Proceedings

November 29-30, 2001
Montreal, Quebec
Canada

Held under the auspices of the:
North American Agreement on Labor Cooperation Cooperative Activities Program
United States - Canada - Mexico

CONTACT INFORMATION

Canada
Office for Inter-American Labour Cooperation
Labour Branch
Human Resources Development Canada
Phase II, ^{8th Floor}
165 Hotel de Ville Street
Hull, Quebec
Canada K1A OJ2
(819)953-8860

México
Oficina Administrativa Nacional de México
Secretaría del Trabajo y Previsión Social
Av. Periférico Sur 4271
Edificio A Planta Baja
Col. Fuentes del Pedregal, Deleg. Tlalpan
14149 México, D.F.
(525)645-3995 ext. 2431

United States
National Administrative Office
Bureau of International Labor Affairs
U.S. Department of Labor
200 Constitution Avenue, N.W.
Room S-5205
Washington, DC 20210
(202)693-4900

Secretariat
Commission for Labor Cooperation
1211 Connecticut Avenue, NW
Suite 200
Washington, DC 20036-USA
(202)464-1100 or 1-800-682-5557

Many people contributed to November 2001 Conference on Violence as a Workplace Risk. I would like to extend my sincere thanks to the ministère du Travail du Québec who, as conference co-host, supported and actively participated in this important event. I would also like to acknowledge the members of the conference steering committee, Labour Program Communications, and the staff of the National Administrative Offices of the NAALC countries for their assistance with the coordination of this event.

Special thanks are reserved for conference speakers and moderators who capably shared their knowledge and experiences with us.

Finally, I would like to acknowledge the generous sponsorship of the Commission de la santé et de la securité du travail du Québec and the Bank of Montreal.

Kevin Banks
Director, Canadian National Administrative Office
Labour Program
Human Resources Development Canada

Together with an agreement on the environment, the North American Agreement on Labour Cooperation (NAALC) is one of two parallel accords to the North American Free Trade Agreement (NAFTA). The NAALC came into effect on January 1, 1994 and is the first agreement to address labour rights and labour standards in parallel to an international free trade agreement.

The NAALC highlights cooperation on labour matters, the promotion of eleven principles in three key areas of labour law (industrial relations, occupational health and safety and employment standards), and the effective enforcement of domestic labour law in the three NAFTA countries - Canada, Mexico and the United States.

The NAALC also provides for an extensive program of trinational cooperative activities, including seminars and conferences. This program is one of the pillars of the Agreement; it aims to foster better understanding of laws, policies and practices in each country as well as to encourage innovation and the sharing of information regarding workplace issues.

The Trinational Conference on Violence as a Workplace Risk, hosted jointly by the Labour Branch of Human Resources Development Canada and the Ministère du Travail du Québec, was part of the NAALC's continuing program of cooperative activities. Held in Montreal, Canada on November 29-30, 2001, this two-day event brought together more than 200 people representing labour, business, government, academia and non-governmental organizations. The purpose of the event was to raise awareness of the issue of psychological and physical violence in North American workplaces, and to provide practical solutions by sharing information, highlighting best practices and identifying successful methods of prevention.

Although the presentations made at the conference are not to be considered official documents and do not necessarily represent the policies or official positions of the governments of the United States, Canada, or Mexico, we are hopeful that their publication will give rise to further discussion on workplace violence in the member countries of the NAALC. Please note that remarks made in Spanish and French were translated to English.

CONFERENCE PROGRAM
Note: The page numbers listed by the panel sessions follow the report Proceedings Section

North American Agreement on Labour Cooperation
Cooperative Activities Program
TRINATIONAL CONFERENCE ON VIOLENCE AS A WORKPLACE RISK
November 29-30, 2001
Fairmont Queen Elizabeth Hotel
Montreal, Canada

Objectives of the Conference:

This two-day conference is part of the Cooperative Work Program of the North American Agreement on Labour Cooperation for 2000-2001. It will aim at:

• raising awareness of the issue of violence in North American workplaces among employees, unions, employers, governments, human resource and industrial relations experts as well as the general public;

• outlining the nature and extent of the issue in each of the North American countries;

• providing explanations for this phenomenon;

• providing a forum to discuss successful policies and solutions adopted in various organizations and jurisdictions;

• discussing how workers’ compensation and insurance systems in various jurisdictions treat the issue of physical and psychological harm resulting from workplace violence;

• presenting various forms of assistance to victims, witnesses and perpetrators of workplace violence; and

• providing an agenda for further research and prevention.

Background:

The issue of workplace violence started to generate concern in North America in the early 1990s. Despite greater awareness, lethal and non-lethal workplace violence continues to be a major contributor to occupational injuries and deaths. For instance, according to a survey of the Canadian Union of Public Employees, 40 per cent of respondents said they were struck and about 30 per cent were actually hit, grabbed or scratched in their workplace. In the U.S., an average of 20 workers are murdered and 18 000 are assaulted while at work or on duty every week.

The costs and consequences of workplace violence, albeit difficult to quantify precisely, are real. Compensation costs, loss of productivity and personal tragedy, to name a few, can all result.

Two of the objectives of the North American Agreement on Labour Cooperation are to encourage the exchange of information and improve working conditions. It is in this light that the Canadian, American and Mexican governments organized this conference.

DAY 2 - Friday, November 30, 2001

Note: This conference was made possible with the assistance of the Ministère du Travail du Québec and through the sponsorship of the Bank of Montreal and the Commission de la santé et de la sécurité du travail du Québec.

Stéphane Bédard, Député de Chicoutimi and Adjoint-parlementaire au ministre d’État à l’Éducation et à l’Emploi (Québec)
Claudette Bradshaw, Federal Minister of Labour (Canada)

Warren Edmondson, Assistant Deputy Minister of the Labour Program, Human Resources Development Canada, welcomed participants to the Conference on Violence as a Workplace Risk, organized under the North American Agreement on Labour Cooperation (NAALC). This conference, with workplace violence as its theme, was the 45th cooperative activity under the labour cooperation side agreement to the 1994 North American Free Trade Agreement (NAFTA).

Stéphan Bédard extended Quebec Labour Minister Jean Rochon’s regrets that he could not attend the conference, and assurances of the minister’s commitment to preventing violence in the workplace. Labour has a central place in everyone’s life, Bédard noted. However, due to the overload of social networks and the breakdown of families, there are fewer and fewer common reference points that make people feel safe as a collectivity. He pointed to a recent Quebec survey indicating that three-fifths of the province’s workers report feeling greater stress. Stress and situations of harassment in the workplace lead to increased absenteeism, and are accompanied by major costs and consequences for individuals, businesses and society as a whole, he said. Last October, the Province of Quebec adopted a new policy outlining managerial responsibilities with respect to health and safety, and employee assistance.

The NAALC is a landmark agreement linking labour standards to trade, said Federal Minister of Labour Claudette Bradshaw. In addition to the agreement with the United States and Mexico, Canada has also signed similar labour initiatives with Chile and most recently Costa Rica.

Workplace violence can be psychological as well as physical-whatever the form, it creates fear, stress and anxiety, and is damaging both to the employee and the organization, the minister said. Citing a survey by the Canadian Union of Public Employees, Bradshaw reported that 40 per cent of respondents said they had been struck, and 68 per cent said they had been subject at some point to verbal aggression. “That is unacceptable,” she said. “No one should have to put up with that atmosphere or behavior in their workplace.”

The Canadian government has introduced amendments to the scope of the labour code providing for increased powers to health and safety, and security representatives in terms of establishing an internal process to settle complaints.

Kevin Banks, director of Inter-American Labour Cooperation with HRDC’s Labour Program and head of the Canadian delegation, extended a warm welcome to everyone. Lewis Karesh, head of the American delegation, stated that, thanks to NAALC, barriers are being broken down to improve the lives of all workers throughout the continent. “While we may have different laws or different languages, I believe we share the same goal, which is to send our workers home safe and healthy every day. By sharing our experiences and best practices in forums such as this, we will make it a reality,” he said. Mónica Mora, head of the Mexican delegation, introduced the four other participants from Mexico. Treatment of violence in the workplace as a workplace risk is just emerging in their country, she explained, and they were motivated and encouraged by the conference’s focus.

Vittorio Di Martino, co-author of the International Labour Organization (ILO) Report “Violence at Work,” gave the keynote presentation. Most people in the workplace have been subject at some moment in their lives to violence or violent behaviour, he stated. Workplace violence is generally defined as incidents in which workers are abused, threatened, assaulted, or subjected to offensive behaviour in circumstances related to their work. However, he noted, this definition may vary in different environments; for example, some people deny that sexual harassment is violence.

It is clear now that psychological violence and its impact can be as bad as or even worse than physical violence; its presence in the workplace is enormous, Di Martino said. He also noted the importance of recognizing minor, repeated acts of violence, which individually may seem small, but when grouped together can be seen to have long-lasting negative consequences on the health and safety of the people concerned. Yet while focusing on psychological violence is well warranted, it is critical not to lose perspective of the bond between psychological and physical violence. “Any act of physical violence impacts enormously on psychological [well-being], and any act of psychological violence has a physical effect on people. They cannot be separated,” Di Martino stated.

There is growing awareness of the importance of acknowledging cultural differences related to the issue of violence. This raises the issue of human rights. How much in the name of culture should be accepted when it comes to violence? Where is the balance? It’s an issue that many people in the field find themselves grappling with. In much of the industrialized world, there is a linkage between trade and human rights. Some developing countries accept this as a matter of development; others reject it as a matter of protection.

The yearly cost of violence in the workplace in the United States amounts to $35.4 billion. Worker absenteeism in the U.S. due to exposure to violence is 30 to 40 per cent higher than in the European Union. A recent ILO report estimates the combined cost of workplace stress and violence at 0.5 to 3.5 per cent of national GDP per year. As the costs have been quantified, there has been recognition of workplace violence as a valid issue and major health and safety cost for enterprises, the elimination of which is necessary for success. It is essential to link managerial and economic goals, and make the fight against violence an integral part of enterprise culture and growth, as well as a self-sustained process in the workplace, Di Martino said.

In conclusion, he noted an emerging phenomenon of precarious employment in industrialized countries, the increasing number of so-called self-employed people who are not really self-employed, yet are not unionized or otherwise protected. They fall into a big grey area where they have no protection, he said.

It is vital to know the risk factors associated with violence at work in order to identify the appropriate preventive strategies that should be implemented to counter this phenomenon, said Michel Vézina of the Institut national de santé publique du Québec. Psychological violence is defined in the report by the Quebec interministerial committee on psychological harassment at work as behaviour shown through words, acts or repeated gestures which are non-desired and which go against a person’s psychological integrity or physical dignity, or is of a nature which compromises a right, or brings about unfavourable working conditions, a layoff or forced resignation.

Individual and organizational factors may represent an increased risk of psychological harassment at work. There are various psychological profiles of aggressors. They are sometimes defined as technocrats, narcissistic, paranoid and obsessive, egocentric and without any sense of morality, empathy or respect for others. They are intelligent and charming, mainly toward those who accept their manipulation. “The difficult economic context generates and creates these personalities in strategic positions, because they’re cold and calculating,” Vézina said.

While there is no typical psychological profile of victims of psychological harassment at work, some people are more vulnerable than others; for example, people who at the outset have poor self-esteem or are loners are easier to dominate. “Atypical” people, who do not fit in with the style of the enterprise, may suffer harassment, while others face discriminatory harassment that infringes upon Charter rights, such as sexual harassment or harassment because of their age or race.

Several work situations lend themselves to psychological harassment. “Strategic harassment” is characterized by a deliberate strategy on the part of a hierarchical superior, aiming to make life difficult for the victim and encourage undesirables to quit. This strategy can be found in situations where the incompetence of the victim is difficult to demonstrate. Other organizational factors that lend themselves to situations of violence include denial of violence, non-management of conflicts, incompetence or mismanagement, tolerance of incivility or management practices that create feelings of injustice.

The literature calls attention to the importance of leadership style in incidents of workplace violence. A management style characterized by competition among workers, or by threat, humiliation, discrimination or favouritism enhances conflict and violence at work, he stated. The lack of real authority in an enterprise, or a passive management style, can also lead to situations of physical or psychological violence.

Another risk factor is the intensification of work and precarious employment in industrialized countries in recent decades. A European Union survey of workers indicates that violence and intimidation in the workplace is 30 to 80 per cent higher when the work pace depends on the work of colleagues or direct demands from clients, when complex tasks are involved, or when there is not enough time to carry out work. The figures are similar when workers cannot take their breaks when they choose, alter their pace of work or have monotonous tasks. “These are pathogenic situations that have increased in Canada, the United States and Europe in the last few years because of economic and technological change linked to the globalization of markets and competition,” he concluded.

Dr. Gisela Estrada Rodriguez of IMSS presented an overview of the results of Mexico’s efforts to reduce workplace injuries due to violence and work-related risks, categorized as occupational accidents, accidents in the workplace or work-related illnesses. The Institute insures more than 12.5 million workers in more than 800,000 companies throughout the country.

Psychological violence is not covered, and statistics on this type of violence are not compiled. “We hope to use your surveys and results to establish ways of defining cases of psychological violence, an approach both for the institutions we insure as well as the Institute itself,” she explained.

Statistics over the past three years show that the greatest number of workplace accidents and deaths involving violence have occurred in industrialized and urbanized states, such as the Federal District, where Mexico City is located. Estrada noted that a gender breakdown of accidents showed that 83 per cent of cases involved men, and 17 per cent women. An understanding of these findings is important; she suggested that perhaps the reporting pertained only to physical injuries and not psychological violence. “If psychological cases were reported, there would probably be a greater number of women,” she said.

A breakdown by trade showed that labourers, janitors, hotel, retail and sales clerks, security guards and police officers top the list of those with the most occupational accidents. Security guards, police officers, truck drivers, construction workers, cashiers and taxi drivers are most at risk of death on the job.

Compiling and cross-referencing information on workplace violence, including the psychological component, is vital to a prevention plan and its implementation, she concluded.

Data on workplace violence provide important insight into patterns of occupational injury and death, as well as the rates and risk levels for particular groups of workers, said Lynn Jenkins of NIOSH. For example, she noted that the rates for workplace homicide are higher for males than females; however, homicide has been the leading cause of occupational-injury death for women. Rates also increase with age because older workers do not survive as well as younger workers. Researchers have also found that older workers are perceived as softer targets.

The highest rate of work-related homicide occurs in the taxicab industry, which has a rate that is 60 times the average workplace homicide rate. Other high-risk occupations include law enforcement officers, gas station and garage attendants, convenience store workers and security guards. Seventy-five percent of workplace homicides occur during the course of a robbery. In 10 per cent of cases, the crime is committed by a co-worker or former worker; six per cent of cases involve customers or clients; and seven per cent are personal disputes that are brought into the workplace.

Data from the National Crime Victimization Survey of the U.S. Department of Justice indicate that the risk of workplace victimization is related more to the task performed than to the demographic characteristics of the person performing the job. Routine face-to-face contact with large numbers of people, the handling of money and jobs that require routine travel or that do not have a single work site are all factors that pose increased risk. The delivery of passengers or goods, and dealing with the public are also associated with an increased risk of workplace assault. However, she noted, “risk factors vary dramatically by industry and occupation. There is not a single description of an act of workplace violence-there is an entire matrix of risk factors-and that makes it difficult to think about preventive strategies, because there is not one answer.”

With the recent acts of terrorism, the conference comes at a time when a great deal of attention in the United States is focused on security in general and security at work in particular, said Jane Walstedt of the U.S. Department of Labor. Several recent newspaper articles illustrate this, she said. For example, according to a November 27, 2001, column for The Washington Post, “What comes out of the wreckage is the realization of just how intense, important and intimate the workplace is - for better and worse,” and “The attacks have also led many people to re-examine their working environment: Is my workplace safe? How is my boss responding to the continued threats of violence?” The Bureau of Labor Statistics (BLS) in the U.S. Department of labor collects data on fatal occupational injuries and illnesses through the Census of Fatal Occupational Injuries (CFOI) and on nonfatal injuries and illnesses through the Survey of Occupational Injuries and Illnesses. Both capture assaults and violent acts. Most of the fatalities that occurred as a result of the acts of terrorism on September 11 fall within the scope of CFOI. BLS plans to collect information on all the work-related fatalities associated with the September 11 tragedy as part of the 2001 Census. The results of the Census will be available in the fall of 2002.

Turning to non-fatal workplace violence, Walstedt noted that while non-fatal assaults and violent acts accounted for less than two per cent of all non-fatal injuries and illnesses in the U.S. in 1999, there still were 23,000 incidents of this nature which resulted in time away from work. Women suffered 57 per cent of the nonfatal assaults and violent acts. Assaults and violent acts by persons include not only physical assaults but also “threats or verbal assaults.” Threats or verbal assaults constituted less than 1% of nonfatal assaults and violent acts by persons; however, women suffered 85% of them.

With regard to fatal occupational injuries, assaults and violent acts accounted for 16% of all such injuries in 2000. One type of assault and violent act - occupational homicide - accounted for 677 or 11% of all work-related occupational injuries in that year. Both women and men in retail trade had the highest number of occupational homicides, followed by services and government. Women and men were almost equally likely to be the victim of homicide at the hands of a work associate - a co-worker, customer, or client. One-fifth of women who were victims of occupational homicide were killed by a husband, an ex-husband, a boyfriend, or an ex-boyfriend. No men were victims of occupational homicide by a wife, an ex-wife, a girlfriend, or an ex-girlfriend. Foreign-born workers suffered almost one-third of occupational homicides. They were more likely than all victims of occupational homicide to be self-employed and to be male.

While women make up at least 50 per cent of the workforce, women in senior management positions remain at very low levels, said Frema Engel, author of the book Taming the Beast. “That means our workplaces and the culture of organizations are generally formed by male values, not female values,” she stated.

While not a problem per se, a corporate structure that inculcates the values of one gender and excludes the values of the other gender leads to an obvious discrepancy, she said. If a senior manager (usually male) is abusive towards a worker in the support staff (usually female), how difficult will it be to address the manager’s behaviour issues?

Such is the importance of understanding the risk factors and issues surrounding the values, culture and conduct that shape an organization, she concluded.

Pierrette Cassista of Health Canada asked if any of the panelists had data pertaining to the occupational risk factors for criminal attorneys; her empirical research shows the profession is vulnerable and indeed at increasing risk. Jenkins said their risk factor has not, at least, risen to the level of taxicab drivers, and offered to share data from the U.S.

Bill Chedore, Coordinator of Health, Safety and Environment at the Canadian Labour Congress, raised his serious concern about the policies of governments at all levels, in Canada and abroad, which remove money from the systems that were previously allocated to dealing with issues that helped reduce stress levels, such as housing and economic initiatives that support homes and families and funding for education, health care and social services.

Engel agreed. There is a clear link between stress and workplace violence, and situations in which corporations and institutions face cutbacks and there is more work for employees and fewer resources will lead to less-than-courteous work environments, she said. As we face a growing recession and further cutbacks, the survival of the fittest may prevail. “In order to survive you need to stand out and show your value, and survival can sometimes mean you have to be tougher-or meaner.” This kind of environment and culture can lead to workplace abuses: “Organizations in survival mode don’t have time to deal with complaints, particularly complaints about bad treatment. These are the real risk factors related to economy that will present great challenges this year and next, while we’re in a recession,” she said.

Vézina pointed to the demonstrated link between increasing job demand and violence at work, as well as increasing risk factors related to employment precariousness and diminished autonomy. He agreed that there is a relationship between cutbacks in investments from both public and private sectors, and the increasing phenomenon of workplace violence.

Éric Plante, a health and safety researcher at Université Laval in Quebec, asked if there is literature pertaining to the distinctions or similarities between the terms psychological harassment, mobbing and bullying or intimidation. Terminology varies from country to country, Di Martino replied. In France, there is a well-known book on psychological harassment, yet the French speak about mobbing. The English refer to bullying, while Germans use the term mobbing, as do Italians and people in Northern European and Scandinavian countries. Americans talk about victimization. It’s a situation that’s constantly evolving, Di Martino said.

Jacques Servant, Chief of Occupational Health and Safety for Civil Aviation at Transport Canada, suggested that the three countries in North America should harmonize their approach and use consistent terminology on violence in the workplace. The value of educating young people and creating nurturing family and social environments cannot be underestimated, he added. Vézina supported the idea of standardizing the terminology across the three countries. While there is a link between social violence, family violence and violence at work, he reiterated the significance of organizational violence; the dimensions of work that are under the control of business leaders, such as budget cuts, the intensification of work, and management style, are issues that require different interventions.

Larry Stoffman, Director of Occupational Health and Safety at the United Food and Commercial Workers Canada Council, stated that organizational violence is embedded in the social and workplace structures in Western Europe and North America. He asked if there were any case studies addressing organizational violence. Very little information is available and this is an area that requires further study, replied Di Martino.

Corinne Peek-Asa, University of Iowa College of Public Health and Iowa Injury Prevention Research Center

Organizations must understand how at risk they are for different types of workplace violence, said Corinne Peek-Asa. She presented four types of events of workplace violence, based on a typology developed by the California Occupational Safety and Health Administration (OSHA) Program.

In a Type I event, the perpetrator has an “illegitimate” business relationship with the workplace and enters with criminal intent, such as robbery. About 80 per cent of workplace homicides fall in this category. In a Type II event, the perpetrator has a business relationship with the affected workplace, for example as a customer, client, patient or inmate. In a Type III event, the perpetrator is an employee or past employee of the business. In a Type IV event, the perpetrator does not have a relationship with the business, but has a personal relationship with an employee. An example would be a case of domestic violence playing out in the workplace (which some do not consider a workplace issue).

Actions against violence in the workplace can only be partial solutions, until issues of violence are dealt with in the community, said Barbara Hall, chair of Canada’s National Strategy on Community Safety and Crime Prevention. She moderated the session on Case Study #1, which addressed customer and client workplace violence in the medical and mental health care industry, and education.

Héctor Ulises García Nieto of Mexico’s National Productivity Commission of the National Union of Social Sector Workers (SNTSS) presented an overview of some of the root causes that lead to the risk of violence in the health care work environment. Patients waiting for care can become impatient during long waiting periods; sometimes they are not given their medication in a timely fashion. The capacities of medical units in Mexico have been overloaded for many years, he explained, and health care professionals regularly suffer physical and verbal abuse. Workplace violence was not an issue in Mexico prior to the 1970s, but has been on the upswing since then.

The cost of violence in the workplace is difficult to quantify. However, it includes costs related to disabilities, loss of workdays, increased workloads for other workers, lower levels of service for patients and legal issues. The Mexican Institute for Social Security covers more than 50 per cent of the Mexican population. Client workplace assault can involve a patient or a relative of the patient.

Overloaded doctors have also had to contend with an increasing population over the last decade. Work overload and the lack of medicine, personnel, infrastructure and support staff are among the most important risk factors leading to violence in the workplace. Dissatisfaction in the workplace leads to incidents of violence and loss of workdays due to absenteeism or disability. The lack of resources is largely due to neo-liberal policies adopted in recent years, he added. Programs to prevent violence in the workplace must include human resources, care for workers, labour law and leadership by the union, he concluded.

Over the past couple of decades, the construction industry has experienced demographic shifts, said John Gaal, Coordinator of the United Brotherhood of Carpenters and Joiners in St. Louis, Missouri. These trends have included a shrinking pool of available white males in the 16-22 age range, a growing number of retirements, an increase in women and minorities in the profession, and an influx of immigrants.

A recent study indicates that the St. Louis, Missouri marketplace alone will need to fill in excess of 2,000 construction-related job openings per year for the next seven years. In light of its history, the union construction industry is faced with a seemingly insurmountable task, Gaal said.

He presented several case studies on workplace hazing, threats and sexual harassment. It is essential for leaders to implement effective diversity/conflict resolution programs that will strengthen the union construction industry, he concluded.

Sharon Kirwan, Coordinator of Critical Incident Stress Management (CISM) at Health Canada, discussed the day-to-day routine of a high-risk occupational group: nurses working in rural and remote communities in Canada’s north. The only health care providers in the community, they provide advanced health care, including trauma work normally carried out in the hospital emergency wards.

The CISM program began as a retrospective review identifying data on exposure to workplace violence and turnover of staff from three years prior. About 24 per cent of nurses were exposed to events involving assault, attempted assault and threats. CISM statistics showed interesting trends. For example, the number of critical incidents was high in a small nursing station where only one nurse was employed. When two nurses were employed, the number of critical incidents decreased.

A cost-benefit analysis taking into account the absolute minimum cost of replacing a nurse who leaves due to workplace violence, including recruitment, training and orientation, estimates that every dollar spent in a CISM program results in savings of seven dollars. As a result of their evaluation, Health Canada has agreed to continue funding this program and will be expanding its services based on this kind of evidence, she concluded.

Health care providers have a complicated relationship with violence in the workplace, said Corinne Peek-Asa. While they undoubtedly deserve a safer work environment, they don’t necessarily expect it-they often believe that workplace violence is part of their job. Nonetheless, health care workers have a crucial role in research and designing prevention strategies.

Some risk factors in the health care sector are physical; for example, workers often work in isolation, at the scene of an incident, in small units or in small rooms alone with patients. Others risk factors are organizational, such as work tasks and how they are delegated. Peek-Asa presented a case study on efforts by the California Occupational Safety and Health Administration. Researchers found that despite the existence of a reporting system, there was a lack of formal reporting and ongoing communication.

Ted Mansell of the Service Employees International Union noted that panelists from Canada and Mexico have highlighted staffing constraints as a key risk factor. Workers in the health sector are at particular risk because their jobs involve hands-on intensive interaction and care provision. He emphasized the proven dramatic decrease in workplace violence that occurs when nursing stations (i.e. Northern Canada) are increased from one worker to two. Peek-Asa concurred, and added that in addition to staffing level, the type of staffing can also be a risk factor. For instance, the United States is experiencing a growing number of contract workers at every level, which affects workplace relationships; high turnover also raises quality issues.

Moderator Patricia Biles welcomed participants and said presenters would be discussing violence in which the perpetrator does not have a legitimate relationship with the workplace. Ms. Biles noted that this form of violence is responsible for the highest percentage of workplace homicides in the U.S.

Larry Stoffman discussed three actual incidents, looking at risk factors, follow-up and prevention. His first example was a case of verbal assault and stalking that stemmed from a dispute over bottle returns. There were repeated threats to a young cashier, who was followed home and threatened with sexual assault.

After the incident, a team looked into issues such as the return procedure, security procedures, the emergency response, the incident investigation and follow-up, post traumatic stress and the return-to-work program. The measures adopted after this investigation included moving the bottle return area to a secure location and training personnel on safe return procedures. Education was done on compensation rights and return to work procedures. Health and safety committees were trained to do audits, incident reports and effective follow-up.

Stoffman then described a shoplifting incident that degenerated into multiple assaults. The shoplifter was chased through the workplace. He was detained, injured and bleeding, escaped, collided with workers and assaulted them with a hypodermic needle.

The post-incident investigation looked at loss prevention procedures, emergency response procedures, security personnel training, incident follow-up, biohazard exposures and sharps procedures. The employer co-operated in revising and implementing many procedures and enforcing a no-chase policy.

The third case was a violent kidnapping and sexual assault at a suburban mall. A young worker arrived at 5 a.m. for her first day of work but was unable to enter the building because she did not have the correct access code for the door lock. Other employees could not hear the victim because of their location in the building and because the victim’s car was parked a considerable distance from the employee entrance.

The issues studied were access and egress, keypad procedures, an intercom system, the parking policy and design, worker and management education and work refusal policies. Stoffman said his organization argues that employers should be responsible for making sure employees are not put in danger while trying to get to work and that employees should have the right to refuse to enter unsafe situations.

Stoffman called for site-specific risk assessments. “Enforcement of violence prevention regulations is instrumental in a successful prevention campaign,” he concluded.

Dr. Javier Calero Lomelín discussed bank robberies in Mexico. He said that the incidence of bank robberies this year is 45 percent lower than last year, a decline he attributed to recently adopted prevention measures. The methods of bank robbers fall into general categories from those with threatening notes and no weapon, to those in which a hand-held weapon is used to the worst extreme, which involves kidnapping. Calero Lomelín noted that bank robberies can affect everyone in the bank, or just the teller. The psychological impact of any bank robbery can be deep and is often delayed.

Some of the preventative measures taken in Mexico include promotion of operational standards and the respecting of cash limits, planning and training on how to react to a robbery, alarm systems and coordination with local law enforcement authorities. Calero Lomelín said that the level of physical aggression in bank robberies has decreased.

He listed some of the effects on mental health that can result from being the victim of a bank robbery. These include confusion, disorientation, memory loss, drug abuse, excessive concern about security, compulsive eating and a sense of abandonment. The doctor discussed a specific case of a woman who is still dealing with the after-effects of a 1997 robbery. He noted that employees sometimes come under suspicion themselves, adding to the post-traumatic stress for victims of bank robberies. He said that ensuring employees get help from a psychotherapist benefits employers in the long run.

Barbara Kabrick spoke about violence problems specific to the taxi industry. Taxi and livery drivers are 60 times more likely to be assaulted than workers in any other field because they face a number of risks - working alone, working with the public, working at night, working in high crime areas and working with cash. Cab drivers have little or no health coverage or workers compensation and are reluctant to seek medical attention for all but extremely serious injuries.

Preliminary results of a national survey of cab drivers show that approximately 75 percent of assaults against cab drivers go unreported. Kabrick calculated an incidence rate of 735.2 per 1,000, making taxi and livery drivers more than twice as likely to be assaulted on the job as police officers. These results do not include drivers from many of the larger high crime areas.

Kabrick said the OSHA report listed some effective safety measures, such as GPS, caller I.D, first aid kits, in-car surveillance cameras, partitions, protocol with police, an open mike switch, safety training and cashless transactions. Kabrick noted that a Baltimore study shows partitions reduce assaults and are cost-effective; however, the companies now bear none of the costs of injuries and robbery. Those costs are borne by the drivers and taxpayers, Kabrick said.

She added that assaulting a cabdriver carries little risk to the assailant because of the likelihood that an assault won’t be reported to the police. Kabrick spoke of a driver in Kansas City who said that he no longer reports any assaults or even robberies because the first time he was assaulted and robbed, he called the police and ended up being fined for a parking violation-while no statement was even taken from him.

Kabrick said that cab drivers are a vital part of the transportation system in many cities, acting as ambassadors to the city and saving lives by hauling home drunks. She gave several examples of cab drivers being thought of as expendable and called for recognition of the crisis of violence in the industry.

Larry Offutt said Burger King’s violence prevention efforts have been built on two premises: that death or injury is not the inevitable result of coming to work and that there is no place for violence in the Burger King workplace. Offutt said Burger King developed a holistic approach involving a cross-section of departments and disciplines, including professionals from the medical, psychological, security, law enforcement and insurance sectors.

Threats of workplace violence were found to come from several sources. Armed robbery was seen as the greatest threat, followed by impaired or disgruntled customers. Employee-on-employee verbal assault or bullying was also seen as a problem. A corporate policy was developed, which included commitment from the highest levels of management. Training materials were distributed throughout the system. The “Life Balance” program was implemented, which provides a 24-hour contact to assist with stress release and personal issues. Some design changes were made as well, including placing time-delayed safes under the front counter, redoing landscaping and revising signage. A strict back-door policy was enforced.

Offutt said that 70 percent of fast food industry robberies are related to current or past employees. He also said making sure managers followed Burger King policy on staffing levels and door policies is important. Since implementation of the new policies, reporting of incidents has increased while armed robberies and assaults have decreased. This has led to improved morale and faster recovery when incidents do occur.

Offutt added that some problems require regional solutions. For example, in Mexico, managers were not interested in having alarm systems connected to local police stations. Instead, they first tried armed guards but then settled on attack dogs. In the U.S., closed circuit television (CCTV) has been a popular choice. Offutt noted that regulations in some parts of Canada may make the CCTV solution less likely.

Offutt said his company is generally happy with their progress in preventing workplace violence. He added that the Safety Coordinator Program (SCP) at Burger King is growing and eventually all managers will be required to undergo that training and have experience in the SCP position in order to be eligible for promotions.

Moderator Patricia Biles summarized the four presentations before requesting questions or comments from the audience. She noted the concept of work refusal as a way for workers to force employers into action and expressed surprise to hear that hypodermic needles had become a weapon of choice in Canada. She said she was pleased to hear about the anti-violence work being undertaken in the fast food industry and acknowledged that the taxi industry is still a major source for concern.

Robyn Robbins asked several questions about Offut’s presentation. Offutt explained that robberies were most common in the early morning and late at night, at opening and closing times. There should never be employees alone at a Burger King store but managers sometimes violate this policy, he said. He noted that managers who do so now face termination. He said he feels drug abuse places employees in situations where they share inappropriate information about their workplaces, which is then used by criminals. He stressed that he was not suggesting that in every case employees were intentionally giving out information that led to robberies.

Another participant noted that “smile campaigns” can be causes of stress in themselves, as well as leading to misunderstandings with customers. While most employees want to be friendly, forcing them to do so can have the opposite-to-intended effect.

A participant expressed concern about employees keeping lists and reporting on each other and called for supportive rather than punitive prevention. Stoffman agreed, saying the focus should be on the source of greatest violence, which is external. Calero Lomelín said that BANAMEX has an anonymous line for reporting trouble to avoid personal conflicts.

A participant asked Calero Lomelín about take-over robberies. He said that such robberies are less common because of new procedures, which make the risks outweigh the rewards for organized groups.

Another participant expressed concern about who responds to workplace violence. He noted that the police often respond first while health and safety authorities are more hands-off. Stoffman said there are effective policies to ensure follow-up by the proper authorities. He added that health and safety authorities can make a big difference if they can inspect a workplace before an incident occurs.

Calero Lomelín urged participants not to forget that the mental health effects of being the victim of workplace violence can lead to inappropriate behaviour if not dealt with in a timely fashion.

Fiona Gilligan and Francois Legault made a joint presentation on the response to the OC Transpo shootings. OC Transpo operates a public transit service in Ottawa, Canada. On April 6, 1999, four employees of OC Transpo were shot and killed by a former co-worker in the south garage of the company’s headquarters, two other employees were wounded and the gunman eventually killed himself on the same site.

The perpetrator was a loner with a history of violence. He had been terminated and reinstated and then quit before the tragedy. His actions appeared to be premeditated. A colleague who had advance knowledge of the plan committed suicide three months after the incident. The perpetrator had a “snuff” list, although he did not kill any of the people on that list. As well, the company had a history of bitter labour relations, violence in the workplace and a wide gap between the large blue-collar population and the small, elite management team. Vigilantism, absenteeism and festering anger were underlying factors at OC Transpo before the incident.

The immediate focus after the incident was to keep OC Transpo operating. The basic goal was stabilization and reintegration. Responders had to deal with primary and secondary victims on a 24-hour basis. For example, a mechanic on the night shift might need help at three in the morning. One-on-one counselling and information sessions were provided.

In an effort to get rid of the old style of management, one-third of the old management team was terminated. With the support of the union, employees who made threats were terminated. Increased employee power has meant increased productivity, and management advancement is now based on merit.

Two-and-a-half years after the incident, Gilligan said, OC Transpo is on the road to healing. She predicted it would be a 10-year process to full recovery.

Dr. John Byrnes spoke about his company’s method for preventing workplace violence. Current methods of preventing aggression and violence in workplaces, schools and society are not working, he said. “Conflict resolution” presupposes conflict, and “anger management” is also flawed because anger is difficult to measure and to manage. Byrnes said one must distinguish between prevention and reaction.

As aggression escalates, he said, quality of judgement diminishes. When a person stops coping, and triggers accumulate on top of each other, the individual enters into “escalation phase” and “mounting anxiety.” Mounting anxiety changes behaviour, body language and ways of communicating. Byrnes reviewed the body language of an aggressor who is losing verbal control. Finally, the aggressor loses complete quality of judgement and then loses physical control.

Byrnes said his program demonstrates how aggression changes the communication process and trains better communicators in the aggression environment. He described non-verbal pacing or manual pacing. By matching the aggressor’s posture, movements, speech patterns, breathing and blinking rates, one can create a connection that will cause aggressors to follow a trained Aggression Manager.

Byrnes said his objective is to demonstrate that prevention is possible and easily attainable through the “Arts of Aggression Management.”

Robyn Robbins said she takes issue with the terminology worker-on-worker or employee-on-employee because of the suggestion that only rank and file workers are responsible for violence in the workplace. She said she prefers the term “internecine workplace violence” because it does not necessarily connote fault on the part of the worker.

Robbins said it is important to challenge the myth that unstable co-workers are the greatest risk for workers. She said clients and customers are by far the biggest threat to employees. She said that too many employers focus on their workers with profiling and screening that can lead to discrimination and workplace stress. A recent survey found that the majority of workplaces have not had risk assessments done. Job stress is a significant cause and effect of workplace violence. Understaffing, excessive supervision, threatened job stability, differing cultural backgrounds and rumours of layoffs are all stress-inducing factors.

A participant asked why there is not more discussion of eliminating the triggers that cause workplace aggression. Byrnes said his company is trying to provide the tools for dealing with aggression on an individual level. Robbins said that companies divert their resources to the exclusion of a systematic approach to violence.

Gilligan said the OC Transpo system was so rigidly hierarchical that it was a time bomb waiting for the wrong people to get into power. She said that companies should look at their organizational charts now to avoid future failures.

Another participant noted that jobs with high demands and low autonomy are virtually guaranteed to create high levels of work related stress.

Joanne Colucci, Security Director for American Express, presented a captivating survivor’s account of the World Trade Center attacks on September 11th that included her personal and professional reactions to the tragedy. As she circulated pictures she took that day, Colucci described some of the terrible and terrifying scenes she witnessed. (Early photos show the first tower with a gaping black hole, building still sunlit, while the images following the collapse of the twin towers seemed like black and white photos due to the thick layer of dust that covered everything and everyone.)

Participants then shared personal experiences and discussed actions their organizations have implemented since September 11th and the ensuing bio-terrorist attacks. Among other measures at American Express, wearing ID badges has become absolutely mandatory; security coverage and patrols have been added on all shifts in all its buildings worldwide; mailroom security has been enhanced; and access control systems have been introduced.

Jane Walstedt stated that since the recent terrorist events, the U.S. Department of Labor has evaluated its own security and has introduced stronger measures: staff, not just visitors, must now undergo routine screening; ID badges must be worn at all times; and visitor badges specify floors to which visitors have access. The Secretary of Labor has kept employees well-informed through email throughout these changes, she added.

Mundy McLaughlin reported that already stringent security measures at the Ontario Power Corporation, which owns nuclear power stations in the province, have been heightened. Such circumstances, accompanied by inconveniences such as long waits to get into buildings, can raise stress and violence levels, she warned. She also noted the backlash against Sikh and Muslim workers.

The second day’s sessions would focus on issues related to physical and non-physical forms of violence in the workplace, such as consequences, intervention, assistance and prevention, Mónica Mora told participants. Assistance to individuals involved in workplace violence would be addressed from the perspectives of compensation and psychological assistance. Panelists would also discuss innovative approaches to preventing workplace violence and promoting healthy and safe workplace environments.

Public sector workers are most often the people on the frontline, said Anthony Pizzino of CUPE. CUPE is Canada’s largest union, representing more than 500,000 workers in a wide variety of occupations, in schools, libraries, hospitals, nursing homes, municipal services, transport, community and social services, etc. About one in 55 Canadians is a CUPE member.

These workers often tell clients that they must or cannot do something; in some cases, they have the authority to deny important requests such as permit applications, or they enforce by-laws-write parking tickets, collect fines, or take children into protective custody. However, while it seems that public sector workers are able to determine what people can do, and how and when they can do it, in reality these workers have little control over their work situations. “They rarely make the rules they administer and they certainly haven’t designed their work environment or chosen their pace of work,” said Pizzino.

Several hundred thousand CUPE members have been assaulted over the past two years. Pizzino gave examples of some recent incidents of workplace assaults upon its members: a B.C. arcade worker sustained serious injuries while trying to keep under-aged people off the premises; an Edmonton custodian was raped at an elementary school working alone late one night; a Winnipeg social worker was taken hostage in a van rigged with explosives by the father of the children she was empowered to take into protective custody; and an Ontario hospital worker was beaten and left unconscious in a hallway. “Had a proper investigation been carried out, they would have found out that hospital employees were asked to confront any strangers in the hallway-the hospital had recently reduced its security staff in order to save money,” he said.

He then presented some video testimony by workers in a nursing home in Nova Scotia. Workers described the stress of taking abuse daily - being attacked, kicked, slapped and spit at by patients. “The biggest thing to overcome is not the physical violence, it’s the fear,” one said. Another described lying awake at night distressed by the racial discrimination she faced on a regular basis. Such violence is taken to be the norm, a worker explained. “It might shock you, but we take it every day.” And, said another, the violence and abuse is getting much worse than ever before.

Violence is an occupational health and safety hazard; however, it is not uncommon for its root causes and consequences to be concealed, Pizzino said. Workplace violence prevention programs must focus on the risk factors that exist within organizations, rather than centering the problem on the workers-the victims.

Her first-hand experience with workplace violence eight years ago set Rebecca Speer on a new career path, focusing on proactive workplace violence prevention and management. In 1993, she had a brush with a gunman who killed eight people and injured six others in a downtown San Francisco high-rise. A labour law specialist and principal of Speer Associates/Workplace Counsel in San Francisco, she now helps clients conduct critical incident management and handle threatening circumstances as they arise.

Following her personal experience, Speer realized that many organizations did not know how to prevent and manage violence in the workplace. Employers addressing threatening misconduct and violence generally operated out of a denial about violence, or with a fear of it. Not knowing how to assess the nature of the violence, they either minimized or exaggerated a problem, she said. Many organizations lacked systems that would help them process reports of threatening misconduct or violence.

It is absolutely essential that employers implement a formal workplace violence prevention and management program, Speer said. Such a program should consist of five elements: clear policies and guidelines governing workplace behaviour; an incident management team; a reporting and response mechanism; training; and other employment and legal practices. Collectively, these elements contribute to a program that ensures that an organization can identify problems early, when chances for effective intervention are greatest.

“Ultimately a workplace violence prevention and management program provides awareness or education, preparedness and empowerment,” Speer concluded. “It acts as an incredible tool for helping companies bring a measure of control and structure to all forms of misconduct affecting workplace safety.”

Bernard Chabot explained that the CSST is responsible for prevention, inspection, financing, compensation and rehabilitation issues in the workplace. Since 1985, Quebec has made no distinction between compensation for physical or psychological injuries; they do, however, have different characteristics. A physical injury usually occurs in a single incident, is treated by a medical doctor and heals with time. Much research is available. On the other hand, the causes of psychological injury are often multiple, require multidisciplinary intervention and involve a subjective environment. It is essential to deal with psychological injury speedily, in order to prevent it from becoming chronic, Chabot said. More research and documentation on this phenomenon is required, as well as possible solutions.

The workplace must be accountable for psychological violence, Chabot said, pointing to the clear link between health and the workplace. Organizations should evaluate the abilities of their employees in terms of workplace violence prevention and inspection, and compensation and rehabilitation. Specific, concrete measures are needed to prevent stress and violence in the workplace, he concluded.

Law professor Katherine Lippel presented findings from two empirical studies on employee compensation claims made to the CSST, and an overview of regulations on worker compensation in Canada. There is a plethora of realities when it comes to workplace violence, she stated. Some are more readily understood and accepted, such as physical acts of aggression. In Quebec, compensation is also provided for psychological aggression or violence that arises out of situations involving harassment.

Lippel’s studies involved 152 decisions made by administrative review and appeal tribunals in Quebec, which heard appeals made by employers and employees on workplace violence from 1986 to 1997. Aggression among workers was found to be mainly due to organizational factors, such as competition between workers, work and a pace of work that depends on group performance, policies encouraging workers to tell on co-workers or policies that discourage reporting of workplace accidents. “These organizational factors create situations where workers turn on each other,” Lippel said.

Acts of aggression that are often overlooked include those carried out by Alzheimer’s patients, who are not criminals but can be physically violent because they don’t know what they are doing. Hazing, rites of initiation, patterns of practical jokes and sexual or racial harassment comprise other organizational risk factors that lead to chronic stress.

Cases of aggression differ along gender lines. For men, the majority of cases (55 percent) involved physical assault; for women, 51 per cent of cases involved verbal assault. For men, 47 per cent of cases of aggression were perpetrated by co-workers; for women, 51 per cent of cases of aggression were perpetrated by clients. Women tend to work more closely with customers, Lippel noted. Most cases of psychological aggression involved women: 91 per cent compared to 54 per cent for men.

Five provinces in Canada provide compensation for psychological harassment in the workplace: Yukon, Alberta, British Columbia, Saskatchewan and Quebec, Lippel said.

Legislation on compensation for work-related injuries in Mexico is universal across all states, explained Dra. Gisela Estrada Rodríguez. The IMSS employs about 1,000 physicians, health and safety technicians and administrative staff, and provides health promotion programs and occupational hazard prevention programs. There are 19 multidisciplinary teams that include physicians, psychologists and social workers, which are responsible for evaluating accidents and establishing applicable benefits.

Legislation protects all workers in the event of an injury. A range of services is provided according to the case: medical and hospital care, wage replacement, rehabilitation, artificial prostheses and devices, disability pensions or burial costs and dependent benefits.

Barry Llewellyn of NCCI gave an overview of the benefits, trends and costs related to the workers’ compensation system in the U.S. The workers’ compensation system is no-fault, state-based mandatory coverage. Workers can be covered under private insurance, self-insurance or coverage obtained through state funds. Premiums are experience-rated and there are mechanisms enabling companies to decline insurance to employers if they are deemed too hazardous, or “assigned risks.” Compensation benefits are tax-free.

“Generally, the key test on whether or not injuries are compensable is whether or not they are injuries ‘arising out of and in the course of employment’-and that can have a lot of meanings across the states,” he explained. Individual states differ on whether physical, mental and/or cumulative injuries are covered. “The general rule based on case law is that workplace assaults that are unrelated to employment are not usually covered under workers’ compensation.”

A new phenomenon in the U.S. economy is the growing number of people who tele-commute. This is an emerging issue that remains to be resolved; are injuries sustained by people who work from home indeed work-related, and are they covered by workers’ compensation or not?

From an employer’s perspective, workers’ compensation represents just a fraction of the cost of workplace violence. Additional costs are incurred through lost productivity, medical costs and security measures. Most workplace assaults occur in the services and retail trade. About 75 per cent of service workers have been assaulted in the workplace, even though they make up only 33 per cent of the workforce. More than 50 per cent of healthcare workers have been assaulted although they comprise only five per cent of the workforce.

Llewellyn stressed the importance of educating and training new workers in order to prevent incidents of workplace violence. There are many opportunities for industry to counter workplace violence where the risks are greatest, he concluded.

Jane Walstedt asked Barry Llewellyn whether workers' compensation had been awarded for injuries stemming from workplace assaults by intimates. Llewellyn explained that, based on court rulings, the general perception and practice is that when a domestic-related assault or homicide occurs at the workplace, it is largely coincidental and does not arise out of the employment, and therefore is not compensable as workers’ compensation.

François Paroyan, legal counsel for Loblaws Companies Limited, suggested that there might be a much larger incidence of co-worker violence in the workplace than has been documented, and that as many resources and prevention policies must be put into this area as into workplace violence involving unknown perpetrators.

It is also important to distinguish between colleagues and supervisors, because their stories are different, Lippel said. For both male and female workers, supervisors are the second most likely source of aggression and assault. “Not all co-workers are equal,” she noted.

An audience member asked about workers’ compensation for psychological injuries in the U.S. Llewellyn replied that while regulations vary among states, the general pattern is that purely psychological injuries are less frequently compensated than if they are related to physical injuries as well.

Larry Stoffman of the United Food and Commercial Workers stated that, Quebec aside, the reality is that stress-related injuries are not compensated, even if they may be covered under provincial policies. Further, the compensation system has tightened up over the last decade. As budgets are tightened and compensation boards across the country reduce benefits and eligibility, more problems will arise, he said. Finally, focussing on worker-on-worker violence does a tremendous disservice to workers by blaming the victim, he said. The data is clear that for women, for example, most assaults are client or supervisor related, and that people who work in retail are at greater risk of customer or criminal-related violence.

Increased awareness of the frequency of violence in the workplace combined with an appreciation of the costs of not preventing it is propelling managers to develop policies on workplace violence, said François Legault, national manager of the Employee Assistance Services Division of Health Canada’s Occupational Health and Safety Programme. He discussed a variety of services to address the issue, including pre-incident training of managers and Critical Incident Stress Management Intervention.

Prior to developing a specialized pre-incident training session, numerous factors must be considered: the nature of the usual violations against workers, the genders of victim and perpetrator, the presence of protocols and procedures and knowledge of these by employees, isolation of workers; and past training initiatives and their results.

Legault reported that a cost-effectiveness study conducted by an independent researcher has concluded that the cost benefit ratio of CISM programs, such as the one for First Nations and Inuit Health Branch nurses, is 1:7. In other words, he explained, the Government of Canada saves $7 for every $1 spent on this type of service. “This not only supports the premise that psychological injury can be mitigated when a combination of CISM interventions are put in place-including the pre-incident training, the development of protocols, the training of peer supports and the production of information manuals-but that not doing anything or relying on a response-only model of CISM may not be in the best interests of the employee or the employer,” he said. “Obviously, more research on the efficacy of different models needs to occur.”

An understanding of violent behaviour is essential to understanding workplace violence, said Dr. Alejandro Córdova Castañeda of the IMSS. An important element to this is an understanding that human beings are basically aggressive. “We belong to the animal kingdom and we have animal instincts. Our behaviours are often driven by survival instincts.”

Further, Castañeda said, there must be an understanding that the victim must also be treated as an aggressor. A victim of a violent act can become an aggressor toward themselves or their environment, he explained.

In Mexico, worker frustration with their labour conditions is high. “We’re not a violent community but we have some social characteristics that turn us into a community with a high risk of turning out aggressors,” he stated. “Work can be tense and a frustration because our salaries are low, the cost of living is high, labour relations are not well-legislated and codes are not well-applied.”

It is important to look at labour life and relations within an organization, train workers on workplace tolerance, as well as integrating community and social prevention initiatives, he concluded.

When violence happens in the workplace, the first order of business for an organization should be to assist its workforce and help its employees regain their sense of equilibrium and return to their pre-incident level of functioning, said Marilyn Knight, M.S.W. of Incident Management Team in Southfield, Michigan.

An act of violence in the workplace has a host of impacts on its people, image, operations, loss and risk. Crisis intervention helps workers re-establish control of the situation and brings closure to those who were victims or witnesses. The intervention activities demonstrate loyalty to the workforce, provide awareness and education about the predictable reactions they may experience, allows the organization to assess the severity of the event and should set an expectation of recovery.

Most employers think of organizational recovery and re-stabilization in terms of a return to “business as usual” - resuming production and taking care of their customers. However, "the workforce has to recover before the organization can return to normal". Failure to recognize this important element of recovery will only delay resumption of production. While employees struggle, on their own, to overcome the impact of a traumatic event, the organization may experience decreased productivity, an increase in accidents, worker turnover, poor performance, and a multitude of other problems.

Establishment of a Crisis Response System provides the mechanism for employers to assist those impacted individuals so they do not become overwhelmed by the event. This reduces the psychological truama and prevent employees from becoming emotionally “stuck” and possibly becoming long-term disabilities or developing post-traumatic stress disorder.

While most symptoms subside after a few weeks, 20 percent or more of employees will continue to have post-traumatic stress problems. Additionally, some individuals who have no immediate reactions may begin to show delayed onset of symptoms weeks or even months after the incident. Since post-traumatic stress reactions can occur regardless of one's pre-incident personality, the ideal strategy for managing the potential risk of employees developing long-term stress problems is to provide crisis intervention services to all affected employees as a preventative measure.

Early crisis intervention is dramatically cost-effective for employers. Research shows that early intervention cuts costs in terms of time loss, treatment costs, litigation, rehabilitation and disability. Employers can provide assistance through on-scene support, individual consultations, group debriefings, family assistance, workplace re-entry and follow-up services.

Dr. John Byrnes stated that workplace violence prevention is often focused on psychological assistance imparted after the incident. More needs to be done to put into place truly effective and preventive programs. In the U.S., pre-incident psychological assistance programs are not used enough, often because employees fear their employers will learn of their circumstances, and there will be stigma attached. Castañeda agreed that unfortunately, mental health issues are generally perceived as a weakness. It is important to bring mental health out into the open and understand its clinical symptoms.

Workplace violence prevention programs must recognize the damaging effects of cumulative violence, said Legault. It is critical to set up CISM protocols and procedures that are proactive, diligent and humanistic vis-à-vis the needs of workers. An understanding of their reality is essential in order to know where to spend funds most efficiently.

The importance of pre-incident training cannot be underestimated, said a former airport security administrator, even for people whose occupations by nature involve risk and violence, such as police officers, firefighters and customs officials. Another participant pointed to the issue of under-reporting. “We know there is a lot of hesitancy among workers to report incidents, especially if they do not involve physical injury,” she noted.

Jessie Callaghan said the CCOHS recommends nine steps for developing a workplace violence prevention program:

1. Determine the specific risks of workplace violence within the organization by conducting a detailed risk assessment.
2. Write a workplace violence prevention policy that articulates management’s commitment to preventing workplace violence and provides examples of unacceptable behaviour and working conditions, as well as consequences and corrective measures.
3. Develop specific measures to eliminate or minimize risks. Using the principles of basic industrial hygiene practice, prevention can be achieved through administrative practices (such as policy development), workplace design (such as office lay-out), and specific work practices (such as cash-handling procedures).
4. Establish procedures for reporting on and investigating violence.
5. Establish an emergency response plan, which clearly and specifically outlines how to respond to a serious incident in progress.
6. Develop the resources and means to provide victim support services, including formal or informal counselling, legal advice or time off.
7. Conduct follow-ups on any incidents that occur.
8. Train and educate employees on the workplace violence prevention policy and procedures.
9. Conduct a program review annually, or more often if there is a significant change in the workplace.

Joanne Colucci said that at American Express a multi-disciplinary task force developed a policy to encourage employees to report incidents of inappropriate behaviour to their leaders. This policy is distributed to all employees on an annual basis. With the assistance of an external consultant, the team customized a training program to help leaders recognize the warning signs of a troubling situation or individual. The company also provides conflict resolution seminars for all employees. Quarterly meetings are held to debrief on workplace incidents and analyze trends, and common patterns in the workplace. Management reports are presented to senior leadership.

A direct outcome of this program was the identification of domestic violence as a serious workplace issue. Many of the reported incidents of violence involved an intimate partner. In 1998, the team developed a protocol for supervisors in handling these situations. Members of the team were trained in interview techniques, which allowed them to help employees develop a safe plan of action.

An outgrowth of the program was the development of a comprehensive new-hire screening program. All employees undergo standard background verification as part of the recruitment and selection process. The team has also recommended a program for major contractors and vendors, Colucci said.

American Express’ most successful practice, and the best prevention, is the early recognition of warning signs and a comprehensively planned intervention, Colluci concluded.

Héctor Ulises García Nieto said violence in the workplace has to do with government policies. A rigid organizational structure can also increase violence in certain spheres. The SNTSS has developed a plan linking the institution, unionized workers and experts. The goals are to strengthen the institution, improve the quality of care and improve the situation for workers.

Training includes dealing with the possibility of violence in the workplace. When the repercussions of violence, such as absenteeism, appear, health and safety committees are convened. The objective is to avoid accidents and other issues stemming from the work process. The union is now investing dues money to train workers in violence prevention, he said.

Anthony Pizzino spoke about solutions based on experiences in workplaces his union represents, such as applying collective bargaining strategies and participating in the development of legislation. Employers have a responsibility to provide safe working conditions, and workers have a right to participate in making conditions safe, he said. The principles the union has adopted while working with the federal government to develop laws include identifying the problem, solving it using a preventive focus, involving workers and monitoring results. Violence should be defined inclusively, he said.

Pizzino said it is clear that external threats are the dominant cause of workplace violence. Occupational health and safety and the right to know outweigh confidentiality concerns, he said, adding that “not-so-innovative approaches” include worker profiling and zero tolerance policies, which are mostly reactive and not preventive.

Patricia D. Biles said OSHA recommends utilizing the elements of a safety and health program as specified in OSHA’s safety and health program management guidelines, published in 1989. It contains four main elements:

• hazard analysis, including risk factors such as handling money, working with the public, working alone, in community settings, and so on.
• hazard prevention and control. Some examples of engineering controls are panic alarms, lighting, bulletproof barriers and mirrors. Examples of administrative controls are locking doors, putting post-incident response systems in place, increasing staffing and having a zero-tolerance policy.
• training in aggression management, defusing anger, and procedures to follow in the event of an emergency are important topics to be covered.
• urging employees to report incidents and management to respond when there is a report made.

OSHA is moving rapidly to develop more complete guidance in response to terrorist incidents. They have developed an extensive site on their web page to provide accurate information on hazardous agents and their health effects, emergency response planning, exposure controls and training, among other topics. Public officials such as the police, fire and emergency personnel, the unions, insurers and employee assistance programs are also good sources of information, Biles said.

Dr. Alejandro Córdova Castañeda said that inter-sectoral collaboration is an important part of prevention. For example, security services have a role to play when external sources of violence are a problem. It is important to remember that approaches must be tailored to the different employers and different cultural styles involved. Tolerance for different ways of expression is necessary. “We do not have to change our essence, instead a few traits.”

Education can help neutralize violence, he said. In the event of violence, various bodies must act to avoid the disability of the victims. Also helpful are epidemiological surveillance, crisis intervention, immediate access to the victim, encouraging complaints, including health repercussions, avoiding “sequels” and reducing damage (including secondary consequences.) He called for providing alternatives so victims of violence do not lose their means of survival.

Robyn Robbins said that co-operative programs, in which management is voluntarily “doing the right thing,” are usually the most effective. These programs are positive and usually experience less management resistance than actions imposed on management as the result of a grievance or citation from an outside agency. However, co-operative programs to prevent workplace violence require strong management commitment, good labour relations, meaningful worker participation and a positive organizational culture.

Worker involvement should include union representatives, frontline workers, supervisors and all affected stakeholders. Worker involvement also includes encouragement by management to report threats and violent incidents, without fear of management retaliation and with meaningful follow-up.

There must be a commitment from managers and union leaders to use a consensus process to reasonably consider all recommendations that derive from the co-operative program. In the absence of federal or state mandates, one of the most effective alternate strategies for workers and unions is to negotiate specific contract language, she said.

In Washington State, one UFCW local union worked with a large retail employer, to train all workers and supervisors in the stores on how to react in a violent incident. Personnel from the local police department were brought in to assist and provide guidance, Robbins concluded.

Robert G. Thomas shared the key elements that helped Sears in developing an excellent violence in the workplace prevention program after a tragedy. He said the violence prevention program is one component of a bigger program of developing “mutual respect” in the workplace. Importantly, the program has top management support. The employee assistance program is a valuable tool for any organization to support their “mutual respect” program, Thomas said.

Sears found a consultant with experience in the business sector. They also decided to have all the support elements in place before beginning implementation. They developed a headquarters team of senior human resources and resources protection professionals. A training workshop covered myths and realities of workplace violence, their role in recognizing and assisting troubled associates and recognizing and reporting troubling situations. Incident investigation, follow-up and tracking were done.

When security people were involved in apprehending theft/fraud suspects or other criminals, there was a high risk of injury. All investigators are now trained in the use of tactical verbal skills to reduce the opportunity for violence in these situations. This involved changing the culture from, “I have to hang onto that person,” to “there is no shame in disengaging and taking on the role of witness.”

Frema Engel called on participants to remember the roots of violence. “If we could prevent these problems we wouldn’t be here,” she said, adding that we should “be clear in our message that we do not tolerate abusive behaviour.” She said one must be cognizant of the fact that others may not have the wherewithal to say no to violence. One should ask, “what are the organizational and societal irritants that lead to violence,” and work together collaboratively to make workplaces exciting places of excellence. She counselled paying careful attention to how a product or service is delivered. She said it is important to speak about respect, dignity and collaboration. She called for a society where we are not fearful and there is an end to the love-hate relationship with violence.

A participant asked about the relationship between prevention programs and police forces. Biles said now in many U.S. states, it is not necessary for the victim to file charges of domestic violence, which gives the police more room to respond effectively to these incidents. Pizzino encouraged communicating with the police, in advance, about the situation in a workplace.

Engel said that the most successful multi-disciplinary approaches she has observed include local police. She noted that in Seattle and NYC, the police forces have workplace violence units. Colucci noted that Amex policy is to make contact with local law enforcement before any incident arises.

A participant suggested it is important to follow up on what happens to the people involved in violent incidents, rather than following up on the case. She said that training sessions are useful but workers complain that people don’t behave in the real world the way they do in a seminar. She suggested training should be coaching, an ongoing process.

Biles said she espouses zero tolerance. She noted that critics of the concept take it to mean firing for any incident. Biles said zero tolerance means any inappropriate act will be responded to. She said it is important to have a written policy.

García Nieto discussed the importance of improving general working conditions. He said that violence is intimately connected to inequity, as well as cultural and social conditions.

Pizzino said he does not like the term “risk assessment” because it is so difficult to decide where to place the bar with respect to violence. He prefers the term hazard identification.

Castañeda stressed the importance of training, noting that one trained worker can train two more, spreading information around the organization.

Robbins said that peer training is effective because it is better received and better retained. She said workers often take risk maps back to their place of work to keep them current.

Éric Plante of the University of Laval discussed the definition of violence in the workplace. He said that some standardization of the definition would be helpful, although it is important to keep in mind cultural differences. He pointed out the links between organizational structure and aggression.

Engel said that a widely accepted definition of violence would be difficult to achieve because each individual has a different perception of violence. She gave the example of the different responses people have to shouting.

Thomas challenged the organizers to provide participants with access to the data of the many researchers at the conference.

Castañeda said it is possible to reach a uniform definition of violence without forgetting cultural patterns. He also said that zero tolerance does not mean intransigence.

A participant noted that many violent incidents are investigated by a superior, leaving affected workers out. Colluci and Thomas both agreed that including workers in health and safety committees is essential. Robbins said it is important to acknowledge and respect the knowledge of workers.

Bill Chedore said there is no need for a lot of research to know violence in the workplace is a problem but there is room for research on what works. Victims are not seen as collateral damage, he said, adding “This conference should be part of our commitment to prevent violence and save lives.” He remains optimistic that Canada will have federal legislation on workplace violence in the new year. Orientation training on policies, regulations and consequences of violence is essential. “We’ve talked the talk, now we have to walk the walk,” he said.

Glenn French said everyone at the conference shared the ideal that people have a right to go to work and not feel threatened. He said decision-makers (such as employers, legislators and union officials) have not yet been reached. Unfortunately programs often are not implemented until someone is dead. Data is needed too make the case that violence prevention is actually a cost saving. Some employers do not care and only legislation will get them to act, French said. Others are confused and need more education, some are ready to act and just need some guidance on how to proceed. There is a need to share intelligence, advance legislation and education and work on follow up, he concluded.

Estrada Rodríguez said that her organization is over 50 years old and, like much of Mexico, is undergoing profound structural transformations. She said it is important to look back and study in order to make decisions on new initiatives and new challenges. She is involved in the “quality circles” program that includes a holistic quality plan, a code of ethics, training and evaluation. Individuals must be trained on anti violence. Institutions must have violence prevention programs for workers and management. Statistical records need to be improved including better classification and enhanced reporting, she said.

Corinne Peek-Asa said the public health approach to prevention relies on the careful collection of data to understand the relationship between risk factors and adverse outcomes, and the use of this data to develop and evaluate prevention strategies. The first step is surveillance, in which the magnitude of the problem is defined and populations at risk are identified.

The second step is risk factor assessment, in which individual and environmental factors that place certain individuals or workplaces at higher risk for violence are described. This requires carefully conducted studies in defined populations. While there is good information on risk factors for Type I events, little is known about what makes workplaces within certain industries at high risk for other types of violence.

The third step is the development of comprehensive, cost-effective prevention programs. Prevention programs need to be based on the risks found within the workplace, and they need to incorporate management and policy protocols, control of the physical environment and individual training. One problem is businesses that want a “magic bullet” and believe that purchased security equipment can end their problems with violence. The most common piece of equipment is the surveillance camera, although the purpose of a security camera is not to prevent violence but to apprehend, she noted.

A second common problem is a workplace that identifies the individual as a potential risk, but ignores management, the corporate environment and the physical environment as risks. Peek-Asa said these businesses often hire consultants to identify the “about-to-blow” worker, but fail to actually prevent the underlying risks for ongoing violence.

The final step in the public health model is evaluation, in which existing prevention programs are carefully evaluated to determine their effectiveness and their benefit in relation to cost. Without evaluation, we may expend a great amount of energy and resources to implement legislation, to write guidelines and even create regulations, or to implement programs that might not only be ineffective but could exacerbate the problem.

Peek-Asa said an important element of this model is that it is a feedback loop. Lessons learned from evaluating programs should be used to improve surveillance and risk factor assessments, and should be a vital piece of designing and re-designing prevention programs.

A key to preventing workplace violence is collaboration, she concluded. “We must include stakeholders and decision-makers who can act on the information learned, and we must all be responsible for closing the feedback loop in the research model.” Another key is funding. Evaluation studies are among the most expensive of all studies to conduct, but Peek-Asa believes they are also the most informative.

Pizzino and Peek-Asa had a debate on terminology such as “public health model,” “acceptable risk” and “hazard identification”. Pizzino said that no risk is acceptable, while Peek Asa emphasized that in order to decrease existing risk we must learn from risk to which workers have already been exposed.

A participant noted that good legislation is not enough if there is no commitment or obligation to follow it. He said participants should all go home and lobby governments and industry to spend a few dollars to save lives.

Chedore noted that enforcement is difficult when even the federal government does not make an effort to follow it owns regulations.

There was some discussion on how to get employers to commit to dealing effectively with violence in the work place. There was a call for hard data on cost-effectiveness. Chedore responded that if organizations are not willing to do the right thing, they should be forced to do so.

Another participant pointed out that some strict, inflexible laws create perverse effects. She said a bottom-up process can help to avoid this.

Chedore said when he has participated in the legislation-creating process, it has been a co-operative, tripartite effort involving government, unions and business.

Lynn Jenkins concluded the afternoon session with a synthesis of issues raised over the course of this session and the conference:

Overall, it is clear that participants see workplace violence as an important problem that can take a number of forms (robbery-associated violence, violence among co-workers, customers, clients, as well as family and intimate partner violence) and has significant impact on both workers and workplaces (i.e. employers).

In terms of research, there has been a great deal of discussion around standardization of definitions and terms and the limitations of our current research and data, especially with regard to organizational and psychological violence and evaluation of various prevention strategies.

In terms of prevention, we have heard of the importance of evaluating prevention strategies so that we implement the most effective approaches in various high-risk settings, the need for implementation of new and existing strategies ("walking the walk"), the need for training, the need for basic ethics and respect in the workplace, and the role of regulation in "leveling the playing field" so that those who want to do the right thing and protect workers are not at an unfair disadvantage and that those who have not been forthcoming in protecting workers have some clear motivation to do so.

Important crosscutting issues that have been discussed include the importance of collaboration between labour and management, the involvement of "front-line" workers in the development and implementation of research and prevention efforts, the need for linkages and more broad-based sharing of information.

Finally, it is clear that action is of critical importance. We must all reach out to decision-makers in our individual and collective efforts, we must continue our ongoing work, and we must all make a commitment to moving a trinational effort on workplace violence forward so that this conference is just the first step in many toward reducing the burden of workplace violence on workers and workplaces in our respective nations.