In 2016, Ontario’s healthcare system was confronting a reality that the numbers could no longer obscure. Fifty-six percent of all lost-time injuries from workplace violence in the hospital sector were among registered nurses. Emergency departments, psychiatric units, and long-term care facilities had become some of the most dangerous workplaces in the province. Not construction sites. Not mines. Hospitals.
I was brought in as Lead Consultant to design and facilitate what would become the Workplace Violence Prevention in Health Care Leadership Table, a joint initiative between the Ontario Ministry of Labour and the Ministry of Health and Long-Term Care. These two ministries had not collaborated on a shared mandate since the 2003 SARS crisis, when Justice Archie Campbell’s commission identified “continuing discord” between them as a systemic failure that cost lives. Thirteen years later, it took another crisis to bring them back to the same table.
The scope was unlike anything I had led before. Twenty-three members. Two Deputy Ministers co-chairing. Unions, hospital associations, patient advocates, researchers, front-line workers, and regulators, all with legitimate but competing interests. The mandate was to produce actionable recommendations that would protect over 400,000 healthcare workers across the province. Not a discussion paper. Not a set of guidelines that would sit on a shelf. A framework for systemic change.
The Scale of the Problem
The data painted a picture that was difficult to look away from. Ontario’s healthcare sector represented 11.7% of the provincial labour market but accounted for a disproportionate share of workplace violence. In 2014, hospitals recorded 639 lost-time injuries due to workplace violence. Manufacturing recorded 77. Construction recorded 10. Mining recorded 1.
Workplace Violence in Ontario Healthcare
A Statistics Canada survey had found that one-third of Canadian nurses providing direct care in hospitals or long-term care facilities reported physical assault by a patient in the previous year. Close to half reported emotional abuse. And experts consistently noted that actual rates were far higher due to chronic underreporting, with many incidents dismissed as “part of the job.”
The human cost extended beyond physical injuries. Post-traumatic stress, burnout, and attrition from the profession were accelerating. Ontario was losing experienced nurses not to retirement but to an occupational hazard that the system had normalized.
Building the Leadership Table
The Leadership Table was co-chaired by Deputy Minister Sophie Dennis of the Ministry of Labour and Deputy Minister Dr. Bob Bell of the Ministry of Health and Long-Term Care. Ministers Kevin Flynn (Labour) and Dr. Eric Hoskins (Health) had announced the initiative in August 2015.
The twenty-three members represented the full spectrum of Ontario’s healthcare ecosystem: Linda Haslam-Stroud, President of the Ontario Nurses’ Association. Anthony Dale, President and CEO of the Ontario Hospital Association. Warren “Smokey” Thomas, President of OPSEU. Dr. Joshua Tepper, President and CEO of Health Quality Ontario. Dr. Cameron Mustard from the Institute for Work and Health. CEOs of hospitals and mental health centres. Patient advocates from Ontario Shores and the Centre for Addiction and Mental Health. The Chief Prevention Officer. Assistant Deputy Ministers from both ministries.
The challenge was not assembling the right people. The challenge was building a process that could produce consensus among groups with fundamentally different priorities. Unions focused on worker rights and enforcement. Employers focused on operational feasibility. Patient advocates focused on care quality. Regulators focused on compliance. Every recommendation had to survive scrutiny from all of these perspectives simultaneously.
My role was to design the structure that made this possible. That started with the logic model, a framework that connected inputs to activities to outputs to short-term, medium-term, and long-term outcomes. Version 9.0 of that model became the backbone of the entire initiative, giving every stakeholder a shared language for what the project was trying to achieve and how progress would be measured.
An Advisory Committee was established to provide additional expert input, bringing in leaders like Dr. Dave Williams of Southlake Regional Health Centre and Dr. Catherine Zahn of CAMH. Four Working Groups were formed to develop specific products: Leadership and Accountability, Hazard Prevention and Control, Communications and Knowledge Translation, and Indicators, Evaluation and Reporting. In total, 108 people participated across the Leadership Table and its Working Groups.
From Logic Model to Implementation
The project operated in two phases, each producing a distinct set of deliverables.
Phase 1 focused on nurses in hospitals and delivered 13 products: a sustainable accountability framework defining who is responsible for what in a hospital organization. A transition toolkit housing leading practices across six key areas. An organizational assessment tool helping hospitals identify where they stood in their workplace violence prevention journey. A program assessment checklist that went beyond minimum OHSA compliance. Risk assessment tools and pre-assessment surveys. Training matrices calibrated to the level of violence risk in each role. Indicators for measuring improvement at both organizational and provincial levels. Communication plans for internal and external stakeholders.
Phase 2 expanded to all workers in hospitals and produced 21 additional products. These addressed curriculum integration for nursing schools, ensuring students received workplace violence prevention training before entering the workforce. Technology solutions for incident tracking and reporting. Standardized security training for hospital personnel. Care planning tools that engaged patients and families in creating safer environments. Public awareness campaign frameworks.
The implementation plan structured all of this into 166 key items, each with an identified owner, timeline, required reviews, implementation partners, achievement measures, and quality assurance oversight. This was not a list of aspirations. It was an operational blueprint designed to survive the transition from committee to execution.
The Twenty-Three Recommendations
The Leadership Table produced 23 recommendations spanning four categories.
Leadership and Accountability addressed the structural foundations. Recommendations included creating Transition Teams, sustainable groups of experts to assist hospitals in implementing workplace violence prevention tools. Developing a Workplace Safety Environmental Standard based on Crime Prevention Through Environmental Design principles. Resources for psychologically safe and healthy workplaces based on the CSA Z1003 Standard. Amendments to the Occupational Health and Safety Act to allow designated worker members of the Joint Health and Safety Committee to participate in workplace violence investigations. Strengthening workplace violence language in Accreditation Canada’s standards and required organizational practices.
Hazard Prevention and Control focused on practical tools for the front line. Promoting PSHSA’s Violence, Aggression and Responsive Behaviour tools across all Ontario hospitals. Developing additional tools for incident reporting, code white procedures, patient transit and transfer, and work refusal procedures. Working with the College of Nurses of Ontario to clarify nurses’ right to refuse care in hazardous situations. Requiring post-secondary institutions to provide enhanced workplace violence prevention training. Establishing minimum provincial training standards for hospital security personnel.
Indicators, Evaluation and Reporting tackled the measurement gap. Addressing eight specific issues with workplace violence incident reporting systems, from capturing psychological injuries to standardizing code white protocols. Including workplace violence prevention in hospital Quality Improvement Plans.
Communications and Knowledge Translation ensured the work would reach the people it was designed to protect. Creating consistent communication protocols between hospitals and external care environments. Expanding protocols for preparing healthcare facilities to receive incoming patients for psychiatric assessment. Implementing a joint ministry public campaign. Posting information about MOL fines against healthcare employers.
At the time of publication, two recommendations were complete, four were in progress, five were in the planning stage, and twelve were in active stakeholder engagement.
What Large-Scale Government Projects Demand
This initiative reinforced lessons that apply far beyond healthcare.
Cross-ministry collaboration at the highest levels of government does not happen organically. It requires a designed structure with clear governance, shared accountability, and a neutral process that allows competing interests to surface without derailing progress. The logic model was not an academic exercise. It was the mechanism that kept 108 participants aligned over sixteen months.
Stakeholder management in these environments is fundamentally different from the private sector. Every party has a legitimate mandate. No one can be overruled by market dynamics or executive authority. Consensus has to be earned recommendation by recommendation, and the process has to be perceived as fair by everyone at the table.
The difference between producing a report and producing an implementation framework is the difference between a symbolic gesture and a systemic change. Reports create awareness. Implementation plans create accountability. The 166-item framework was designed with the understanding that the Leadership Table would eventually disband, and the work had to continue without it.
The results validated this approach. Workplace violence became the first mandatory indicator in hospital Quality Improvement Plans for the 2018/19 fiscal year, a direct outcome of the Leadership Table’s recommendations. Legislative amendments to the Occupational Health and Safety Act were advanced. The tools and resources developed through the initiative remain in active use through the Public Services Health and Safety Association and workplace-violence.ca.
The Leadership Table’s work represented something rare in government: two ministries, historically siloed, aligning around a shared mandate with real deliverables and real accountability. The 2003 SARS Commission had called out the discord between these ministries as a systemic failure. Thirteen years later, this initiative demonstrated that the failure was not inevitable.
For the 400,000+ healthcare workers across Ontario, the 23 recommendations were not an endpoint. They were the beginning of a structured, measurable, accountable framework for changing how the province protects the people who protect us. That framework exists today because 108 people with competing priorities sat at the same table and chose to build something together.
References
- Ontario MOL/MOHLTC (2017). Workplace Violence Prevention in Health Care: Progress Report. workplace-violence.ca
- WSIB Ontario. Safety Check: Provincial Statistics. wsib.ca
- CCOHS (2015). Health and Safety Report: Violence in the Healthcare Sector. ccohs.ca
- Ontario Government. SARS Commission Report Archives. archives.gov.on.ca
- PSHSA. Workplace Violence in Healthcare Resources. pshsa.ca
- Ontario Government. Workplace Violence Prevention in Health Care: Guide to the Law. ontario.ca
