By Amanda Schiavo
Most often, in the wake of tragedy, leaders get together to discuss what could have been done to prevent such a shocking incident, but what if that plan were already in place?
Recently, HealthLeaders hosted a Now Summit event on the topic of workplace violence within the hospital and health system space. In the first of three sessions from the online discussion, healthcare leaders— Dr. Peter Hahn, president and CEO of Michigan Health-West, and Elizabeth Seely, chief administration officer for the hospital division of Ohio State University Wexner Medical Center—discussed how their organizations work to prevent incidents of workplace violence.
Incidents of workplace violence cost hospitals approximately $2.7 billion in 2016, according to a study from the American Hospital Association. Additionally, 13% of employee sick time is the result of workplace violence, according to the American Nurses Association. Workplace violence-related absenteeism can cost hospitals $53.7 million a year, according to the AHA report.
Throughout the conversation, Seely and Hahn discussed the different safety measures hospitals and health systems are taking to keep their organizations safe and where the biggest investments in safety measures should be made.
HealthLeaders: What steps does your organization take to prevent workplace violence?
Elizabeth Seely: It’s helpful to recognize the prevalence of workplace violence and to start with a definition. Violence in the workplace really can range from something that is verbal, threatening, or non-verbal, it can be physical aggression, it could be intimidating or harassing behavior. It can be bullying, and it can be a physical assault. We tend to think about those things that are physically violent, but there is typically a pattern of progression, and any aspect of that continuum should be considered workplace violence.
One of the things that we’ve done at Ohio State is made this a top priority of leadership. There’s been an investment of senior leadership time and attention. In establishing the organizational support, we put together a workplace safety steering committee. It is a group that I chair and that has leaders at the most senior levels of the organization, including our chief legal officer, our chief human resources officer, our communications leader, nursing, and physician leaders, as well as our security colleagues. That group really makes sure we are devoting organizational leadership time and attention to this topic.
We also want to make sure we’re understanding what’s happening at the bedsides of our various clinical environments. We’ve also engaged a workplace safety work group that includes frontline individuals and management that interfaces with our steering committee so we’re able to hear what is happening and what are [our employees’] concerns. We’ve also done a campaign to make the public aware of what is not acceptable behavior in a healthcare setting. We also communicate to our staff that this is not part of the job and not something we expect them to tolerate.
Peter Hahn: We are very similar [in our approach]. Violence in the healthcare space has been present for a long time but has certainly increased during the chaos of the pandemic. We think about [workplace violence] in three broad buckets—prevention, response, and learning.
In terms of prevention, we’ve invested in extensive signage to send a message to our visitors and patients that this is a place of healing and there is zero tolerance for any type of aggression. Investing in prevention, we have very regular drills at all of our sites on how to respond to aggressive visitors or patients. We use Epic as our EHR and use that as a flagging system for patients or visitors who’ve had a history of any type of violence on the spectrum that Elizabeth spoke of.
With the response, we have a mandatory eight-hour training for all of our patient-facing employees. It is pretty extensive and takes quite a bit of investment in terms of training the trainer and then all of the patient-facing employees. We use a badge communication system and that is part of the response that any nurse, technician, or physician can use to alert others in their department if they are facing a situation. And then there is an investment in security obviously and additional training for security in terms of de-escalation. There is a debate over whether invisible or visible security works best, but we’ve invested in a lot more visible security—especially on the hospital floors. And we do extensive debriefs even for the slightest violent situation, so that we are constantly learning.
HL: Where should hospitals focus their financial resources when it comes to preventing workplace violence?
Hahn: There are key areas, facilities would be an example for us. We installed card-key access points in the ICUs, the EDs, and different areas of the hospital where before—pre-pandemic—we had really advocated for free access. But we’ve installed more card access points throughout the hospital and clinics. There have been investments in technology. But our key investment is in personnel education.
There is also the question of how you handle applications to co-worker behavior. I would say it is very similar training because whether you’re dealing with a patient, visitor, family member, or even a coworker, the techniques are the same in terms of recognition, prevention and response, and de-escalation.
HL: How should preventing workplace violence be integrated into a hospital and health system’s budget?
Seely: First and foremost, the obvious is the security department and making sure you have security resources and making sure that those are responsive. As organizations grow, recognize that new sites might require additional investment in security presence. We have some large ambulatory locations that we’ve built over the past five years and those are seeing a large volume of patients. So, we have security resources in the hospital and directed to some of our high-risk areas—the emergency department and our behavioral health setting. We’ve also recognized we have some very high-volume ambulatory settings, so we’ve invested in a security presence in those settings. The training of the officers and de-escalation that Dr. Hahn mentioned is very important.
We’ve also integrated new technology into our processes. We were an early adopter of body-worn cameras for our security officers. Our officers are not armed but having the body-worn camera and letting folks know, ‘hey, I’m turning this on now,’ tends to help calm things down because people realize their behavior is being monitored.
The other thing I would say, in terms of the budget, is to think about workplace safety not just from the aspect of your security team but what else can you do in the physical environment. If you’re undertaking a renovation project or building something new, think about workplace safety and how you design that space. Think about how people will enter and think about the physical barriers out front.
We had an incident in Columbus—not at Ohio State—where an individual drove their vehicle into a free-standing emergency department, right through the front glass window into the lobby. That was a tragic incident and so having concrete barriers and those types of things looked at when you are budgeting for a new project or renovation [is key].
The other thing we’ve done that does require a budget investment is to invest in staff that can help assist the clinical teams who may not be as adept in addressing patients with challenging behavior. We have implemented a behavioral emergency response team made up of social workers and mental health clinicians who will provide consultative support to teams that are dealing with a patient that is challenging in a non-mental health setting.
Amanda Schiavo is the Finance Editor for HealthLeaders.