Work-related aggression and violence is a major issue in most sectors, with the highest assault levels being experienced in the health-care sector. Evidence shows that incidents have increased over recent years to an unacceptably high level. The estimated number of incidents of violence experienced by people at work in England and Wales was 655,000 in 2004–2005 (Source: British Crime Survey (BCS) 27 October 2005). The dental teams deal directly with service users, for example, customers and patients in their everyday working lives, and are therefore likely to face the risk of verbal and physical ill treatment. The Health and Safety Executive (HSE) is committed to raising awareness of work-related violence and supports a number of initiatives to reduce the level of incidents relating to conflict. A conflict situation can take minutes to escalate from a misunderstanding to aggression and violence. Employers have a duty of care to identify situations that may exist and look at ways of addressing them in order to significantly reduce the incidence of verbal and physical abuse.
- Health and Safety at Work etc. Act 1974:
Employers have a general duty to ensure, so far as is reasonably possible, the health, safety and welfare of all employees. The general duty covers and includes protecting employees from violent behaviour whilst at work.
- Management of Health and Safety at Work Regulations 1999:
Employers [are] to make suitable and sufficient assessments of risks to the health and safety of employees to identify the measures needed to remove the risks or reduce to an acceptable level. The assessment should, where foreseeable, include the need to protect employees from exposure to violence and aggression.
- Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR):
Employers are required to report certain specified accidents and dangerous occurrences to the enforcing authority, via the HSE’s incident contact centre, if they arise out of or in connection with work activities this includes acts of physical violence.
- The Corporate Manslaughter (England, Wales and Northern Ireland) and Corporate Homicide (Scotland) Act 2007:
The organisation must manage or organise their activities in order to prevent serious accidents which could result in death of an employee, and will be guilty of an offence if a person’s death amounts to a gross breach of a relevant duty of care owed by the organisation (employer) to the deceased.
The dental teams are exposed to situations of conflict everyday of their working lives; however, it is often not realised until it escalates into a more serious situation. Have you ever been faced with an unsatisfied patient? It may have started as a minor disagreement; for example, what he/she expected was not what he/she received. Did you feel intimidated by the abusive words, tone of voice and were you threatened by physical gestures like finger wagging? If so, you may be a victim of workplace violence. The HSE defines workplace violence as ‘Any incident in which a person is abused, threatened or assaulted in circumstances relating to their work’. You will notice that this definition is quite wide ranging as it includes any form of abusive or threatening behaviour towards a person. The HSE expands the definition by saying what constitutes workplace violence as a situation where a person
- uses abusive language or behaviour towards another;
- makes a threat towards another;
- physically assaults another.
Types of Violent Behaviour
- Intimidation – physical or verbal threat
- Bullying and exclusion – imposing opinions or ‘sent to Coventry’
- Verbal abuse – name calling, shouting, swearing or belittling language
- Physical gestures – raising or shaking fist or pointing finger
- Physical abuse – touching, pushing, prodding, slapping, punching or kicking
- Stalking – unwanted attention, for example, anonymous or owned messages or being followed
Any form of conflicting or violent behaviour should not be tolerated; staff has a right to work safely. To tackle the issue of conflict and violence it is important to recognise how incidents might occur and the effects it can have on individuals and the business.
In the dental environment, conflict can occur for a variety of reasons, usually due to misunderstandings and disagreements between people. It should be recognised that the cause is not always attributed to patients. The following provide an overview of some of the underlying causes.
Caused by Service Providers (Dental Professionals)
- Staff not trained in customer service delivery
- Training needs analysis not undertaken
- Lack of essential customer service skills
- Unable to interpret customer needs and wants
- Waiting times and delay in service not communicated
- Unable to deal with complaints effectively and ethically
- Difficulty balancing regulatory requirements and patients’ needs
- Poor communication, for example,
- Information not actively distributed or communicated
- Customers inappropriately informed about service delivery
- Changes to service not communicated
- Lack of information when there is delay in service delivery
- Reluctance to apologise for mistakes
- Inappropriate responses to problems
- Inconsistencies in information given
- Preconceived attitudes about people, which is reflected in behaviours
Caused by Service Users (Customers/Patients)
- Preconceived ideas and expectations
- Unreasonable expectations
- Overly dependent on the service provider
- Reluctance to take advice
- Unwilling to compromise
- Cultural differences and misunderstandings
- Arrives late or does not attend
- Feeling insecure because of being unfamiliar with surroundings, equipment and the environment
- Lack of knowledge and understanding of treatment procedures
- Fear of losing control
- Out of their comfort zone
- Suffering from pain
- Drug or alcohol abuse
- Predisposed conditions, that is, physical and emotional ill health
- Personal problems
- Personality traits, for example, arrogant, selfish, rude, prejudiced and temperamental
Caused by Disagreements within the Dental Team
- Telling someone else about another individual
- Everyone having their own ideas
- Viewing things differently
- Having diverse expectations
- Reacting to situations in a variety of ways
- Differences due to age, gender, background, experience, etc.
- Different priorities
- Inappropriate management style
There are many factors that can cause a situation of conflict, and in most instances this is not a deliberate intent on behalf of the individuals concerned. It is important for the practice to recognise how it may occur and how to reduce the risk.
Effects of Conflict