Mitigating Violence

Mitigating Violence

COVID-19 has stretched the limits of hospitals and staff

Hospitals and health systems are tasked with controlling costs and cutting budgets while maintaining the highest levels of patient care, safety and privacy which heighten our awareness of the vital role played by security services in the nation’s ever-evolving healthcare landscape. With the unpredictable rise and fall of COVID cases stretching the limits of some hospitals, tensions can escalate and the opportunity for violence can rise.

Violence against healthcare workers has become more widespread since the pandemic began. A report from Insecurity Insight and the University of California, Berkeley's Human Rights Center found that more than 1,100 threats or violent acts against healthcare workers and facilities occurred worldwide in 2020, with around 400 of those attacks related to COVID.

Security has proven to be more essential than ever in the health care world as the chaotic, uncertain nature of the coronavirus has created new threats for patients and health care workers within the walls of a hospital. The hallmarks of an effective workplace violence prevention program include numerous partnerships among a wide variety of stakeholders. The workplace violence prevention (WPV) team or committee should be a cross-functional and diverse group dedicated to a culture of safety.

Internal partnerships include stakeholders including security, patient safety, nursing, compliance, risk management and human resources. External partnerships include regulatory, compliance and consulting organizations such as The Joint Commission (TJC) which released new WPV prevention standards effective January 1st 2022 along with a free webpage that includes a host of tools to assist healthcare organizations strengthen their culture of safety.

Creating Safer Workplaces Guide
The American Hospital Association (AHA) and the International Association for Healthcare Security & Safety (IAHSS) collaborated on “Creating Safer Workplaces: A Guide to Mitigating Violence in Health Care Settings.” This new guide is a crucial read for healthcare security leaders as it offers a number of case studies that illustrate how a range of organizations used best practices and individual solutions tailored on the organization’s size, culture and resources.

The report offers a framework to guide leaders in building a culture of safety, mitigating risk, violence intervention and the support of trauma survivors and recommends holding all parties accountable. Recording metrics and promoting ongoing education and training across the organization are vital.

The IAHSS Council on Guidelines defines WPV as “an act or threat occurring at the workplace that can include any of the following: verbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; harassment; physical assaults or other behaviors of concern involving staff, licensed practitioners, patients, visitors, or others on-site or off-site when related to the healthcare facility.

Hospitals face many challenges in regard to active shooter risk such as providing care to victims of shootings and being prepared in the event a shooting situation occurs at the hospital. In times of crisis, it is imperative that proper protocol is followed to minimize risk to workers and patients, and to end the situation as safely as possible. It is important for hospitals and healthcare systems to practice best practices that offer the ability to easily train hospital staff. All staff need to have the following:

  • Overview of the potential threat of active shooters in hospitals
  • Tips about how to prepare a hospital facility to protect against an active shooter threat
  • Information on how to recognize a potential shooter
  • What to expect from first responders and how to help and preserve life during an active shooter incident
  • Outline a plan to quickly recover to help keep the facility open and operational

Security leaders are encouraged to go through industry-specific training, education, and self-development. For security leaders serving as hospital security professionals, this means staying up-to-date on healthcare security publications, participating as an active member in the International Association for Healthcare Security and Safety (IAHSS), ASIS International, attending formal healthcare security seminars or educational programs, participating in industry research, and so on.

The IAHSS Industry Guideline on Violence recommends that Healthcare Facilities (HCFs) implement a multi-disciplinary process to address workplace violence prevention and response. The process should support an effective safety and security program, whose five main components also apply to preventing workplace violence.

  1. Management commitment to support efforts to minimize violence
  2. Employee involvement and training to engage staff in violence prevention and mitigation efforts
  3. Risk assessment, identification, prevention and mitigation
  4. Worksite analysis and development of response plans
  5. Internal and external data gathering and management, record keeping, evaluation and reporting

Workplace Violence Prevention Compendium
Hospitals and critical access hospitals will find the compendium of resources offered in the JHC’s “Workplace Violence Prevention Compendium of Resources to Support Joint Commission Accredited Hospitals” invaluable. These resources were compiled from a wide variety of sources including national organizations, federal and state agencies, associations, academic institutions, and peer-reviewed publications.

Recommendations to reduce rising violence in hospitals and healthcare systems includes:

Establishing clear workplace violence policies. (Johns Hopkins University, for example, has established clear policies as part of its “Safe at Hopkins” program, which covers everything from bullying to violence to disrespectful behavior).

Enforcing policies consistently. The WPV policies should have clear goals and objectives for preventing workplace violence, be suitable for the size and complexity of operations and be adaptable to specific situations and specific facilities or units.

Offering training (particularly non-escalation/de-escalation training). Training should be mandatory and ongoing — not an easy-to-forget, one-time session.

Increasing security. In the 2018 ACEP/ENA survey, nearly half of respondents said that hospitals could do more to protect workers by adding security, video surveillance, metal detectors, and visitor screening, especially in the emergency department.

Studying your space. Improvements can include better lighting, clear evacuation plans, badge detectors, mirrors (so that no area is hidden), removing potential weapons (such as IV poles, which are now frequently built into beds), and reducing the number of exits and entrances.

Protect against cyber stalking. Cyberstalking refers to the use of the Internet and other technologies to harass or stalk a healthcare person online.

Emergency Department on Frontlines
While any part of a hospital could become violent, the emergency department (ED) has the greatest potential for violence. The lack of healthcare resources available at night and on the weekends drive many people to the ED. The ED is the most challenging and stressful area in any hospital where dramatic life-and-death cases come in the front door.

Nurses, physicians and other medical professionals are on the ED’s front lines and are at an increased risk for workplace violence.

The American College of Emergency Physicians (ACEP) believes that optimal patient care can be achieved only when patients, healthcare workers and all other persons in the ED are protected against violent acts occurring within the department. As such, ACEP advocates for increased awareness of violence against healthcare workers in the ED and for increased safety measures in all EDs.

The pandemic has taught us several lessons when it comes to hospital safety and security. For example, it is critical for hospitals to develop mutual aid relationships, consider contracts for emergency security staffing during disasters, and establish appropriate/regulatory “Just-in-Time” training modules for various disaster scenarios. A WPV committee that keeps all of these risk factors at the forefront while updating the group on actions taken is crucial to combating violence.

While a hospital cannot determine the types of patients they treat in their ED, they can establish acceptable behaviors for patients and the visitors who may accompany them by adopting a disruptive patient policy. With that policy in place, staff and physicians who are experiencing unacceptable behaviors know the exact steps to take as soon as these behaviors escalate.

The root of WPV problems in the healthcare sector is a combination of clinical, environmental and organizational risk factors. Organizations need to address all three areas when addressing the potential of WPV.

Clinical risk factors may include patients who are under the influence of an impairing substance, in pain or have mental/behavioral health issue or who are custodial. Environment risk factors may include lack of access control to a high-risk area, lack of safe areas for violent patients, or lack of duress alarms.

Organizational risk factors include inadequate policies and procedures for reporting and managing WPV, inadequate staffing, lack of training and inadequate security.

This article originally appeared in the April 2022 issue of Security Today.


  • Maximizing Your Security Budget This Year

    7 Ways You Can Secure a High-Traffic Commercial Security Gate  

    Your commercial security gate is one of your most powerful tools to keep thieves off your property. Without a security gate, your commercial perimeter security plan is all for nothing. Read Now

  • The Power of a Layered Approach to Safety

    In a perfect world, every school would have an unlimited budget to help secure their schools. In reality, schools must prioritize what budget they have while navigating the complexities surrounding school security and lockdown. Read Now

  • How a Security System Can Enhance Arena Safety and the Fan Experience

    Ensuring guests have both a memorable experience and a safe one is no small feat for your physical security team. Stadiums, ballparks, arenas, and other large event venues are increasingly leveraging new technologies to transform the fan experience and maintain a high level of security. The goal is to preserve the integrity and excitement of the event while enhancing security and remaining “behind the scenes.” Read Now

  • Protecting Data is Critical

    To say that the Internet of Things (IoT) has become a part of everyday life would be a dramatic understatement. At this point, you would be hard-pressed to find an electronic device that is not connected to the internet. Read Now

Featured Cybersecurity


New Products

  • A8V MIND

    A8V MIND

    Hexagon’s Geosystems presents a portable version of its Accur8vision detection system. A rugged all-in-one solution, the A8V MIND (Mobile Intrusion Detection) is designed to provide flexible protection of critical outdoor infrastructure and objects. Hexagon’s Accur8vision is a volumetric detection system that employs LiDAR technology to safeguard entire areas. Whenever it detects movement in a specified zone, it automatically differentiates a threat from a nonthreat, and immediately notifies security staff if necessary. Person detection is carried out within a radius of 80 meters from this device. Connected remotely via a portable computer device, it enables remote surveillance and does not depend on security staff patrolling the area. 3

  • ResponderLink


    Shooter Detection Systems (SDS), an company and a global leader in gunshot detection solutions, has introduced ResponderLink, a groundbreaking new 911 notification service for gunshot events. ResponderLink completes the circle from detection to 911 notification to first responder awareness, giving law enforcement enhanced situational intelligence they urgently need to save lives. Integrating SDS’s proven gunshot detection system with Noonlight’s SendPolice platform, ResponderLink is the first solution to automatically deliver real-time gunshot detection data to 911 call centers and first responders. When shots are detected, the 911 dispatching center, also known as the Public Safety Answering Point or PSAP, is contacted based on the gunfire location, enabling faster initiation of life-saving emergency protocols. 3

  • PE80 Series

    PE80 Series by SARGENT / ED4000/PED5000 Series by Corbin Russwin

    ASSA ABLOY, a global leader in access solutions, has announced the launch of two next generation exit devices from long-standing leaders in the premium exit device market: the PE80 Series by SARGENT and the PED4000/PED5000 Series by Corbin Russwin. These new exit devices boast industry-first features that are specifically designed to provide enhanced safety, security and convenience, setting new standards for exit solutions. The SARGENT PE80 and Corbin Russwin PED4000/PED5000 Series exit devices are engineered to meet the ever-evolving needs of modern buildings. Featuring the high strength, security and durability that ASSA ABLOY is known for, the new exit devices deliver several innovative, industry-first features in addition to elegant design finishes for every opening. 3