Mac’s Safety Space: Managing aggressive behavior—some next steps to consider

By Steve MacArthur, Hospital Safety Consultant

Among the many unique challenges to healthcare safety and security folks, the management of aggressive behavior and workplace violence probably stands a little more prominently in the hierarchy. There are so many moving pieces—personalities, situations, “regular” health issues, behavioral health issues—it is as complex an undertaking as I can imagine (and I’ve been thinking about this for a very long time!) And it seems that among the endless combinations of the aforementioned elements, the task is to distill the response protocols down to essential elements.

But what are those elements?

Listening, remaining calm, maintaining eye contact, not being judgmental, understanding the power of silence, understanding the power of not demanding compliance in the moment, establishing clear expectations, showing cultural sensitivity, building a rapport, avoiding negative verbiage, giving yourself “time” to respond—there’s a ton of call/response data to process in what could be only a few moments (if not nanoseconds). At any rate, I suspect that this is going to be an undertaking that requires the collection of information and experiences from within the four walls of your organization as well as outside.

To that end, I would point you in the direction of a couple of articles that appeared recently in Healthcare Facilities Today. The first article outlines in-state experiences collected by the Massachusetts Health & Hospital Association (MHA) and includes links to MHA’s report on workplace violence in healthcare facilities, as well as links to a United Code of Conduct Principles that MHA has encouraged member organizations to adopt.

The second article is brief (it also mentions the Massachusetts efforts), including some strategies being employed in Vermont.

I know we’ve probably shared this one in the past (probably a fair amount of time past), but it never hurts to check in with the folks at the Occupational Safety & Health Administration on healthcare workplace violence—there’s a lot of useful information that can be linked from this home page.

I’m beginning to think of this as a puzzle for which it seems like some of the pieces are missing. But the “big picture” is really the only endgame to the management of workplace violence, so we may have to come up with some pieces of our own to make it work in our facilities.

About the Author: Steve MacArthur is a safety consultant with Chartis Clinical Quality Solutions (formerly known as The Greeley Company) in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at