Healthcare Security Crisis: What’s Keeping Them Up at Night

The statistics are staggering. The reality is frightening. Recent OSHA figures show that close to 75 percent of nearly 25,000 assaults and other workplace violence reported annually in the United States happen in a healthcare setting and healthcare workers are four times more likely to be the victim of a violent workplace event than any other private-sector employee.

These are the facts that haunt healthcare security directors and the reality they face each day. Hospitals and healthcare facilities are posed with a unique security challenge because of the constant flux of people coming and going and the 24/7/365 nature of the enterprise. There has been a marked increase in workplace violence in the healthcare setting over the last decade. While James Romagnoli, Vice President of Corporate Security for Northwell Health, which is New York State's largest healthcare provider and private employer, is hard-pressed to provide answers to why the uptick in violence against hospital staff is occurring, he admits it is consistent with the rise in workplace violence across all industries nationwide.

Contributing Factors Abound

“I do believe that there are many contributing factors that are placing more stressors on our patients, visitors and staff. When these stressors are coupled with the stress and anxiety surrounding the serious illness of a loved one, or an end of life scenario regarding a friend or family member, we now see these frustrations and stresses manifest themselves into a workplace violence situation. It is necessary now to identify any and all persons in the facility,” says Romagnoli, who has been with Northwell for two decades and served as an NYPD detective for more than 20 years. “A security director must install a HIPAA-compliant visitor management system as well as an electronic access controls and optical barriers. These measures, if socialized properly to staff and the public will aid in identifying who is in our buildings for a legitimate reason, identify everyone to others that they belong in the building while deterring those who may have untoward reasons from entering the facility.”

Bryan Warren, the former Director of Corporate Security at Atrium Health in Charlotte, NC, the second largest healthcare provider in the U.S. and past president of the International Association for Healthcare Security and Safety (IAHSS), states that workplace violence has always been a part of healthcare due to the dynamic and emotional situations that people find themselves in at hospitals and the fact that many people lack the coping mechanisms with which to deal with bad news or unexpected situations involving themselves or a loved one.

“At one time, decades ago, there were certain areas that were considered societal ‘safe havens’ such as schools, houses of worship and hospitals since these institutions served the community and were a place of learning and healing. Unfortunately, this is no longer the case, and each of these community institutions have felt the effects of a populace more prone to violence outbursts regardless of the location or situation,” explains Warren. “Most workplace violence issues in healthcare, unlike many in schools and houses or worship, are not premeditated, but think about the types of situation that hospitals deal with daily that other industries do not. Giving of bad news or poor prognosis, refusing demands for narcotics, dealing with the aftermath and injuries of criminal activity, etc. There is no other business that sees such a remarkably broad spectrum of potentially violent activity on a routine basis.”

Bonnie Michelman, Executive Director of Police, Security and Outside Services for Massachusetts General Hospital in Boston offers another perspective explaining potential cause and effect for this violent trend in healthcare. She figures that increased behavioral health patient populations, the Opioid epidemic, an aging population with more dementia, a larger homeless problem and inadequate beds for all these populations and inadequate forensic medical facilities all factor in creating the current state of healthcare violence. 

“To combat this issue, hospitals need a comprehensive healthcare violence program with the right policies, procedures, training programs, proactive and reactive response capabilities and a multi-disciplinary engagement. This is critical. Mandatory training for all employees on de-escalation, dealing with upset people etc. is critical. Having groups meet to review patients who could pose a risk or are at risk to determine thoughtful, well communicated plans are important,” says Michelman. “Having systems like a flag in the medical record for those posing an extreme risk can lower injuries or incidents.  Collaborative programs with security and the clinical team are critical in optimizing safety for all.  A strong formula of educated, well trained, well paid, committed security staff, state of the art technology designed to fit the risk, prudent policies and procedures and good training and awareness programs for all will help to deter and minimize workplace risk and violence.”

Tracking the Top Risks

Considering the wide scope and breadth of healthcare workplace threats and risks, I wondered what are the top concerns that keep each of them up at night. For Romagnoli, it is infant abductions, assault against staff and narcotic diversion.

• Infant Abduction: “The abduction of an infant would do irreparable harm to the hospital or health system’s image and the trust that our patients place in our staff. An infant abduction system alone does not guarantee the prevention of an abduction. Human assets, visitor controls and other access controls must be utilized in tandem with an infant abduction system to further reduce the risk of an abduction. False alarm rates diminish the authenticity of a true alarm, thereby necessitating the use of other surveillance and access controls to reduce this risk to an absolute minimum.”
• Assault against staff: “An alarming increase in assaults against staff is taking place in the healthcare sector. The physical confrontations we are seeing are increasing in both frequency and severity. This is resulting in a larger security presence, especially in our high-risk areas namely the emergency department and behavioral health units. Many workplace violence surveys are now placing healthcare workers at the same at-risk percentiles of law enforcement and corrections officers.”
• Narcotic Diversion: “The diversion of narcotics has become an all too frequent occurrence, creating a cat-and-mouse scenario whereby measures of security that are put in place are soon defeated by the person committing these diversions. This is a reflection of the opioid crisis that we are seeing in the public at large.”

Michelman’s chief concerns include:

• Healthcare violence with the particular emphasis on assaults on caregivers by patients and visitors.
• Proliferation of weapons, drugs, and drug contraband that patients bring in creating a major risk for them and others.
• Overcrowding of Emergency Departments and Behavioral Health units creating long waits and stays and difficulty placing dangerous and very violent individuals due to lack of appropriate facilities.

Warren says that of the many issues that routinely impact the security and safety of patients, staff and visitors in the healthcare environment, his top concerns are that of long term boarding of BH patients in Emergency Departments or other ‘‘holding areas’’, the prevalence of workplace violence in almost every departments and setting and the challenges of translating the value of security as a business enabler to the organizations C suites.

“Long-term boarding of behavioral patients in an ED bed or other temporary ‘holding unit’ in which they are not receiving appropriate psychiatric care is a formula for disaster, since this results in increased WPV events that are often a part of patient restraint and seclusion incidents. Added to this is the always present threat of elopement, the incredibly inefficient use of security personnel as ‘sitters’, plus the intangible effects of additional wait times and its impacts on revenue generating potential for Emergency Department beds (think about how many acute care patients are displaced by one long term BH patient taking up an ED bed) and you can see what a drain this has not only on the staff but also on the organization itself,” chides Warren.

Workplace violence rates, especially in the healthcare sector, is incredibly high and according to a 2017 AHA study on the costs of workplace violence, millions of dollars are lost not just on the immediate effects and response to events but also on issues such as workman’s comp claims, turnover rates of staff and the replacement costs of highly skilled healthcare professionals that do not want to work in what they perceive as an unsafe environment. Considering that the average WPV prevention program costs approximately $17,500 (according this this study) it is surprising that education on this topic is such a challenge at many hospitals, especially considering the ROI of preventative efforts.”

The sentiment is that this crisis of violence is not abating anytime soon. However, the diligence of today’s healthcare security professionals is reflected in the approach of these three veteran executives.