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Cost benefit tradeoff between workplace violence and zero tolerance safety policy in hospitals in central Nigeria

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https://www.eduzhai.net International Journal of Applied Psychology 2013, 3(4): 114-119 DOI: 10.5923/j.ijap.20130304.04 Workplace Violence and the Cost-Benefit Trade off of Zero-Tolerance Safety Policies in Central Nigerian Hospitals Wurim Ben Pam Plateau State University, Bokkos, Jos - Nigeria Abstract A well written and implemented Workplace violence prevention program, co mbined with engineering controls, administrative controls and training can reduce workplace vio lence and the attendant costs in both private and public organisations. The major objective of this paper is to unravel and analyze the cost-benefit trade off of implementing zero-tolerance policies and to investigate the potency of such policies in the reduction of workplace violence. Data was collected fro m a convenient sampling of 103 emp loyees of 4 hospitals and clinics and analyzed using the Kruskal-Wallis test statistic. The result showed that early identification of certain risk factors significantly impact violence prevention and protection; zero-tolerance safety policies do not reduce workplace violence and costs; and the costs of imp lementing zerotolerance safety policies are greater than the benefits of imp lementation. The paper recommends that employers should provide safety education for employees, secure the workplace, provide drop safes to limit the amount of cash on hand, instruct emp loyees not to enter any location where they feel unsafe and equip field staff with cellu lar and hand-held alarms or noise d ev ices . Keywords Workplace, Vio lence, Cost-Benefit Trade off, Zero -Tolerance, Safety Policies, Central Nigeria, Hospitals, Prevention, Risk factors, Safety Education 1. Introduction Workplace v iolence is a far mo re co mmon feature in organisations than previously thought. While about a million Britons may have experienced physical aggression in the workp lace in the past two years, nearly 2 million American workers are vict ims of workp lace vio lence each year. Unfort unately many more cases go unreported[1]. The situation is not any different in developing countries of Africa, Asia and Latin A merica. Workplace v iolence can strike anywhere, anytime and no one is immuned. It ranges from threats and verbal abuse to physical assaults and even ho micid e. It can affect and involve employees, clients, customers and visitors.Ho micid e is currently the fourth-lead ing cause of fatal inju ries in United States. According to the Bureau for Labor Statistics Census of Fatal Occupational Inju ries (CFOI), of the 4,537 fatal workplace v iolence that occurred in the United State in 2010, 506 were workplace homicides. Ho micide is thelead i ng cause of death in the wo rkp lace. Workplace v iolence can be inflicted by an abusive emp loyee, a manager, supervisor, * Corresponding author: wurimpam@yahoo.com (Wurim Ben Pam) Published online at https://www.eduzhai.net Copyright © 2013 Scientific & Academic Publishing. All Rights Reserved co-worker, customer or family member. What can managers and emp loyers do to protect emp loye es, clients, customers and visitors of the organisation? Managers are faced with tough policy issues in the area of workp lace v iolence and prevention. The Occupational Safety and Health Act (OSHA) and other governmental leg islations and obligations further make it mandatory for organisations to draw and imp lement violence protection and prevention policies. Under such laws, each employer has a “general duty” to provide a p lace of emp loy ment free fro m recognized hazards (violence) and to comply with all standards of safety and health established in the law. As a result, many organisa tions have applied isolated employee strategies ranging from risk assessment of violence to employee counseling, and Emp loyee Assistance Programs (EAP)[2][3]. What has come out of these isolated strategies of prevention and protection? In spite of the aforementioned, about 16 U.S workers die on the job each day[4] and mo re than 5.7 million workers (roughly 6.3 of every 100) get sick … every year because of their jobs. Of these, 1.8 million workers have ergonomics-related injuries, such as Repetitive – Stress Injuries (RSIs) (Kuntz, 2000:1–14) and more than 600,000 workers miss time at work each year because of them[5]. Thirty five million work days are lost per year[6]. 1.1. The Problem International Journal of Applied Psychology 2013, 3(4): 114-119 115 The thrust of several workplace v iolence prevention and protection programs in organisations is to maintain a safe haven conducive for work and devoid of threat, verbal abuse, physical assaults and homicide. In spite of the existence of these violence protection programs, the rate of workp lace violence is on the increase. Organisations have spent time, money and other resources with minimal returns on such investments. Vio lence has continued to breed poor morale and poor image for the organisation, making it difficult to recruit and keep staff. It has also increased costs associated with absenteeism, higher insurance premiu ms and legal fees, fines and co mpensation payments where negligence is proven. In most workplaces where risk factors can be identified, the risk of assault can be prevented or minimized if emp loyers take appropriate precautions. Whereas some of these risks can be clea rly identified, others are la rgely re mote in operation and effect. Also, the problem is whether the easily identifiab le risks as opposed to the remote risks are the worst culprits militating against violence prevention and protection. What is also not yet very clear however is whether or not or further still, which policy prevention strategy best suits the various risks. Further co mpounding the problem is the apparent uncertainty as to the cost-benefit trade-off of the various policy prevention strategies. What is the comparative advantage of adopting a zero tolerance safety policy? Is the cost of imp lementing such a policy lower or higher than the benefits derivable? How does the cost of implementation compare with the amount of loss that would have been incurred as a result of the occurrence of violence? 1.1.1. Object ives of the Study It is therefore a major objective of this paper to unravel and analyse the cost benefit trade-off of imp lementing zero tolerance safety policies. Specifically, the paper seeks: 1) To determine the risk factors militating aga inst violence prevention and protection. 2) To investigate the potency of zero tolerance safety policies in the reduction of workplace v iolence and costs. 3) To co mpare the costs of imp lementing zero tolerance safety policies with the benefits derivable. 1.1.2. Methodology The research design used for the study is the survey research method. Primary data for the study were sourced fro m four hospitals and clinics in central Nigeria. The four categories of hospitals were purposively sampled for purposes of ensuring a good representation of all hospitals which represented a broad spectrum of health care providers in central Nigeria. They include Jos University Teaching Hospital (JUTH), Sau ki Hospital, New Health Clinic and Jos North Primary Healthcare clinic. Convenient sampling technique was used to select 103 senior personnel of the hospitals comprising of medical doctors, nurses, midwives and top management staff. For its data collection, a suitable Likert Scale (5 point) questionnaire was designed and developed. Respondents were requested to determine the idea of agreement or disagreement on the 16 statements under the three sections contained in the instru ment. The data so collected was then analyzed using the Kruskal Wallis test statistic. The Kruskal-Wallis one-way analysis of variance by ranks named after William Kruskal and W. Allen Wallis is a non-parametric method for testing equality of population med ians among groups. It is identical to a one-way analysis of variance with the data replaced by their ranks. It is an extension of the Mann-Whitney U test to 3 or more groups. The test statistic is given by[7]: where: ni is the nu mber of observations in group i ; rij is the rank (among all observations) of observation j fro m group I; N is the total number of observations across all groups and is the average of all the rij. However, the Kruskal-Wallis co mputer-statistical packag e for social sciences (SPSS)-16.O version was used to test the three hypotheses. 2. Theoretical Perspective Workplace vio lence can be any act of physical violence, threats of physical vio lence, harassment, intimidation, or other threatening, disruptive behaviour that occurs at the work site[1]. It refers to incidents where people are abused, threatened or assaulted in circu mstances relating to their work, involving an explicit or imp licit challenge to their safety, well-being or health. Workplace vio lence can strike anywhere and no one is immuned. It can affect and involve emp loyees, clients, customers and visitors. So me workers, however, are at increased risk. A mong them are workers who exchange money with the public; deliver passengers, goods, or services; or work alone or in small groups, during late night or early morn ing hours, in high-crime areas, or in co mmun ity settings and homes where they have extensive contract with the public. Th is group includes health-care and social service workers such as visiting nurses, psychiatric evaluators, and probation officers, community workers such as gas, electricity and water utility emp loyees, phone and cable TV installers, and letter carriers; retail worke rs; and taxi drivers. Workplace vio lence can also orig inate fro m employees or emp loyers and threatens employers and other employees. For employees, violence can cause pain, distress and even disability or death. Physical attacks are obviously dangerous but serious or persistent verbal abuse or threats can also damage employees’ health through anxiety or stress. By understanding the cause of violence, the organisation is better able to eliminate, reduce and manage the risk of it 116 Wurim Ben Pam: Workplace Violence and the Cost-Benefit Trade off of Zero-Tolerance Safety Policies in Central Nigerian Hospitals occurring. There are four main types of work related violence: (1) Criminal v iolence perpetrated by individuals who have no relationship with the organisation or victim. Normally, their aim is to access cash, stock, drugs, or perform some other criminal or unlawful act. (2) Serv ice user violence perpetrated by individuals who are recip ients of a service provided in the workplace or by the victim. This often arises through frustration with service delivery or some other by-product of the organisation’s core business activities. (3) Worker-on-worker v iolence perpetrated by individuals working within the o rganisation; colleagues, supervisors, managers, etc. Th is is often linked to protest against enforced redundancies, grudges against specific members of staff, or in response to disciplinary act ion that the individual perceives as being unjust. (4) Do mestic violence perpetrated by individuals outside the organisation, but who have a relationship with an employee. For examp le: partner, spouses or acquaintances. This is often perpetrated within the work setting simply because the offender knows where a g iven individual is during the course of a working day[2]. What can employers or managers do to protect employees, clients, customers and visitors? One of the best protections emp loyers can offer their workers is to establish a zero-tolerance policy towards workplace violence. This policy should cover all workers, patients, clients, visitors, contractors, and anyone else who may co me in contact with company personnel[8]. By assessing their worksites, emp loyers can identify methods for reducing the likelihood of incidents occurring. OSHA believes that a well written and imp lemented Workplace Violence Prevention Program, combined with engineering controls, ad min istrative controls and training can reduce (or eliminate) the incidence of workp lace v iolence in both the private and public workp laces. This can be a separate workplace v iolence prevention program or can be incorporated into an injury and illness prevention program, employee handbook or manual of standard operating procedures. It is critical to ensure that all workers know the policy and understand that all cla ims of workp lace violence will be investigated and remedied promptly. The USDA also encourages emp loyees, managers and supervisors, agency heads, human resources staff, employee assistance program counselors, labour unions, security / facilit ies staff, law enforcement staff and conflict resolution offices to be familiar with their safety rights and responsibilit ies. A sound prevention plan is the most important and, in the long run, the least costly portion of any agency’s workplace v iolence program. Th is programme should cover pre-employ ment screening of potential emp loyees; maintenance of a safe workplace (security); Alternative Dispute Resolution (ADR); threat assessment team (to assess the potential of workplace violence and, as appropriate, develop and execute a plan to address it).; and Agency Work and Family Life Programs (such as flexi place, child care, maxiflex) to identify and modify policies and procedures which cause negative effects on the workplace climate[1]. The imp lementation of zero-tolerance safety policy is a two sided coin. The elimination or reduction of workp lace violence leads to a violence-free organisation which enjoys substantial savings in costs, increased productivity and reduction in moral and legal tussles. The other side of the coin portends the two types of costs to be incurred by management when violence occurs. These are direct costs in the form of compensation payable to the dependents of the victims if the v iolence is fatal, and medical expenses incurred in t reating the patient if the vio lence on the emp loyee is non-fatal. The management however, is not liab le to meet the direct costs if the victim is insured. More serious than the direct cost are the indirect or hidden costs which the management can not avoid. In fact, the indirect costs are three to four times higher than the direct costs[9]. Let us face it: violence is expensive. Aside from workers compensation (direct costs) mentioned above, consider the indirect costs of violence: cost of wages paid for t ime lost; cost of damage to material and equip ment or amount of loss through robbery attacks; cost of overtime wo rk by others required by the violence; cost of wages paid to supervisors while their time is required for activit ies resulting fro m the violence; cost of decreased output of the injured worker after he or she returns to work; costs associated with the time it takes for a new worker to learn the job; uninsured medical costs borne by the company; and cost of time spent by higher management and clerical workers to investigate or to process workers’ co mpensation forms[10]. As long as the outlays required for the imp lementation of zero-tolerance safety measures are less than the benefits derived, the enforcement of the policies is worth it and the organisation, employees and the society will benefit. 3. Discussion and Implications of Findings The questionnaire was distributed to 135 senior level staff of the four selected hospitals and clinic and 103 copies representing 76.3% were co mpleted and returned as shown in Table 1.1. Table 1.1. Breakdown of Sample size According to Organisations Organisation Sample Size New Health Clinic 11 Sauki Hospital 9 Jos University Teaching Hospital 48 Jos North Primary Healthcare Clinic 35 Overall Sample Size 103 Source: Field Survey, 2012 The Kruskal-Wallis computer-statistical package for social sciences (SPSS)-16.O version was used to test the relationship between risk factors and violence prevention International Journal of Applied Psychology 2013, 3(4): 114-119 117 and protection, the potency of zero tolerance safety policies in the elimination of workplace vio lence and the comparison of the cost of implementing zero to lerance safety policies with the benefits derivable. (i.e. hypothesis 1, 2, 3). We set out to provide the necessary lead for emp irical examination of the cost-benefit trade-off of imp lementing zero tolerance safety policies in addition to other specific objectives. For these and other purposes, we formu lated hypotheses as fo llo ws : 3.1. Hypothesis I: The i dentification of Risk Factors Significantly Impact Vi olence Prevention and Protecti on The result of the Kruskal-Wallis test showing the relation ship between the identification of risk factors and violence prevention and protection (as shown on Table 1.2) reveal that the risk factors examined militate against violence prevention and protection by 82 %. Table 1.2. Result of the Kruskal-Wallis Test Showing the Relationship bet ween Risk Factors, Out come of Prevent ion policies and Violence cost s Test Statisticsa,b Risk Fact ors Violence Prevention & Prot ect ion Cost of imp lement in g Zero-Tolerance Safety Policies Chi-Square Df 0.357 1 0.220 1 Asymp. Sig. – P Risk Factors - 0.8209 - Potency of Zero Tolerance Safety - 0.55 Policies - Benefits of Imp lement in g Zero-Tolerance - - .40 Safety policies a. Kruskal Wallis Test b. Grouping Variable: Risk factors, outcome of prevent ion policies & implement ation of policies. Source: Field survey, 2012 Statistical Decision Level of significance = 0.05; Samp le size (n ) = 103: Test statistics = Kruskal-Wallis; Decision criterion = Reject Ho if Kc Calculated > kt = 0.5. Since Kc = 0.82 > kt = 0.5, we reject Ho and accept H1. It was concluded that certain risk factors significantly militate against violence prevention and protec tion in central Nigerian hospitals and clinics. This result agrees with regulation 3 o f the United Kingdo m Management of Health and Safety at Work Regulations 1999 wh ich states that “every employer shall make suitable and sufficient assessment of the risks to the health and safety of his (or her) emp loyees to which they are exposed whilst they are at work and the risks to the health and safety of persons not in his employ ment arising out of or in connection with the conduct of him or h is undertaking”. The hospitals under investigation reveal that belittlement, insults, false rumo rs and envy on employees by other colleagues and patients were identified as some of the risk factors that impact on vio lence prevention and protection. Others include worry over salary inadequacy, lack of adequate facilit ies; assaults from the public while on the way to or return from night shifts and call duties; and contagion arising from patients with infectious diseases. Regulation 4 then obliges the employer to apply a hierarchy of risk controls. The A merican Society of Safety Engineers (ASSE) also reco mmends that employers conduct a risk assessment of the organizat ion and its emp loyees. Unfortunately, only 16% o f surveyed employers have conducted such a study[11]. In addition to comp leting assessments in order to satisfy your legal requirements, you may want to consider their practical value. They can be instrumental in reducing the number of ‘safety crit ical’ incidents that occur. Also, they underpin a process that creates a safe, secure and welco ming environ ment, which is likely to enhance corporate image as well as customer confidence and loyalty. Lastly, they ensure time and resources, including expenditure, are targeted efficiently and effectively[11]. After co mp leting such a study, an organization can establish HR policies to identify how workp lace v iolence is to be dealt with in conjunction with disciplinary actions and referrals to employee assistance p ro g rams [1 2 ]. 3.2. Hypothesis 2: Zero-tolerance Safety Policies Significantly Account for Reducti on in Work place Violence and Costs The result of the Kruskal-Wallis test showing the relationship between zero-tolerance safety policies and workp lace v iolence and costs (as shown on Table 1.23) reveals that zero- to lerance safety policies reduce workp lace violence and costs by 55%. Statistical Decision Level of significance = 0.05; Samp le size (n ) = 103; Test statistics = Kruskal-Wallis; Decision criterion = Reject Ho if Kc Calculated > kt = 0.5. Since Kc = 0.55 > 0 kt = 0.5, we reject Ho and accept H1. It was concluded that zero-tolerance safety policies significantly account for reduction in workp lace vio lence in central Nigerian hospitals. The hospitals under investigation reveal that the absence of active safety policies to protect emp loyees fro m violence wh ile on transit to and from work, contagious diseases and practices, attacks from co lleagues and danger in handling cash, drugs and other hospital properties have led to increase in the occurrence of violence and the costs of handling these th reats . The result agrees with the findings of Aswathappa[9] which revea l that a violence-free organization enjoys certain benefits. To Aswathappa, direct costs in the form of compensation and medical expenses are incurred when 118 Wurim Ben Pam: Workplace Violence and the Cost-Benefit Trade off of Zero-Tolerance Safety Policies in Central Nigerian Hospitals violence takes place on an emp loyee but more serious than the direct costs are the indirect or hidden costs which the management cannot avoid. The indirect costs are three to four times higher than the direct costs. Hidden costs include loss on account of down-time of operators, slowed- up production rate of other workers, materials spoiled and labor for cleaning, and damages to equipment 3.3. Hypothesis 3: The Benefits of Implementi ng Zero-tolerance Safety Policies are Significantly Greater than the Cost of Implementation The result of the Kruskal-Wallis test showing the relationship between the benefits of implementing zerotolerance safety policies and the cost of imp lementation (as shown on Table 1.2) reveal that the benefits of imp lementing zero-tolerance safety policies are greater than the cost of implementing such policies by 40%. Statistical Decision Level of significance = 0.05; Samp le size (n ) = 103; Test statistics = Kruskal-Wallis; Decision criterion = Reject Ho if Kc Calculated > kt = 0.5. Since Kc = 0.4 t˂=k 0.5, we accept Ho and reject H1. It was concluded that the cost of implementing zero - tolerance safety policies are by far greater than the benefits of implementation. The hospitals under investigation suggest that central Nigerian hospitals spend so much on security with little results. Also, in spite of the hospitals’ preventive measures, there is a high rate of disease contagion, insults, rumor mongering, hatred, tension, aggression, public assault and general insecurity to life , cash, drugs and other organizational properties. If organisations are concerned with efficiency and profits, why should they spend money to create conditions that make them run at a loss? The ans wer is the profit motive itself. The cost of vio lence can be, and for many organisations is, a substantial additional cost of doing business. The direct cost of violence to an employer shows itself in the organizat ion’s workers co mpensation’s premiu m. The costs is determined by the insured‘s violence history. Indirect costs, which generally far exceed direct costs, must also be borne by the emp loyer. These include wages paid for time lost due injury, damage to equipment and materials, personnel to investigate and report on accidents , and lost production due to work stoppages and personnel changeover[13]. The impact of these indirect costs can be seen from statistics that describe the costs of violence for American industry as a whole[14]. The Abstract reports that in 1983, workers compensation cost emp loyers approximately $18 billion. Vio lence additionally cost emp loyers billions in wages and lost production. The significance of this latter figure is emphasized when we note this cost is approximately ten times greater than losses caused by strikes, an issue that has historically received much public attention[13]. Ashford[15] brings the issue to rest by asserting that as long as the outlays required for p reventive measures are less than the social costs of disability among workers, higher fatality rates, and the diversion of medical resources, the enforcement of safety and health standards is well worth it and society will benefit. 4. Conclusions In most workplaces where risk factors can be identified, the risk of assault can be prevented or minimized if emp loyers take appropriate precautions. Also, widely varying approaches and strategies to workp lace v iolence prevention and protection exist. One of the best protections emp loyers can offer their workers is to establish a zero-tolerance policy toward workplace vio lence. Therefore, the establishment of a zero-tolerance policy significantly reduces workplace violence and makes it a safe haven for workers to put in their best. It is also worth noting that the cost of imp lementing zero -tolerance policies for workp lace violence prevention and protection can be higher than the intended benefits 5. Recommendations The Occupational Safety and Health depart ments of organizations should identify risk factors in the workp lace early enough to prevent or minimize v iolence in the workp lace. Organizat ions should establish zero-tolerance policies. These policies should cover all workers, patients, clients, visitors, contractors, and anyone else who may co me in contact with co mpany personnel. In addit ion, emp loyers should provide safety education for employees so that they know what conduct is not acceptable; what to do if they witness or are subjected to workp lace vio lence and how to protect themselves; and how to recognize, avoid, or d iffuse potentially vio lent situations. Also, organisations should secure the workplace (where appropriate) to install video surveillance, ext ra lighting, and alarm systems and min imize access by outsiders through identificat ion of badges, electronic keys and guards; provide drop safes to limit the amount of cash on hand; instruct employees not to enter any location where they feel unsafe: and equip field staff with cellu lar and hand-held alarms or noise devices and require them to prepare a daily work plan and keep a contact pers on informed of their location throughout the day. REFERENCES [1] USDA (2011), “Workplace violence,” The USDA Handbook on Workplace Violence Prevention & Response, http:// www.usda.gov/news/p ubs/violence/wp v.ht m. [2] Wikimedia Foundation Inc. (2009), Workplace Violence. http://en.wikipedia.org/wiki/workplace violence. [3] OSHA (2011), “Workplace violence” Available at: www.OSHA.gov. International Journal of Applied Psychology 2013, 3(4): 114-119 119 [4] Census of Fatal Occupational Injuries Summary (2001), [9] Cascio, W. F. (2003), Managing Human Resources- www.b/s.gov/news/release/cfoI.nro.htm. Productivity, Quality of work, Profits, Irwin: M cGraw-Hill [5] OSHA (2000), “Ergonomics Rules Draw Flak.” The Denver [10] Workplace Survey and White Paper (2001), Available at: Post, P.34. www.asse.org [6] Dieterly, D. (1994), “Industrial Injury Cost Analysis by [11] M athis, R. L. & Jackson, J. H. (2003), Human Resources Occupation in an Electric Utility”, Occupational Research Management, Bangalore: Thomson. Division, Southern California Edison Co. [12] DeCenzo, D. A. & Robbins, S. P. (1998), Personnel/Human [7] Kruskal, W. and Wallis, W.A.(1954), ‘Use of Ranks in Resource Management, Shengang: Prentice –Hall. One-criterion Variance Analysis’, Journal of the American Association, Cincinati:Wesley. [13] Ashford, N.A.,(1976), Crises in the Workplace: Occupational Disease and Injury, Cambridge, MA: MI Press. [8] Aswathappa, K. (2005), Human Resource and Personnel management (Text & Cases, New Delhi: Tata M cGraw-Hill Publishing Co. Ltd.

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