Health Workers Attacked. Investigations Bungled. Will This Spur Change?

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.”

* Story amended on Dec. 15, 2022 at 3:30 p.m. to include additional comments from Annalee Yassi.