The healthcare industry is struggling to reduce violence in the workplace. It has dramatically changed the current healthcare landscape. A problem perpetuated within healthcare for decades has now reached a boiling point. It severely affects patient care, staff recruitment, and healthcare image. As healthcare institutions struggle to manage violent incidents, many look to explore the latest strategies to help mitigate workplace violence. Recently, the Joint Commission has set a standard on workplace violence reduction.
Staff training should be recommended, emphasizing staff reporting, creating an incident review committee, and implementing security technology, i.e., weapons detection, visitor management, cameras, or access control. Although these processes can be instrumental in the reduction of violence, it is the proper implementation of these principles that effectively reduces the potential for violence.
Staff Training
For decades, OSHA has recommended crisis intervention training for healthcare staff. Many hospitals have implemented training programs in the past decade or so. However, this training is segregated chiefly to specific high-risk areas and staff, such as nurses and security staff working within the Emergency Department and Behavioral Health. Allowing the remainder of the hospital staff to flounder when confronted by an aggressive person. In today’s healthcare environment, every hospital staff member should be trained to deal with difficult people, from housekeepers to cashiers, physicians to volunteers.
Current crisis intervention training programs do not address the needs required within the present healthcare setting. These programs are designed for healthcare staff who are asked to deal with violent people in crisis who are out of control or physically acting out. They do not address techniques for verbal interaction and de-escalation in the beginning stages of violence progression.
To reduce the potential for violence, all healthcare staff should go through training that focuses on how to talk to difficult people. Like what customer service representatives go through, training should focus on verbal de-escalation and empathy. In addition, the current trend in violence reduction training is teaching healthcare staff situational awareness. Training that teaches staff to recognize potentially violent people before they escalate. Customer service and situational awareness training should be an annual event starting with employee orientation. This will be followed by periodic competency evaluations and condensed yearly training so that staff are refreshed on techniques they will need to use in the current healthcare environment.
Violence Reduction Committee
As the Joint Commission recommends, to reduce the potential for violence within healthcare, institutions need to have a violence reduction committee, and institutions need to ensure that staff recognize that there is a program in effect. The most important part of a violence reduction program is creating and operating a violence reduction committee. A group of healthcare staff that collects, evaluates, and makes recommendations on violent incidents, monitors training programs and works to make changes within the healthcare environment to reduce the potential for violent incidents.
It is vital to program success to ensure front-line employees know that a program is in effect. Ensuring healthcare employees know what role they play within the program and exactly how the program works. Understanding what constitutes an incident, how it should be reported, and who it should be reported to. Additionally, the program should have a mechanism where staff feel comfortable reporting incidents. Some of the most successful violence reduction programs have either a general email address or phone number to call to report an incident. This way, staff can make notifications from home and outside the healthcare setting.
In violence reduction, it is essential to focus on incident victims and remember that there is more than one victim in a violent incident. Victims also include all those who witnessed the event. Those individuals and those who were directly affected should not be forgotten in the restitution process. Remembering to care for and help those involved is key to creating a successful violence reduction program.
The Right Security Staff
Suppose security staff are tasked with responding to a violent incident or monitoring disruptive patients. In that case, the right person must be hired to ensure positive results in responding to a violent incident. Having the right temperament helps to de-escalate already stressful situations.
Training staff in security techniques and strategies is easy when hiring the right person. Security personnel should have training in crisis intervention and advanced techniques in verbal de-escalation and situational awareness. Their training should be detailed and occur at least semi-annually so that they are adequately prepared to interact in the event violence should occur.
Technology
Technology today can integrate disparate security systems into one platform, which can restrict access, identify people, alert security staff of an incident, and predict violent incidents before they occur. Security technology plays a significant role in the reduction of violence. For example, video cameras do more than just record incidents. When AI is incorporated into video technology, systems can alert security and hospital staff when a violent incident occurs. They can accomplish this through video interpretation or sound. Cameras can also determine certain weapons, alarm when people are loitering or pacing, and when audio is used in conjunction with video, these systems can alert security when people raise their voices.
Healthcare institutions have been reluctant to implement visitor management systems to screen and track visitors. In the fight to reduce violence, visitor management systems are crucial. Today’s visitor management systems are more than long lines and large data inputs. Patients can manage the system, allowing them to supervise who visits and when. Allowing those that they want to see and those they do not. Visitor restrictions are a central piece in managing potentially violent situations. Giving patients the power to manage their visitation frees nurses to do more critical tasks and offers patients more control over their care. Visitor management systems also reduce the need for security or other hospital staff to enroll and manage visitors. Today, kiosks can manage visitor activities, provide access credentialing wayfinding, and alert security staff when a restricted visitor tries to gain entry.
Controlling access is another valuable tool in reducing violence. Healthcare institutions have come a long way to understanding the importance of maintaining access inside the institution, but not at entry and exit points. Healthcare institutions still feel the need to provide a variety of access points within the facility. Most healthcare institutions have far too many entry points, often leaving them open without a screening process. The best security strategy for violence reduction is screening all people entering at all entry points.
Make sure that only authorized people enter the healthcare institution. In the struggle to limit access points, healthcare is slowly understanding the need to segregate services into separate buildings, moving outpatient services and other specialty services away from the main hospital, making it easier to secure each facility based on its services. Exit points are another vulnerability that many healthcare institutions neglect. Confirming that fire exits and other designated exit points are secured, monitored, and checked regularly. This strategy ensures that people are adequately screened and authorized to enter the facility.
Some healthcare institutions are considering turning to turnstiles. Turnstiles, in conjunction with visitor management systems, provide a physical barrier between the entrance and clinical areas of the institution. While not appropriate for every institution, the placement and implementation are essential for properly operating turnstile use within the healthcare facility.
Many hospitals now see the benefits of weapons detection systems in the fight to reduce major violent incidents. Traditionally, hospitals install metal detectors within Emergency Departments. They will be installed at the main Emergency Department entrance and the ambulance entrance—a best practice even today in the area that customarily has the highest rate of violence. Weapons detection systems are different from essential metal detectors, which screen people and packages as a person walks through the detector. These systems have some limitations but can be an effective tool when installed properly and healthcare institutions understand their limitations.
The effective use of security technology in reducing violence depends on several vital factors. First, security management needs to understand the technology that is being chosen to combat potential violent incidents. Security managers need to know the current technology and how it works to determine what technology works best for them. Understanding how technology works, its benefits in reducing violence and what restrictions the technology may have. Second, the chosen technology should be strategically placed within the healthcare institution. Assessing where the technology best fits so that it works effectively. For example, using video and audio for potential violence detection would be most effective in the Emergency Department waiting area where, historically, many violent incidents occur—using gun detection video technology at main entrances or lobbies.
Staff Background checks
Violence within the healthcare institution is not always patient-initiated. Many times, it is the employee that commits the act of violence. That’s why pre-employee background checks are so necessary. Although most healthcare institutions conduct pre-employment background checks, very few continue that process after hiring a staff member.
Criminal background checks completed when employee status changes should be a part of every Human Resource process. When employees are promoted or change jobs, a new criminal background check should be completed to verify that the employee has not been arrested or convicted of a violent crime. Providing periodic criminal background checks can help to reduce the potential for employee violence within healthcare institutions.
Data Analysis
Probably the least used and understood aspect of violence reduction is the use of data collection and analysis to help in the battle against violence. Many healthcare institutions have started to collect data from various sources to help evaluate the magnitude of their violence problem.
However, very few understand the importance and effectiveness of data analysis. To reduce violence, the best strategy is to collect and analyze data from security incidents, Employee Health, Risk Management and staff notifications. Many violence prevention programs silo their data, using it for their purposes and not combining it with others to see the overall violence picture. The collection and detailed analysis of violent or potentially violent incidents can help pinpoint problem areas and patients, allowing the violence prevention committee to focus resources more effectively.
Conclusion
The good news, as outlined within this article, is that significant strategies are available to reduce violence within the healthcare institution. However, the key to successful program implementation is the healthcare institution’s commitment to reducing violence and properly implementing reduction programs. Once that occurs, a violence reduction can begin. Implementing and integrating directed training, installing current security technology, and combining collected violent data and analyzing it to predict potential violent incidents and deter violent events from occurring.
