Curbing the Violence

Violence in the workplace continues to escalate; healthcare workers at risk

• By Paul Baratta
• Aug 01, 2017

Let me let you in on a troubling, not-so-little secret: violence in the workplace is continuing to escalate in medical facilities, despite the fact that national assault rates have been dropping in recent years. In a statement by the International Council of Nurses, they noted that healthcare workers are more likely to be attacked at work than prison guards or police officers.

Why are people in these environments so vulnerable? And what can hospitals, emergency care units and mental health facilities do to better protect staff, patients and visitors?

What’s Triggering the Rise in Violence?

Formulating a strategy for addressing this problem begins with examining its root causes. Healthcare settings tend to be stressful environments for an array of reasons. Stress can trigger disruptive, and sometimes even violent, behavior. Just look at today’s headlines for examples of how stress has been affecting behavior on crowded airplanes.

What are some of the most common stressors in medical facilities?

• Increased wait times in hospital emergency centers.
• Behavioral patients admitted to emergency departments with little or no information, and no intake facility willing or able to take the patient.
• Increased use of hospitals for treatment of acutely disturbed individuals in lieu of jail or holding at police departments.

Vulnerabilities stem from the open design of many medical facilities such as the unrestricted movement of visitors, spillover of gang activity from the streets or prevalence of firearms entering the building. Other issues stem from financial constraints and lack of staff training because of budgets cuts forcing leaner security staff, inconsistent adherence to security protocols and staff inability to recognize warning signs of potentially violent behavior.

Establishing a Multi-pronged Approach to Security

Decreasing workplace violence requires a dedicated effort on multiple fronts: people, procedures and technology.

People. From a people perspective, it starts with senior leadership accepting the fact that there’s always potential for violence in the workplace. So management must be willing to commit adequate funds to curb it. This includes actively promoting a workplace culture that values the importance of security.

Employee education is paramount. Everyone should be informed of the purpose of security measures and prevented from circumventing electronic security devices put in place for their protection.

Security staff should be empowered to enforce rules and regulations regarding workplace violence. They should also be responsible for maintaining close relationships with local law enforcement, relying on them for a rapid response if the situation warrants it. They should record any incidents of workplace violence and report them to the facility’s appropriate departments. Those reports should be tracked to determine if there are noticeable trends and what is being done to address them.

Human Resources should take all incidences of workplace violence seriously and deal with problems immediately—including removing staff if that is the issue. HR should also oversee after care follow-up for any individuals involved in an incident.

Procedure. It’s important for healthcare institutions to create policies, procedures and guidelines around workplace violence. Human Resources, risk management, security, senior leadership as well as frontline staff should all provide input to ensure that these programs address the actual safety and security risks of the facility. All policies should also include after-care follow-up for victims. While it would be impossible to create an exhaustive list of categories for workplace violence that a facility’s policies, procedures and guidelines should address, here are just a few examples.

Domestic violence. Include incidents that occur at staff or patients’ homes as well as at the healthcare facility. The policy should include notifying security and local police (if appropriate), Human Resources and risk management, and requesting a response. It’s important that all parties are notified and that information is shared rather than held by a single department.

In regards to incidents that might involve staff on staff, set ground rules to ensure everyone’s safety. Make it clear that violation of those rules by any staff member will lead to immediate termination.

Workplace violence. Encompass incidents occurring anywhere on hospital grounds whether perpetrated on staff, patients, visitors, or even service providers. Policies should outline the appropriate response to take and any consequences that will be levied for an incident whether it involves staff visitors, patients, or any member of the healthcare community.

Policies for workplace violence must also include after care follow up for any victims.

Rape and sexual assault. This pertains to events occurring at the facility. The policies and guidelines set for any rape or sexual assault should include immediately reporting the incident to local law enforcement and the medical facility’s police department. There should also be detailed guidelines established for collecting forensic evidence to support an investigation of the incident.

Active shooter. In addition to having policies and procedures in place for response to an active shooter, healthcare facilities should also institute mandatory annual training of security and staff in active shooter scenarios. The training should encompass prevention, mitigation, preparation, and response and recovery. Train security and staff to recognize potential signs of a pending threat and conduct threat assessments. Is an individual more belligerent than usual, showing up late for work, insubordinate to supervisors, showing signs of depression or rage? Do they have easy access to a weapon or something that could serve as a weapon? Technology. There is an array of technologies available on the market today to assist healthcare facilities in improving safety and security. What a facility deems most important to deploy will depend on risk assessment and budgetary considerations. Here are a few options: Video surveillance. Install IP video cameras in strategic areas to monitor patients, staff and visitors. They can also be deployed in high-risk behavior rooms to enable security to watch more than one patient simultaneously. Add analytics like sound detection to enhance risk mitigation.

Access control. Use keycards, touchpads and/or biometrics to limit access to specific areas. Create a layered approach to granting entry privileges—becoming progressively more restrictive moving from property perimeter to building perimeter to interior perimeters to highly-sensitive innermost areas where security risks are highest.

Body cameras. These can be issued to security officers, EMTs and emergency department staff.

Staff duress alarms. These can be installed at intake desks and nurses stations or carried on-person (real-time location systems). With preprogrammed cellphones staff can quickly inform security of a volatile situation.

Mass notification systems. These are especially useful for broadcasting messages facility-wide in case of an active shooters or need for immediate emergency evacuation.

Curbing Violence Isn’t a One-and-Done Process

Curbing violence in a healthcare workplace begins with a comprehensive review of the security measures currently in place. This would include any video surveillance and access control technology currently deployed. The next step is to evaluate and review any workplace violence policies to determine whether they are still timely or need to be updated. Security measures, policies and incident reports should be reviewed at least annually.

All staff—police, security emergency department personnel, social workers, psych services, physicians and incoming residence—should be cross-trained on how to respond to workplace violence and active shooter and be required to attend an annual refresher course. They should also attend non-violence crisis intervention training to help them recognize early warning signs of potential violence.

Matching Institutional Vigilance with Personal Vigilance

While risk management is assessing the work environment, for their own safety and security employees should be looking at the workplace with an equally critical eye. Is the lighting adequate? Are there convenient escape routes? Do I have a method to summon assistance? Staff needs to be proactive and pay attention to warning signs. As a matter of course, they also need to report threats from patients, coworkers and others immediately.

Other things an individual can do to help curb workplace violence include:

• Promote respect. Fostering an attitude of respect and consideration can often defuse explosive behavior.
• Eliminate potential weapons. Take an inventory of objects that might serve as potential weapons. Remove or secure objects that could be dangerous.
• Know violence response procedures. Learn techniques to help you respond during violent incidents in a way that minimizes injuries. Also have a plan for summoning assistance and moving people out of danger and into safe areas.
• Trust your instincts. Don’t ignore your own internal warning system.
• Work as a team. If you find yourself in a potentially hostile situation, use the buddy system to extricate yourself.

All employees have a right to a violence-free workplace. By following these tips, effectively enforcing workplace violence prevention policies, and training staff how to recognize and react to violent situations, healthcare facilities can minimize risks to their patients, staff and visitors and curb violence in their workplace.

This article originally appeared in the August 2017 issue of Security Today.