Workplace Violence Is a Leadership Problem: How One Health System Built a Systemwide Response

“As the CMO of a hospital and now a CMO of a health system, I have a profound perspective on workplace violence because I have not only experienced workplace violence but also have had conversations with team members who have been traumatized,” McNeil says. “Physicians and nurses have a calling to help patients, and when they are assaulted by a patient, it is a difficult experience.”

“A systemic approach to workplace violence includes having a wraparound ability to impact the problem in a positive way and drive down the number of incidents,” McNeil says. “Senior leadership cannot address workplace violence on the day shift differently than they address workplace violence on the night shift. That does not support making wholesale changes to ensure your staff is safe.”

The systematic approach to addressing workplace violence at Adventist includes employing several tools, including technology such as weapons detection systems and training.

Training is pivotal, according to McNeil.

“Our team members get Crisis Prevention Institute training, so they can de-escalate potentially violent situations verbally as well as physically de-escalate violent situations without getting hurt or patients getting hurt,” McNeil says.

The health system’s security staff also receives training.

“Security staff must receive training that is adherent to regulatory demands such as not carrying weapons unless they are licensed to do so,” McNeil says. “Security staff must be able to protect team members, which requires a lot of intentionality.”

McNeil says Adventist has a governance structure in place to manage workplace violence initiatives.

Often, workplace violence initiatives at the health system are started and piloted at a single facility. If an initiative is found to be effective in the pilot phase, it is escalated to Adventist’s system-level group for review and potential implementation across the health system. If policy implementation is needed, a workplace violence initiative rolls to a centralized meeting body for approval, and policy implementation decisions are advanced to Adventist’s Quality and Patient Safety Committee and the health system’s board of directors.

“Workplace violence incidents that are impactful enough to require intervention necessitate calling a Code Green, wherein security is dispatched to a site of an incident, or calling a Code Bronze, which brings senior executives to the site of an incident,” McNeil says. “Both of these codes are logged into our incident reporting system. All Code Greens are immediately evaluated for detail and debriefing, and all Code Bronze incidents are reviewed within 24 hours.”

Adventist has established leadership accountability for workplace violence prevention efforts and the response to workplace violence incidents, McNeil explains.

“All incidents are evaluated and logged as well as reviewed for adherence to policy and process,” McNeil says. “All fallouts are raised to leadership accountability at the unit level and are rolled up to an escalated summary for the highest leaders inclusive of the CEOs to review.”

Workplace violence innovations

Adventist has adopted a few innovations to address workplace violence that are not common at other health systems.

One innovation is a forensic medical unit, which is staffed mainly by nurses who are trained in how to evaluate and respond to assaults involving patients and family members.

“Forensic medical unit staff meet with employees who are attacked by a patient or family member, so they can examine the team member, document any injuries, provide counseling for the emotional trauma that results from a workplace violence incident, and document an incident in a way that can be helpful if charges are filed,” McNeil says.

“For example, if there is a workplace violence incident and there is an occupational health examination for a team member, you do not want the response to the incident to end there,” McNeil says. “There are traumas that occur as a result of an incident between a team member and a patient that must be addressed carefully and intentionally. We want to make sure that we use every tool in our toolbox to address a workplace violence incident, and the forensic approach is an important tool.”

Code Bronze is a unique workplace violence innovation that Adventist has developed. If a team member feels that a situation is escalating in the tone, tenor, or verbal interaction with a patient, they can call a Code Bronze and have members of a hospital’s leadership team come to the bedside.

“Having the hospital president, CMO, or CNO come to the bedside shows that senior leaders support the frontline care teams,” McNeil says.

Another workplace violence innovation Adventist has adopted is an in-house webinar called Stand Strong.

“The webinar promotes a culture that focuses on workplace violence by encouraging team members to report incidents,” McNeil says. “The webinar also features data about the prevalence of workplace violence in healthcare, so it helps drive the culture and the importance of addressing workplace violence.”