A Colorado system's formula for keeping workers SAFE

Chris Powell acknowledges that he does not have the answer to eliminate violence against workers in healthcare settings. As he puts it, "No matter what we do or resources or education we provide, as long as doors are open to people in crisis, there will always be violence."

In fact, one recently released report found violence against nurses hit an all-time high. Amid this trend, healthcare associations have supported legislation to strengthen safety protections for healthcare workers.

Mr. Powell told Becker's he realizes no one person or approach will eradicate the issue. However, he also realizes the recognition of and response to the issue should be a focus at Aurora, Colo.-based UCHealth, where he has served as chief security officer since August 2022. 

"The most important piece is communication from the front-line worker to leadership and from leadership to the front-line worker," he said. "We have to be open, honest and transparent about what we do as a healthcare industry, what we do as an organization, and based on that, what our risk factors are from experiencing workplace violence.

"We're taking people on their worst day and we're putting them into an environment they're not familiar with. And that instills fear. There's fear about illness, injury, disease. There's fear of the cost of healthcare, the time they're missing from work, their ability to provide for their loved ones, or they're experiencing something with their loved ones, so there's this fear, there's this anxiousness."

Additionally, he pointed out, those in the healthcare setting — including workers, patients and family members — are all human.

"We have bad days, whether we have a flat tire or got pulled over for speeding or were late. Maybe we had a conflict with a loved one at home, or we're just generally having a bad day," he said. "And when you put those ingredients into the cauldron, it has the capability to become volatile."

With all this in mind, UCHealth rolled out its SAFE program in 2023. The first letter encourages workers to "stop" amid their duties. 

"I don't think it's a word we tell our healthcare workers enough. We push them for patient experience," Mr. Powell said. "We push them for HCAHPS scores. We push them for appointments so we see more people. It's a rush. Our nurses on the floors are looking to get vitals, and the medications, and they're going, going, going. When you move at such a rapid pace, you're more prone to making an error. 

"So the first thing we tell them is it's OK to stop. … If for any reason you feel unsafe, you're stopping for safety."

He said this pause allows workers to "assess" their environment. Whether people appear to be angered or frustrated, for example. 

The SAFE program then encourages workers to "familiarize" themselves with the room, who the patient is, where the patient is, and "any complicated factors that might cause an escalation of behavior," Mr. Powell said.

"This includes looking at ourselves," he said "Putting ourselves in a position where we always have an opportunity to escape should there be an escalation or attempt of physical violence. We repositioned our rooms in primary health settings where the provider is closest to the door and not tucked in a corner."

The last part of the SAFE program encourages workers to "enlist help," meaning bring someone or multiple people into the room with them. 

In addition to the SAFE program, UCHealth, which includes 33,000 employees, 14 acute-care hospitals and hundreds of physicians in Colorado, Southern Wyoming and Western Nebraska, provides employees with one hour of training from the Crisis Prevention Institute. This is in-person training and provides techniques employees may use to remove themselves from potentially violent situations. 

Mr. Powell said the training ensures "that we're all given this information. Communication and education and for people to realize violence is not OK, and it's not part of my job. And I need to raise my hand, I need to speak out."

Employees at the health system may report incidents of violence through UCHealth's patient conduct review board, which can review specific situations, such as whether there may be better resources for a patient's mental health and social needs at another facility.

No 'volcanic eruption'

No specific event led to UCHealth's response efforts around workplace violence, according to Mr. Powell. But his views and the perspective he brings to his role were shaped by his personal experiences. He served in the Navy for 20 years and, before joining UCHealth, worked as director of public safety and security at Salt Lake City-based Intermountain Healthcare.

"I was a provider at the bedside for 20 years," he said. "Then I've been a patient in the bed who wasn't a bowl of peaches. I've been the loved one at the bedside when my wife and I mourned the loss of our children.

"There are a lot of things to this from a personal experience that aren't that sentinel event that drives a person toward a path. … So there wasn't a sentinel event or volcanic eruption that made us [at UCHealth] respond this way. This is just a continuation of what we've seen, and we know the investments that have been made in the past have not been enough."

Overall, he sees addressing workplace violence as similar to a gumbo. 

"You can't just talk about the shrimp and give you a good picture. We have to talk about the roux and the rice and everything else that goes into this for a good picture to be painted so people have an understanding," he said. "We want to solve this with an electronic learning or a 15-minute huddle, but we can't. This is a continuous and a persistent pursuit toward educating, communicating, recognizing, responding to, reporting and recovering from workplace violence."

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