Developing and evaluating a customized evidence-based safety training program for healthcare staff: a quality improvement approach

The high risk of workplace violence (WPV) for workers in mental health care settings and the potentially serious impacts, both mental and physical, have prompted many hospitals to mandate behavioral safety skills training for their staff. There are, however, some considerable challenges to delivering this type of training. First, while there are international and national/regional guidelines for mitigating WPV, the evaluation literature does not provide consistent guidance on which training methods are the most effective across a range of settings. Second, hospitals differ in terms of their objectives and their identified safety issues suggesting that a tailored approach rather than a one-size-fits-all training would be more appropriate. Finally, while there are commonly used evaluation frameworks relevant to health care, these will need to be adapted on a case-by-case basis to a tailored training approach. This article will describe models and frameworks addressing the processes involved in developing, implementing, and evaluating customized behavioral safety skills training. Preliminary findings from an actual quality improvement initiative delivered to a long-term care facility in Ontario, Canada will be presented and used as a basis to discuss where theory and actual experience converge and diverge. Successful results include the development of a replicable and theory-grounded customization process along with demonstrated short-term staff-level improvements; however, challenges remain in terms of evaluating organizational-level impact, sustainability, and resident/patient-level outcomes.