the dental office. But alarmingly, this year alone, there has been two very violent attacks on dentists in their dental offices that have made national news. And with the upsurge of workplace violence in our country, Dentists are certainly not immune to the threat. So, as with any other kind of emergency situation, it's best to have a plan just in case. Today we'll be talking to Mary Govoni, who has some very important recommendations concerning workplace violence in the dental setting, and how this all relates to OSHA's current workplace safety standards. Mary is an internationally recognized speaker, author, and coach focusing on infection prevention and control, OSHA and HIPAA compliance, and ergonomics. 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To learn more, visit ivaclar.com, or to locate a lab near you, check out the link in the description. Mary, thanks so much for joining us. Thank you. It's always a pleasure to be here. Yeah, we're very happy to have you on the show, Mary. I wish we could talk about something a little bit more cheerful, but the reality is that... do need to be aware of the fact that there has been an uptick in violent crimes across the country, and dentists are not immune to this. And just in the past year, we've had two terribly violent attacks against dentists, one where a dentist was murdered in California and another in Louisiana where a young woman... was attacked by her patient and she was injured severely and she may never practice again. So I think it's an important topic to discuss and I'm glad you have a lot of information for us about it. And again, we talked about this before, the best thing to do is to be prepared, have some sort of emergency plan in place. So let's talk about how OSHA plays a role in this. Is there an OSHA standard on workplace violence or does it fall under the general workplace safety clause? good question right now it does fall under the general workplace safety clause which states that employers are required to provide a workplace safe from known hazards and employees are required to follow safety protocols so we need to have in a dental practice an emergency action plan in place in order to be prepared for and to identify potentially violent situations that could happen. And so there also is a set of guidelines from OSHA called Guidelines for Prevention of Workplace Violence in Healthcare Settings and Social Work because healthcare workers and social workers have been killed, threatened. um on the job you can imagine hospital health care workers in the emergency department and someone comes in and shoots and kills them um social workers have been shot at and and killed when they've made home visits checking on children and foster care and and so forth and so those guidelines are utilized if there is an incident that falls under that general duty clause, but it is right now on OSHA's regulatory agenda to have a workplace violence prevention standard. Although nothing in the world of OSHA moves very quickly, I would say that's probably a couple of years away at best, but The fallback, again, is the general duty clause, general workplace safety clause, and the guidelines that we have from OSHA. Now, some states are already moving forward on this. And correct me if I'm wrong. So I think California has its own regulations on workplace violence. Am I correct? Where they have specific... us about you. Yeah. Tell us about that, because I think you already need to have some documentation on annual training. And then there's some five five year requirements as far as documentation that you need to keep. What's that all about? Yes, there are. And there is a deadline for the revisions that have happened to the standard. I believe it's June or July of 2024. So anyone, any of your listeners. who are in california you need to go to cal osha and make sure that you have the most updated data and requirements there are training requirements there are documentation requirements very similar to what osha would require with an emergency action plan and just making sure that there aren't in addition to the california requirements that there might not be some municipal or city requirements as well um and california usually has the strictest standards now i will say that the california dental association for those practices those doctors in california who are members has done and always does an amazing job of keeping on top of these things and helps to provide templates and um guidelines for training and all of those things. So if you're a CDA member, I would contact the California Dental Association for guidance on the specifics of the California standards and Cal OSHA as well. Yeah. And I assume other states are going to pick up on that, right? Normally, California is one of the first to throw regulation on. They're very good at that. And then other states follow. So I think it behooves the office to get that moving forward. And I know how much documentation offices already have. But to have something documented in this type of severity, where if something, God forbid, happens that's that bad, like a shooting or a stabbing or something like that. Now, we also talked offline about the prevalence of different kinds of workplace violence. And the most common form of workplace violence. is a personal thing, an estranged spouse. There's something that could happen there. In those cases, since they're the most prevalent, I assume that anybody in the office that has the potential risk of a personal relationship blowing up into something more violent, should they not inform the other employees about this? They absolutely should, out of respect, obviously, for the other employees. need for safety and the reality is that even though sometimes we don't want everybody to be all up in our business some people are much more private than others we have an obligation that if someone might be coming for us they may be taking out somebody else along the way so yes we do have a responsibility no matter what it is and in the situations that i've been involved with with my clients over the years in many cases it's tough to admit you know my marriage is falling apart and things aren't going well and people if they are abused perhaps at home they go to great lengths to try to cover bruises and things so it doesn't show at work but the reality is that's the time when you need the support of other people to help you understand um that they have your back um in case something happens so yeah absolutely you can tell it to your employer in confidence. You can tell it to your practice administrator in confidence or a coworker, but then there has to be the conversation by the doctor, the directive from the doctor saying, look, we have this potential situation and we all need to be aware and we all need to support this person so that all of us are safe. And you would think that healthcare is one of the safest professions to work in. right because patients are coming in they're looking towards the healthcare clinician to help them but they're also at the same time very exposed they're very vulnerable because they're seeing the public right and and right you don't know they are and and they may be under the influence of medications you know legal or illegal they may be stressed And when people are in stressful situations, they don't always exhibit their very best behavior. A lot of verbal abuse happens when people are in very stressful situations. So being able to recognize some of those signs, you know, everybody kind of makes fun now of the Karens out there makes me think of the woman who was berating the dental office for not letting her in during the pandemic with a a face without a face mask on there's something behind that behavior that's motivating that and it's usually some kind of stress or maybe it's pain or just again it's self -esteem issues whatever it is but we need to be able to recognize that something else is going on with those people and we need to try to de-escalate them and also to protect ourselves We'll be getting right back to Mary in a second, but first, are you looking for an air-driven handpiece that rivals the power and torque of electric? Well, I have good news. It's finally here. It's called the TMAC-Z, and it's from NSK, a company we all know and trust as a world leader in dental handpieces. 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Where do you go to hide? And the other thing that we haven't really touched on is probably when something is happening, not only do we have employees there, but we have patients too that we have to protect. And this could take some work, some discussion about where would we go? Where can we go? Can we easily run out the back door? Are there other exits from the office? That's part of an evacuation plan. Where do we go? Where do we run to? Do we have places where we can hide? And are we capable or should we fight back? And that's where I think law enforcement comes in. And the FBI and the Department of Homeland Security have these great active shooter training videos that are free to anyone to watch, to help them understand when can you fight back and should you? Because, of course, you run the risk of getting. injured or worst case scenario killed but know what you're capable of what are some types of things to do and personal safety training is a great thing to do there are lots of videos you can find a lot of things online that are training videos to understand personal safety training you can go to a community college and take a personal safety training course that teaches you some skills how to disable someone and and protect yourself and in not just in the workplace but if you were out on the street you're going to your car um after you're at the end of your work day and i always tell employees in the practices do not if it's after dark and you have to park in kind of an isolated area do not walk to your car alone that's when the buddy system works we go together if you are working alone in the office before or after hours keep all the doors locked so that you're protected so that you're secure and if you can pull window coverings so people can't look in and see that there's only one or two people in the building wow this looks like a great place to go because we can't forget that there are some people out there that believe that there may be some cash to be had in a dental practice and or drugs and fentanyl number one type of drug that people want to steal from dental offices, particularly oral surgery practices. Those are all good points, Mary. And you did mention something about the patients. Now, again, in the case of a violent crime in the office between a patient and the dentist, That could be taking place in the treatment room. There might be other patients in other treatment rooms. There's staff that are in the back office. There's staff at the front desk in the reception area. There's patients in the waiting room. So all of these people that I just mentioned need to get out to safety as quickly as possible. And of course, in a panic situation like this, it's difficult to think clearly. It's difficult to assess where everybody is. So really the training, again, becomes a very important part of this to be prepared. Do you agree? Oh, absolutely. It absolutely has to be part of the training program down to assigning someone, not a person, but somebody in a position. So someone, for example, at the front desk is responsible for the patients in the reception area or maybe. if it's a big practice maybe everybody at the front desk is responsible for the patients in the reception area and the clinical team in the back office are the ones that are responsible for gathering and helping um them to a hiding place or or escape the patients and the other team members, and then have a place that's kind of like the fire drill 101 that you learned in elementary school, have a meeting place outside somewhere where you can account for everyone. So someone maybe needs to grab a copy of the schedule if they forget what patients were there on a given day. So absolutely, it needs to be very specific to the position the job description of a person not necessarily a name and what it is that we expect them to do where are we going to go um if you're in a high-rise building versus a freestanding building that makes the difference and you know where you're going to go are you going to take the stairs or the elevator in your high-rise building um do you have a place to go another building to go to if you're in a freestanding building so that's why pre-planning is so important and in addition to that some dental practices may elect to have their employees trained with some form of self-defense and again that's the last thing you'd want to use out of the three choices of run hide and fight but if you're in that last bucket and you're you you know you have no choice and there's a deadly threat you know there's ways of using a chair there's ways of using a coffee thermos or something. They have these training programs in self-defense that teach people to use what's available and their own body, like to kick the knees at a certain angle. And it only takes nine pounds, I think, of pressure to, nine pounds of force, I should say, at the right angle to disable somebody by kicking them in the knees in the right place. Now, again, that's the last resort. but it's also an option right for these employees and dental practices to get this self-defense training yes it absolutely is an option and i think that it's not only a great skill to have to fend off some kind of a violent incident in the workplace but just in life in general because as i think you said a little bit earlier that there really isn't a safe place anymore we are under threat almost anywhere and everywhere being aware knowing what to do if i'm walking to my car with my keys am i going to hold them in my hand so if somebody grabs me i can use those keys as a weapon and in the self -protection training i've done we've been told go for the throat go for the eyes or you take your knee to somebody's private parts There are lots of things you can learn to do to defend yourself. But that is, as we've said before, the last resort. We get away, we hide first and fight back last. Yeah, there is a self-defense philosophy called Krav Maga, which is something that was developed, I believe, in Israel. And it's basically self-defense without a weapon and use your body, use anything you can, and it buys you time. The idea is to disable or temporarily disable the perpetrator and then give yourself time to get away. And that's what you need. You need to clear the way so you can get out and free yourself from the situation. Absolutely. Yeah, because when you have a situation where you're caught and you're in that third stage of fight, cowering could be very dangerous. The person who's the perpetrator takes advantage of that. And that's a very serious and scary thought. So we did cover some good territory here. The bottom line is get training, document some stuff, right? We need to keep documentation in the practice. So we have a plan, an emergency plan. Follow OSHA. What do they say? Right now it falls under the general workplace safety clause is what you mentioned, right? Yeah. If you're in California, the July deadline, and what does that deadline mean to people in California? What do they need to do by July of 2024, which is like right in front of us? They must have completed workplace violence training requirements by then. Okay. So if they had a surprise OSHA inspection and there's no training documented on workplace violence, they would be in noncompliance. Exactly. In California. In California. I have not heard of other states, but as you said before, I think there will be other states, especially the state OSHA plan states. There are 25 of them. They will no doubt come out with some kind of a standard, but they also might wait until a federal standard becomes available and then adopt it. We just don't really know. But I think the bottom line here is. being aware. We talk a lot about being aware of how our patients are reacting to treatment, reading their body language. We need to hone those skills even further into now. looking for potentially violent or even just disruptive or threatening behavior in those patients. Absolutely, Mary. And that all comes down to situational awareness. We have to be aware of our surroundings. We're working with the public and you never know what's going on behind the scenes. So let us all be careful. Let's pray that it never happens to any of us. But as always, it's better to be prepared. And so we can react properly in the event something like this happens. Mary, thanks for the input. And we'll get you on another podcast soon. Very, very helpful. Thank you.