Zero Tolerance to Aggression

Apollo Medical has a zero tolerance attitude to violence and aggression to staff and others. We are compassionate and understanding of the stresses placed on people and we support staff to assist patients at times of stress.  However patients and also their families must realise that their access to services provided by Apollo Medical does not include a right to verbally abuse staff or display aggression towards staff or other patients at the medical centre. Any such displays could result in withdrawal of service for the person concerned.


It is a legal requirement under the Health and Safety in Employment Act 1992 that all employers must take all practicable steps to reduce potential work place harm to employees. The New Zealand Government through the Department of Labour in 2009 produced a practice guide for all healthcare environments to manage violence.3

This document will provide practical guidance for situations where people may be exposed to various forms of violence or aggression including:

·         physical assault

·         verbal abuse

·         threats, intimidation, and harassment.

Providing clarity on expectations

1.      Display Zero Tolerance to Violence information on the website and in the medical centre waiting room

2.      Provide training to staff

3.      Display quick guides to management of situations at reception

Management of situations of aggression

Staff to employ de-escalation strategies- see Appendix 1 De-escalation Responses for occasions of conscious violence

Refer to senior colleague if situation is not resolved

Call for assistance

·         Panic button under desk at reception

·         Control F2 if in consultation

·         If in any doubt about the safety for any one dial 1111 (police emergency)

Complete incident form

Management of incident as per Adverse Event/Incident Management Policy


Note In situations of displays of unreasonable aggression the GM may decide to withdraw service provision to the aggressor. In this situation the GM will discuss the situation with the person and formally advise them to enrol with a new general practitioner.



Equip staff to identify and deescalate situations

All staff induction training to include:

·         Risk assessments, including identification of risk factors

·         Recognition of early warning signs and appropriate ways to respond to them

·         Grievance management, processes and techniques

·         Ways to diffuse volatile situations or aggressive behaviour

·         Summoning emergency help

·         Policies for reporting incidents and events and taking part in investigations

·         Discussion about how employee behaviour may promote violence


Employees Responsibilities

Employees have a duty to take all practicable steps to avoid harming themselves or any other person. This general duty implies the following:

·         behaving appropriately

·         taking care to avoid behaviours that generate inappropriate responses from others (including bullying or being dismissive of the needs of others)

·         co-operating with the employer and providing constructive feedback in matters of health and safety

·         a duty to follow care plans and to bring to the attention of the supervisor/ employer any difficulties with those care plans

·         attending training and implementing the health and safety objectives of the training as far is possible

·         fully participating in communication programmes

·         reporting hazards and incidents (including stress and fatigue)

·         taking part in incident investigations and debriefing exercises.



Appendix 1

De-escalation Responses for occasions of Conscious Violence

Potential warning signs or cues that may indicate that a patient may be about to respond violently

Suggested responses to each warning sign that the caregiver can use to try and diffuse the potentially violent situation.

Repeated succession of questions
Appear calm, self-controlled and confident, confirming that you are addressing their concerns.
Using another language in an aggressive manner
Identify language origin and locate interpreter to assist.
Using obscenities or sarcasm
Do not match their language.
Ask for information with a calm voice.
Replying abruptly or refusing to reply
Calmly confirm the received information back to the assailant.
Rapid breathing
Breathe slowly and evenly
Attempt to sit them comfortably
Clenched fist or pointing fingers
Do not fold your arms or clench your fists in reaction.
Invading your personal space
Maintain a comfortable distance.
Maintain normal, but broken eye contact.
Tight jaw with clenched teeth
Open hands to the assailant
Shoulders squared up and dominating
Stand to the side.


Unconscious Violence

This guidance is not intended to assist in the diagnosis of the patient, but to identify that there may be a different trigger and management process necessary when responding.
For example, it would be unwise to call for police assistance to a patient who has hit an employee following a general anaesthetic, as they will have had no intention of harming the staff member and probably have no recollection of events once the effects of the anaesthesia have worn off.
Unconscious violence may occur as a result of the assailant experiencing:
· acute head injury
· post-operative effects of anaesthesia
· blood level of toxins, glucose, septicaemia, electrolytes and oxygen.
The purpose of identifying these situations is all about risk identification so that appropriate thought and planning can go into care plans. In this way, staff safety is preserved while appropriate standards of patient care are supported.


(3) Defining Violence

Violent episode: means any incident where staff are abused, threatened or assaulted in circumstances related to their work, involving an explicit or implicit challenge to their safety, wellbeing or health.

The violent episode can be instigated by a patient, another staff member or a member of the public.

·         Physical assault: means an assault which results in actual physical harm.

·         Physical threats: means attempted physical assault that does not result in actual harm.

·         Verbal/written threats: means verbal or written communication where the individual perceives a risk of harm to their person or property.

·         Damage to property: means items damaged that belong to a person or an organisation.

Examples of violence occurring to employees include:

·         violence with the potential to result in harm such as pushing, pinching, hair pulling, obscene language

·         verbal abuse

·         threatening behaviour, sexual and racial assaults, stalking, intimidation, invasion of privacy, which have also been recorded as precursors to incidents of serious harm

·         incidents with the potential to cause serious harm such as kicking, biting, spitting, scratching, strangleholds, the use of knives, knitting needles and other weapons, head butting and punches to all parts of the body.

Site by Jet Creative Studio