Preventing workplace violence: Safeguarding dental practices through effective risk management

Taiba Solaiman, PHR, RDA
Taiba Solaiman, RDA.

In the fast-paced and challenging environment of a dental practice, ensuring the safety and well-being of both patients and employees is paramount. Incidents of workplace violence can have serious repercussions on the reputation and sustainability of any dental office.

Understanding the scope of workplace violence

The Occupational Safety and Health Administration defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at a worksite. It ranges from threats and verbal abuse to physical assaults and even homicide, affecting and involving employees, clients, customers, patients, and/or visitors.

Recent statistics highlight the importance of addressing this issue proactively. Of 5,486 fatal workplace injuries that occurred in 2022 in the U.S., 841 were cases of intentional injury done by another person, according to the U.S. Bureau of Labor Statistics Census of Fatal Occupational Injuries.

The healthcare sector, including dental practices, is particularly vulnerable. The U.S. National Institutes of Health noted in a recent study that "healthcare and social service industries have the greatest rates of workplace violence injuries, with workers in these industries being five times more likely to be injured than other workers."

The Dentists Insurance Company’s (TDIC) Risk Management Advice Line receives more than 13,000 calls each year from dentists seeking support to navigate practice challenges. Many of those calls are about minor conflicts with patients or employees, illustrating that dentists need expert techniques and tools to help de-escalate potential crises long before there is a risk of violence.

For the safety of patients and employees, all dental team members must be equipped with the knowledge and tools to prepare for, prevent, and effectively manage instances of conflict in the practice environment.

A case study of an angry patient

In one case that was reported to TDIC's Advice Line, a woman brought her 8-year-old son into a dental practice for an exam. The dentist recommended placing sealants on the child's molars. The mother was unsure about the sealant placement and declined the treatment. The following day, she called the office stating that she had changed her mind and wanted to move forward with the sealant application after all.

A week after her child was treated, the mother called the office and expressed concerns about the risks the sealants posed and wanted them removed. The dentist declined her request because he was confident in the treatment that had been provided and in his professional opinion, removal would be unnecessary and could possibly cause further problems.

Over the next few weeks, the patient's mother repeatedly called the office and harassed staff members. Ultimately, she showed up unannounced with the child and belligerently insisted the dentist remove the sealants or provide a refund to allow her to go to another dentist to have them removed.

The dentist happened to be out of the office that day. The patient's mother screamed and cursed at the office manager and office assistant, creating an extremely uncomfortable scene for the dental team and other patients in the office. After consulting with TDIC's Advice Line analysts, the dentist offered the patient's mother a refund and dismissed the patient from his practice.

How to handle conflict with patients and employees

While it is unpleasant to deal with conflict, some key communication strategies can help diffuse difficult situations and lead to better outcomes. 

Keep calm and communicate. Build a strong rapport with patients and employees through effective communication, empathy and understanding. Address their concerns promptly and professionally to prevent misunderstandings. When a conflict first arises, TDIC's risk management analysts suggest sitting down privately with the patient or employee. Let them know you understand they are upset and that you are willing to listen to their concerns. A compassionate ear can go a long way toward diffusing a tense situation.

Set boundaries. Showing compassion does not mean you shouldn't set limits. Be forthright about what is and is not achievable or realistic in conflict resolution. 

Consider compromise. If handled correctly, making a compromise, such as offering an unhappy patient a refund, does not imply or equate to an admission of guilt or wrongdoing. Instead, it demonstrates a desire to bring the matter to a close. In many cases, offering a refund can be the best way to diffuse a situation and prevent it from escalating.

Empower employees. Encourage employees to speak up about safety concerns or instances of workplace violence they may encounter or make them fearful. Foster a culture of mutual trust, respect, and support among team members. 

Don't skip documentation. Be sure to document the conflict, what was discussed, and any steps that were taken to address the problem. Staff members' involvement should also be carefully noted in their employee files in case of a hostile work environment.

When conflicts escalate

It's one thing for a patient or employee to become angry, it's another when that anger manifests into threatening behavior such as yelling, cursing, stalking, or violence. When these behaviors occur, practice leaders must intervene. Employers are obligated to provide a safe working environment for both staff and patients, one in which no one fears for their safety.

If a situation escalates beyond control, it is crucial to seek assistance immediately. Do not hesitate to call law enforcement.

Risk management strategies

California just became the 11th state to pass legislation requiring employers to provide workplace violence prevention plans or training for their employees. Risk management experts agree that even if your state doesn't require you to do so, dentists and practice owners should prioritize the implementation of comprehensive risk management strategies to minimize the threat of workplace violence. These strategies include the following: 

Security assessments. Conduct a thorough evaluation of the practice property's security vulnerabilities, such as inadequate lighting, lack of surveillance cameras, or limited access control. (Access control may be limited by an inability to lock your front office door remotely or not having a supply closet lock that requires a code to open.)

Training and education. Provide regular training sessions for employees on conflict resolution, de-escalation techniques, and recognizing the warning signs of potential violence. TDIC offers a helpful overview of communication techniques for de-escalation.

An emergency response plan. Develop a detailed emergency response plan that outlines procedures to follow in the event of a violent incident, including protocols for contacting law enforcement and ensuring employee safety. Review the plan regularly with staff. If you need help getting started on an emergency plan, the U.S. government offers specific guidance for businesses.

Employee support. Foster a culture of open communication and provide support mechanisms for employees who may have experienced or witnessed workplace violence.

Remember, safety is not just a priority -- it's a core value that should be upheld in every aspect of dental practice management. By being vigilant, proactive, and compassionate, it is possible to create an environment where everyone feels safe, respected, and valued.

Taiba Solaiman joined The Dentists Insurance Company in 2003. She has served as a registered dental assistant, instructor, and consultant. As a certified professional in human resources, Solaiman shares expertise via national events, writing for industry publications, and advising dentists on professional liability, employment, and cyber risks.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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