Shifting the Safety Culture: Evaluation of a Novel Approach to Understanding and Responding to Workplace Harassment and Violence Experienced by Homecare Workers

Emily C King; Janet Chan; Adam Benn; Mel B Michener; Travis A Van Belle; Sandra M McKay

doi:10.1177/21650799241232148

Shifting the Safety Culture: Evaluation of a Novel Approach to Understanding and Responding to Workplace Harassment and Violence Experienced by Homecare Workers

Workplace Health Saf. 2024 Mar 7:21650799241232148. doi: 10.1177/21650799241232148. Online ahead of print.

Authors

Emily C King^{1

2}, Janet Chan², Adam Benn², Mel B Michener², Travis A Van Belle², Sandra M McKay^{2

3

4

5

6

7

8}

Affiliations

¹ Dalla Lana School of Public Health, University of Toronto.
² VHA Home HealthCare.
³ Institute of Health Policy, Management and Evaluation, University of Toronto.
⁴ Department of Physical Therapy, University of Toronto.
⁵ Ted Rogers School of Management, Toronto Metropolitan University.
⁶ The Institute for Education Research, University Health Network.
⁷ The Michener Institute of Education, University Health Network.
⁸ Michael Garron Hospital, Toronto East Health Network.

PMID: 38454778
DOI: 10.1177/21650799241232148

Abstract

Background: Workplace violence and harassment are commonplace for healthcare workers and most incidents are unreported. Normalization of these experiences, lack of confidence in reporting systems, and fear of the consequences of reporting contribute to the invisibility of these experiences. Challenges are exacerbated in homecare settings and for precarious workforces including Personal Support Workers (PSWs). We created, piloted, and evaluated an intervention to enhance safety culture and encourage reporting of workplace violence and harassment.

Methods: A multi-stakeholder steering committee designed an intervention combining policy changes, a pre-visit screening tool, education, and brief end-of-visit reporting. This was piloted with a PSW care team which provided >55,000 client visits during the 32-week intervention. Operational metrics characterized screening, education, and reporting uptake. Pre- and post-intervention surveys characterized PSWs' experiences with workplace violence and harassment, reporting experiences, training history and intervention feedback.

Findings: PSWs reported increased comfort discussing workplace violence and harassment, and increased confidence managing client-to-worker incidents. The screening went smoothly with most clients in private homes. Most PSWs (75%) engaged at least once with end-of-visit reporting and nearly half submitted reports regularly. During the pilot, 21% of PSWs reported incidents and 52% of reports shared client-specific strategies for managing these situations.

Application to practice: Changes in comfort and behavior with reporting indicated a shift toward a more open culture surrounding workplace violence and harassment. Tools created for this intervention and lessons for implementation are shared for consideration by occupational health practitioners throughout the homecare sector.

Keywords: homecare worker; occupational health and safety programs; organizational culture/climate; program planning and evaluation/quality improvement; workplace violence and harassment.