Prevention of Workplace Violence in Healthcare and Social Assistance SBREFA

OSHA is in the early stages of developing a potential standard, Prevention of Workplace Violence in Healthcare and Social Assistance. OSHA convened a Small Business Advocacy Review (SBAR) Panel in March 2023 and heard from representatives from small businesses and who served as small entity representatives (SERs). OSHA received input from SERs representing from the following industry sectors:

• Hospitals, including emergency departments;
• Residential behavioral health facilities;
• Ambulatory mental healthcare and ambulatory substance abuse treatment centers;
• Freestanding emergency centers;
• Residential care facilities;
• Home healthcare;
• Emergency medical services;
• Social assistance (excluding child day care centers): and
• Correctional health settings

SBAR/SBREFA

In accordance with the requirements of the Small Business Regulatory Enforcement Fairness Act (SBREFA) OSHA convened a Small Business Advocacy Review (SBAR) panel in March 2023. The panel, comprised of members from the Small Business Administration's (SBA's) Office of Advocacy, OSHA, and the Office of Management and Budget's Office of Information and Regulatory Affairs (OIRA), listened to Small Entity Representatives (SERs) who could potentially be affected by the draft rule and issued a report following the panel. Each SER was sent information to review, and was asked to participate in a small-group teleconference to discuss any concerns or other input related to the information provided – specifically relating to how the draft regulation might potentially affect the operations of their workplace.

OSHA hosted five SBAR Panel teleconferences between March 14th - 22nd 2023. These teleconferences were open for the public to listen to but not participate in. Each SER was asked to participate in one of the teleconferences.

About a Prevention of Workplace Violence in Healthcare and Social Assistance Standard

Nonfatal workplace violence is more widespread in the Healthcare and Social Assistance sectors than in any other industry. In 2019, the rate of nonfatal workplace violence incidents that required the worker to take time off was nearly five times greater in privately operated healthcare and social assistance establishments than in private industry overall. For certain segments within these industries, the rate is much higher. While workplace violence also occurs in other industries, healthcare and social assistance services have a common set of risk factors related to the unique relationship between the care provider and the patient, client, or their visitors.

Workplace violence is often categorized according to the relationship between the perpetrator and the victim as follows: Type-I (criminal intent; the perpetrator has no legitimate relationship to the business), Type-II (customer/client/patient), Type-III (worker-on-worker), and Type-IV (personal relationship). This rulemaking action will focus on Type-II workplace violence perpetrated by patients, clients, and visitors, because it is both prevalent in the healthcare industry and can be reasonably anticipated and mitigated by employers.

OSHA recognizes that workplace violence in healthcare and social assistance is a sensitive issue. This is not only due to the nature of the injuries sustained by workers, but also because it involves patients and clients who may be experiencing psychiatric, behavioral, or substance abuse issues that may require specialized methods and protocols for the delivery of care.

OSHA is taking all of these factors into consideration in the development of a potential standard. Through the SBREFA process, OSHA will present to SERs a programmatic approach for the prevention of workplace violence, and seek input from SERs on how these approaches might affect the operations of their workplace.

Topics in the potential draft standard to be considered by the SBAR panel include:

• A programmatic approach to workplace violence prevention;
• Workplace violence hazard assessments;
• Workplace violence control measures;
• Preventive training;
• Violent incident investigations and recordkeeping;
• Anti-retaliatory provisions; and
• Approaches that avoid stigmatization of healthcare patients and social assistance clients.

Who Qualifies as a "Small Entity"?

The definition of a "small entity" varies widely across the broad range of industry sectors potentially covered by the standard. The size standards vary by industry sector, but are usually based on either number of employees or revenue (expressed in millions of dollars. A size standard is the largest size that an entity can be and still qualify as a small business for Federal Government programs. For the most part, size standards are the average annual receipts or the average employment of a firm.

Please see the SBA Table of Size Standards for the exact definition of a small entity for your industry sector or contact OSHA or SBA for assistance. Examples of small entities include:

Public entities from these sectors must be in OSHA state plan states and serve populations of fewer than 50,000 to participate. Private entities must meet the SBA definition of a small entity.

Additionally, OSHA considers all non-profit entities to be small entities regardless of number of employees or revenue, and welcomes participation from entities that operate in a non-profit status, regardless of size.

For more information contact Bruce Lundegren at the Small Business Administration, Bruce.Lundegren@SBA.gov, (202) 205-6144 or Jessica Stone at OSHA, stone.jessica@dol.gov, (202) 693-1847.