How 3 health systems have amped up their workplace violence prevention initiatives

As calls to address workplace violence grew louder, hospitals and health systems ramped up initiatives to prevent the growing issue. They have set up training initiatives, updated programs and procedures to prevent violent incidents and increased the level of collaboration among security teams and caretakers. 

Additionally, these increased efforts by hospitals and health systems have created resources to help other organizations address workplace violence and improve safety for hospital workers and patients.

Becker's recently checked in with three organizations to see how their initiatives have evolved in recent months and years. 

Michigan Medicine

In March, Ann Arbor-based Michigan Medicine announced a new systemwide, multifaceted Workplace Violence Prevention Program that the health system said includes policies and procedures to prevent violent incidents; workplace violence-related training and education programs; data analysis and reporting; a post-incident support model, including an approach for follow-up and support for victims and witnesses; and leadership oversight.

The health system has long worked to address workplace violence. However, the latest efforts are focused on a multidisciplinary approach, meaning one that involves experts from the University of Michigan Division of Public Safety and Security as well as experts who have a behavioral health background or other clinical background.

"While we have best practices happening in many areas, we have worked hard over the last year, year and a half to bring all of the experts together to learn from each other and to try to create structures and interventions that are informed from a diverse background," said Nicole Figueroa, MSN, RN, nurse leader for resiliency and well-being at Michigan Medicine. "Knowing that all of us have different expertise and together, we're really better. I think that's been something that's been beautiful in our system. Collaboration is something we really try to foster."

One benefit of this new multidisciplinary team is ensuring a collaborative approach to threat assessment, according to Brian Uridge, Michigan Medicine security director.

Mr. Uridge said experts on the clinical side, the legal department, human resources and physicians are coming together to determine the pre-incident indicators of violence — especially active shooter scenarios and targeted violence related to staff — and identify people who are "on the radar" who have exhibited concerning behavior.

From the day-to-day standpoint, Michigan Medicine has sought to ensure the health system is screening patients who are at risk for behaviors or violence, Ms. Figueroa said.

She said the health system has also been embedding de-escalation training in clinical areas to prevent escalation of conflict and dangerous behavior. The training is done in such a way that the clinical staff receive the same de-escalation training as University of Michigan Division of Public Safety and Security staff.

"We have built a standardized way to document behavior based on de-escalation, and we're working to leverage that documentation to hot spots in the health system to where we're seeing more escalation so we can put more resources there," Ms. Figueroa said.

Additionally, Michigan Medicine has dogs trained in therapy and explosives detection.

Mr. Uridge said the dogs can identify firearms and are used to focus on reduction in anxiety.

"In other words, they interact with patients and staff," he explained.

The University of Michigan Division of Public Safety and Security also recently partnered with nurses to develop a home healthcare model that provides situational awareness training to home health clinicians via scenario-based role playing. 

All of these and other efforts are geared toward allowing staff, patients and visitors to feel safe when they are in the health system's facilities, said Julie Grunawalt, associate chief nursing officer of Michigan Medicine's medical subsegment.

"It's about embedding this culture within our culture to say this is what this means by putting these interventions in place," she said, "We want a compassionate environment for patients while ensuring that staff feel supported and safe."

While Michigan Medicine has made all of these and other efforts to reduce workplace violence, it doesn't mean there aren't challenges.

Mr. Uridge said the biggest challenge in terms of the de-escalation training is to get all 34,000 employees trained in that common language and ensure everyone has that de-escalation training.

"We're a large health system, and that's a challenge to not only [ensure workers] get that initial training but what do we do every year to make sure we're keeping those skills up?" he said.

Ms. Grunawalt encouraged health systems working on their own workplace violence prevention programs to get needed support from their executive leadership — and the right stakeholders — to ensure success.

Oregon Association of Hospitals and Health Systems

In 2014, the Oregon Association of Hospitals and Health Systems launched its workplace safety initiative to collaboratively find solutions to workplace violence. 

"When we started doing work around workplace violence prevention, even though we have a law here in Oregon that requires us to have programs and education in place in healthcare facilities around workplace violence prevention, there really wasn't a lot of tools and resources out there," Katie Harris, director of rural health and federal policy at OAHHS, told Becker's

The Workplace Safety Initiative work group members included representatives from SEIU Local 49, the Oregon Nurses Association and representatives from various OAHHS member hospitals in Oregon. The pilot program started with five Oregon hospitals of varying sizes – Bay Area Hospital (Coos Bay, Ore.), Harney County Health District (Burns, Ore.), Grand Ronde Hospital and Clinics (La Grande, Ore.), Mid-Columbia Medical Center (The Dalles, Ore.) and Providence Portland Medical (Portland, Ore.) – which participated in projects to inform resources to improve workplace violence prevention and safe patient handling. 

Among these resources is the Workplace Violence Prevention Toolkit, which assists healthcare leadership and violence prevention committees and other stakeholders in enhancing workplace safety. 

"Those hospitals were very instrumental in helping to develop a toolkit that would be very adaptable to different size hospitals," Ms. Harris added. 

The variation in hospitals allowed them to prepare for how the scope of workplace violence issues may vary across these hospitals in addition to how these resources might compare across different regions in Oregon. 

Ms. Harris said she sees efforts to improve workplace violence prevention as ongoing. 

"It needs to be very dynamic and not static, in terms of continually assessing what the needs are, how things are changing within your facility or your community to just continue to understand where there may be opportunities for changes or developing new resources," Ms. Harris said. 

Cleveland Clinic

Cleveland Clinic's Protective Services is a leading participant in the health system's Workplace Violence Prevention Committee, which is chaired by Stephen Meldon, MD, senior vice chair, emergency services, and Janet Schuster, DNP, RN, chief nursing officer at Lutheran Hospital. 

Gordon Snow, chief security officer at Cleveland Clinic Health System, spoke about the committee and the clinic's Protective Services intended to prevent workplace violence. 

"We have an enterprise Workplace Violence Committee, and now all our sites have workplace violence committees, and those local sites feed up into the enterprise committee," Mr. Snow said. "And from there, we really take a hard hard look at every single event that takes place, any reportable events of workplace violence and all our unreportable events, or all the events that don't reach a threshold of being a reportable OSHA type event."

In the last few years, Cleveland Clinic hired hospital safety officers who are trained by clinicians and the police department to help de-escalate violent situations in emergency rooms and behavioral health units. The officer typically wears a polo shirt and khaki pants instead of the typical security officer uniform which, Snow says, helps patients feel more comfortable.

"We think that it helps the patients and the people that they're serving see them as somebody that's there to assist them rather than somebody who's there to bring them some type of discipline," Mr. Snow said. 

These officers are embedded with the clinical teams and those units in addition to attending huddles with the clinical teams. 

"And they get to understand more of what the patient is going through and how they can help that patient if they're suffering some type of event," Mr. Snow said. 

Cleveland Clinic also has improved weapons screenings, which include magnetometers in all of the emergency rooms. 

"We see a lot more of the chaos and the gunshot wounds and different concerns coming through the emergency rooms so we just like to take out of that environment anything that could harm our caregivers or other visitors or other patients," Mr. Snow said. 

The clinic also is looking at new gun detection technology at other department entrances, updating panic alarms and new software that would allow computers to activate panic alarms. Computers with cameras or audio capability would alert the security operations center and record video and audio of the event. 

The security team also conducts training events to ensure everyone is performing as planned on the security side in addition to creating a space to hear nursing and clinician concerns. This allows them to continually reassess their security approaches and procedures based on the huddles with team members and security events they hold. 

"We do a lot of education for caregivers. They do their annual modules, where they talk about everything from security events on the security side up to active shooter and then we also train them on de-escalation," Mr. Snow said. 

Mr. Snow added that these training events allow them to consistently reassess security procedures. 

"And we listen to them during those trainings also. I think a lot of the times not only do we learn so much from our after actions or hear so much during our after actions, but we also hear a lot during our training," Mr. Snow said. "And so that constant assessment in the security platform here is just being fed that information."

In addition, the incident reporting system for workplace violence events has been reassessed and made easier to use, Mr. Snow said. 

"Instead of you needing to dig through and find out where to report workplace violence, our forms start out with, ‘Is this a workplace violence incident?'" Mr. Snow said. 

He added that the reporting system allows caretakers to report these events in detail, which helps the security team to understand the incidents better.

"So everybody knows this is an environment of safety and we're here to make this the safest place that we possibly can for you," Mr. Snow said. 

As these health systems have modified and reassessed their programs to prevent workplace violence, they've also acknowledged there is no one solution to fixing the issue. 

For Michigan Medicine's Ms. Figueroa, one solution won't solve everything and it takes strong collaboration in order to continuously improve workplace violence. 

"People are scared about shooters but know that doesn't happen as often. What happens more often is the day-to-day verbal and behavioral aggression we see," she said. "So, some of this is trying to help with a paradigm shift on how we solve workplace violence through a multidisciplinary kind of multifaceted, multipronged approach. One thing won't solve everything. Shifting perspectives, that it's not only security and psychiatry's role to solve workplace violence. It's all of us working together to try to figure this really complex problem out." 

In addition, as hospital staff continually changes, Ms. Harris added it is important to continually educate staff about workplace violence prevention. This includes the inclusion of data recording, education and training to come up with solutions. 

"There's no one panacea, no one tool or one resource when it comes to addressing workplace violence, and it really does need to be like a toolkit and holistic, comprehensive approach," Ms. Harris said. 

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