San Diego-based Scripps Health cut workplace violence injuries to 88 in 2025 — down from a peak of 101 in 2022 — and its CEO sees that drop as the real measure of progress.
For CEO Chris Van Gorder, that injury count is the metric that matters most — not reports filed, he told Becker’s.
The initiative that has contributed most to the improvement is a “10-five-two” rule, which has its origins in hospitality and was brought to Scripps by Todd Walbridge, assistant vice president of security and transportation and a retired supervisory agent with the FBI. It builds on the system’s protocol of placing a green peace sign outside the door of patients who have been flagged for potential violent tendencies as a warning sign for staff.
The 10-five-two rule encourages employees to pause to assess a patient’s level of agitation before putting themselves in harm’s way. It can start with greeting the patient at 10 feet away — “How are you doing today?” — then five feet: “I’m going to take your blood pressure, is that all right with you?” Moving closer depends on the patient’s responses and behavior. If a patient is agitated 10 feet away, there is no reason to proceed into the room without another team member, Mr. Walbridge told Becker’s. The pauses also give employees time to determine whether they need security or another nurse before becoming overwhelmed, Mr. Van Gorder said.
“You need space to allow your brain to catch up with a quickly dissolving situation,” Mr. Walbridge said.
Other metrics on the rise
As Scripps has reduced workplace violence injuries, the system is seeing an uptick in reports of verbal abuse. The shift has come as employees are told it is OK to walk out of a room when a patient’s level of agitation is escalating toward violence — something they may not have been explicitly told in the past as they tried to provide patient care.
Scripps recorded 2,130 reports of verbal attacks in fiscal 2025, up from 1,381 in fiscal 2021 and just shy of the fiscal 2024 high of 2,143.
“When the patients can’t hit us, kick us, punch us, bite us, they’re left with hurling insults at us,” Mr. Walbridge said. “And as unpleasant as that is, I will take that over a black eye or a cracked orbital bone.”
The reporting gap is not new. Mr. Van Gorder recalled being stabbed by a patient while working in a hospital decades ago — and never calling the police or filing a report. Hospital employees have historically left incidents of violence unreported, he said, and Scripps has spent the past several years working to change that norm. The system now brings in law enforcement to walk staff through the reporting process and offers employee assistance psychologists who reach out after an incident.
“In the past, we waited for an employee to call,” he said. “Today, anybody that reports an injury or an incident, an EAP reaches out directly, and we think that encourages more reporting.”
Verbal abuse and sexual misconduct still lag behind physical violence in reporting — an area Scripps is pushing staff to document, even knowing the surge will look, on paper, as though incidents are climbing.
“The reality is you’re just getting more reported, and that is what we want,” Mr. Van Gorder said. “We don’t want to discourage that for statistics. The best thing to look at is actual injuries and harm done.”
Sexual assaults have been the most underreported of all incidents. Most organizations’ protocols focus on assault between employees, leaving patient-on-staff incidents in a gray zone. When Mr. Walbridge joined Scripps more than two years ago, he brought examples of patient-on-staff violence occurring at the system to the district attorney and city attorney, who were “shocked” — and had no idea it was happening at that rate, because none of it had been reported to them. He spent nearly a year working with the attorneys on a one-pager and built an intranet page laying out what counts as a crime, what counts as a misdemeanor, how to report it and what support is available. The city attorney is now prosecuting these cases and tracking them — something that had never happened before.
Mr. Van Gorder said hospitals should not tackle any of this alone.
“They need to take a communitywide approach,” he said. “We would not have the same ability to reduce incidents and respond to them without the support of our district attorney, city attorney, and the law enforcement agencies, who are honestly unaware of the severity and the numbers of hospital employees that were being hurt.”
That community approach has a name in San Diego: the San Diego Hospital Workforce Violence Task Force, which launched in 2023 and brings together hospitals and health systems, law enforcement and prosecutors. It has contributed to a 21% reduction in workplace violence injuries at Scripps from the launch through the end of 2025.
Integrating security staff into clinical teams
Another focus of Scripps’ safety efforts is better security — not just more of it.
“You don’t need more people who aren’t going to do anything, more people who are going to watch you get punched in the face,” Mr. Walbridge said. “There’s a lot of security that do not engage.”
Scripps’ top focus for security staff is training, including specialized training for leaders.
“I train people to my standard, not anybody else’s standard — whether it’s use of force, or de-escalation. Once we trained them on security essentials, and then security advanced, then I realized I needed to train leadership,” Mr. Walbridge said. “So then we trained our security leaders differently, from the managers to the supervisors, and the next step is training the security leads. It’s about better security and then providing things that take some of the load off of security.”
Scripps has implemented a visitor registration system with facial recognition to identify visitors who have previously been violent to staff, allowing the registration station to intervene before they reach other staff members or patients. The system also uses AI in its perimeter camera feeds to flag concerning behavior, cutting the need for staff to patrol outside the hospital and freeing time for community policing.
The security team can now round units and get to know clinical leaders, being a part of the solution by flagging patients who may have been agitated in the ED but do not have a green peace sign outside their room.
“The whole objective for my security team is to be integrated into the care team,” Mr. Walbridge said. “There’s no reason we should be treated differently than an ED tech or phlebotomist. We handle the behavioral problems. A phlebotomist draws the blood, an ED tech will take you for imaging, and we handle the violence. That’s our specialty in healthcare.”
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