Ballarat's health workers are experiencing violence and aggression in the workplace at rates higher than almost every other health service in the state.
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The Ballarat Health Services 2020/21 annual report revealed 1727 incidents of violence and aggression were reported - the second highest in the state behind only Melbourne Health with 2955.
That translates to 54.05 incidents per 100 full time employees - the fourth highest rate in the state and three times higher than both Barwon Health in Geelong and Bendigo Health.
The number of incidents increased almost 11 per cent compared to 2019/20.
Ballarat Health executive director people and culture Claire Woods said while there was some variation in how different health services report occupational violence incidents, Ballarat's numbers were high.
"We report everything that has an occupational violence component as an occupational violence incident but some other health services indicate a bit more nuance with it," she said.
According to the annual report, one in 11 reported occupational violence incidents resulted in a staff injury, illness or condition. Ms Woods said 314 of the 1727 incidents reported resulted in actual harm being caused.
But that is still equivalent to six incidents causing direct harm every week.
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"One of the things we are quite concerned about is those incidents where it's reported as no harm. The person hasn't identified a harm, but what is the impact on someone's psychological wellbeing of repeated exposure to incivility, rudeness, aggression, shouting, anger ... particularly at the moment in a COVID environment where people's working conditions are very challenging?"
Ms Woods said visitor restrictions during COVID had reduced some incidents of violence and aggression, but increased others.
"The value that visitors bring is they provide care and support to their friend and family member, which at times can support a de-escalation of patient or resident behaviour," she said.
Most of the reports come from the emergency department, mental health and aged care.
People who come in to work here bring something of themselves. Yes yes it's a job and yes they get paid for it but people who work in health care do it because they want to give to others and giving to others comes at a personal cost to themselves.
- Claire Woods
"One possible reason for that is we have been really effective in working with staff in those areas to ensure they are reported," Ms Woods said.
"Going back to when you worked in ED or acute mental health service you expected aggression as part of the job and didn't report it, but talking to our staff in those areas they are very well versed in the need to report ... because they understand the reason why and potential use of the data."
Ms Woods said there were a number of initiatives working to reduce occupational violence and aggression and its impact within the health service.
BHS is part of a Worksafe pilot program for frontline workers who experience stress or other issues, often triggered by occupational violence and aggression, giving access to support through Worksafe without having to go through the claims process.
Health Service Violence Prevention Fund cash has seen more alarms installed, improved CCTV, improved lighting and waiting areas, and the first stage of a trial of body-worn cameras has been completed to see if the behaviour of aggressive people changes if they know they are being recorded.
"That was a success and we are looking at how that might be rolled out more broadly," she said.
Ms Wood said a large percentage of occupational violence and aggression incidents occurred with patients and residents who could not always control the reason for their aggression, such as those experiencing delirium, confusion or those with dementia.
"Getting clinical oversight and intervention early on, to start to understand the triggers that might result in a patient or resident's behaviour escalating is an area we can put more time and effort in to," she said.
They manage it over and over and over again then it actually might be something quite small that results in them really feeling unable to cope - it might be the fourth person that swears at them in a day or the person who is very aggressive or very unhappy at the end of a long double shift
- Claire Woods
"While we have security and can put physical barriers in place to prevent aggression, there's some clinical expertise that can support de-escalation particularly in those situations where it's person's illness or injury causing the condition.
"We need to get away from the idea that because someone's illness is causing the behaviour there's nothing we can do and move in to a space where we use the clinical expertise we've got to develop more sophisticated behaviour management plans."
Ms Woods said even if staff were not harmed during incidents of violence and aggression, the toll it took on them was huge.
"For people who don't work in health care, imagine if you are going about your day, going to work or shopping , and are confronted by a person whose behaviour is completely out of character to what you are doing - they are shouting at you, swearing, perhaps it's an experience of road rage or something like that - what our staff tell us is that there's that physical response, the flight or flight response that's immediate.
"They are desensitised to it but then they manage it over and over and over again then it actually might be something quite small that results in them really feeling unable to cope - it might be the fourth person that swears at them in a day or the person who is very aggressive or very unhappy at the end of a long double shift.
"It's not predictable but it's all those symptoms we experience when we face unexpected aggression."
"Another thing staff say is that they don't necessarily realise the impact until they've gone home and they are not who they need to be.
"People who come in to work here bring something of themselves. Yes it's a job and yes they get paid for it but people who work in health care work do it because they want to give to others and giving to others comes at a personal cost to themselves."
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Ms Woods said she wanted people to think about the impact their behaviour could have on others.
"While disrespect for them may be an expression of frustration it can be a trigger or cause or part of the culmination in causing physical or psychological harm to people they interact with," she said.
"Understand for many health care workers that expression of aggression or disagreement could be the tipping point that makes them not want to do the work they doing."
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