Permanente Federation CEO shares how it's keeping physicians safe

As incidents of violence against physicians and nurses continue to rise, Ramin Davidoff, MD, the co-CEO of the Permanente Federation, a consulting organization for the eight Permanente Medical Groups, detailed how the organization is prioritizing physicians' safety both physically and mentally in a May 25 American Medical Association discussion.

Incidents like the May 2 shooting inside an Atlanta hospital that killed one and injured four, some of whom were staff at that medical center, is distressing for healthcare workers to see happen, even from a distance, he explained.

"When healthcare providers experience this level of trauma, there is truly psychological injury that the clinicians experience as a result of the anxiety over the workplace verbal and physical abuse. …" Dr. Davidoff said. "So quality of care is absolutely impacted when our people are worried about their own personal safety." 

The rampant increase of violence toward healthcare professionals is something that requires hospital leaders to not only act, but communicate how these concerns of safety are being addressed. Failing to communicate safety plans can leave clinicians feeling unsupported, he said.

"Our people are our most valuable assets, and they look for us to take action as leaders, to help support and protect them," Dr. Davidoff said. "If we send a signal that we're not there, and we're not going to invest in this, that also is demoralizing to our people."

Beyond offering therapy and mental health support for employees, they are also installing metal detectors at emergency department entrances. Kaiser Permanente has also added marked mobile patrol vehicles at several locations and bumped up security personnel numbers in Southern California, where Dr. Davidoff is located. It has also added several solar-powered security cameras in parking structures as well inside medical facilities. 

Efforts are even being made to increase an understanding about the mental health of patient populations. 

"A vast majority of our patients are very respectful, very well-behaved and grateful for the care that is provided for them," Dr. Davidoff said. "There is a small minority that's having a particularly harder time and much of their aggressive behavior could stem from a sense of helplessness or disempowerment that they're feeling in life, in general. …  It's very important for us to have a handle on why this is happening, and also making sure that our people are trained in terms of areas of potential de-escalation, as well as making sure that physically, the proper resources are put into place to make them feel better." 

To further protect clinicians when difficult or violent situations involving patients occur, hospitals and health systems must prioritize the protection of their greatest assets: their employees, he said. 

Providing proper training and clear safety and reporting structures in addition to adding physical safety enhancements is a start, but ultimately the issue is one that will likely continue, and it's important for legislative policies to continue to support the reduction of violence in healthcare, Dr. Davidoff explained. 

Without it, some "potential ramifications [are] that healthcare needs to remain an attractive field for physicians and clinicians and nurses, pharmacists and everyone involved to enter the field," he said. "If there is continued violence and a feeling of lack of security, then it's likely that less and less people will enter the field. And we already have a shortage of physicians and nurses in the United States."

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