What workplace violence prevention can learn from emergency management
By Matt Phillion
A new survey of 500 healthcare professionals has delved into obstacles these professionals face, with personal safety, mental health, and burnout rising to the top. Among the findings in the report, nearly half (46%) of respondents said that a violent incident occurred in their organization in the past year. Nearly three-quarters (72%) said that a patient becoming violent is their biggest safety concern at work.
The survey found that most respondents believed that their organizations are extremely or very well prepared for incidents like a fire (75%) and severe weather or a natural disaster (64%). By comparison, 40% believed that their workplace is extremely or very well prepared for an active assailant incident.
Is healthcare falling behind in terms of keeping staff safe from violent patients and other personnel safety issues? “That’s not a fair assessment,” says Todd Piett, vice president of Rave Mobile Safety, a Motorola Solutions company. “It’s a trend across all industries, with schools leading the way in preparation given the enormity of some of the tragedies highlighted in the press.”
The results of the healthcare survey aren’t surprising, though, he adds. “We’re in the midst of a mental health pandemic where we’re seeing issues as a society at large. Mental health challenges are not unique to healthcare. The fact is, people are impatient, and when you go into a healthcare setting you’re already stressed, so it’s a powder keg of events.”
Neither is workplace violence a new problem, Piett notes. “Violence in the workplace has always been a top concern for healthcare, both in hospitals and the broader ecosystem of visiting nurses and social workers going into settings that are already fraught with risk,” he says.
The stressors over the past few years have escalated tensions as fear and anxiety collide with new rules for being on-site in a healthcare setting. But our improved tracking of incidents might also be bolstering the data signal. “I don’t know whether there’s been an increase or if we’re just gaining better awareness around it, but there’s a ton of interesting components we can pull from the survey,” says Piett.
His organization got its start in education settings, but the connection to hospitals was logical because there are many commonalities between the two industries. “They both have campus environments, people working all hours, lots of transient populations coming through with buildings that tend to be open to people going in and out,” says Piett. “It’s a combination of things that can lead to violence.”
Emergency management’s role
How can we alleviate the concerns of healthcare workers and do more to keep them safe? Some answers may lie with emergency management—a team that staff have confidence in for disaster response, according to the survey.
“Something that comes out of emergency management that we don’t often think about is the focus on the entire emergency continuum,” says Piett. “How do we ensure that everyone knows what’s going on and what they’re supposed to do and what responders need to do? We have solutions that empower a person to communicate effectively to a big group of people during an active shooter situation or when someone is starting to behave in an emotionally unstable way. What’s interesting is emergency management thinks a lot about before and after—how to mitigate, prepare, and recover afterward—more so than just on response.”
One difference between a natural disaster and interpersonal violence is a reluctance to speak up. There’s no concern about reporting a disaster, but often staff will be hesitant to report a colleague’s unusual behavior, for example. “You don’t want to be the one who says so-and-so is acting weird this week,” says Piett.
The challenge is to make it clear across the spectrum that raising a concern isn’t about getting someone in trouble but rather potentially helping them. Here’s where the right tools, both technological and cultural, can be used to encourage reporting. “There’s technology that can play a role in anonymous tipping, but you also need to establish a culture where employees understand they are helping a person get the help they need rather than getting them in trouble,” he says.
With emergency management, there’s a lot of time spent on up-front action: Is there enough water? Are there enough blankets? There also needs to be significant after-action consideration. “In healthcare, there’s a constant flow of things happening, and very often we don’t take a step back and take a breath,” says Piett.
Taking the time for a post-incident assessment can make a huge difference. “What happened and how can we mitigate this in the future?” says Piett. “Did we know going into this session that the patient was upset and so we should have had a second person in there?”
Once those lessons have been considered and codified, health systems can build in automations to address them in the future. “Lots of processes can be automated up front so you don’t forget in the heat of the moment,” says Piett. Much of this automation involves developing a process that brings an emergency mindset down to the individual level instead of making it solely an institutional responsibility.
“As individuals, we tend not to think about catastrophes. We wing it and figure it out. Emergency management does a great job communicating and raising awareness and keeping safety top of mind,” says Piett.
In healthcare, there’s a lot of noise to cut through: a constant flood of new or changing protocols, training, new technology. How can training and tools be built into everyone’s day to promote muscle memory that takes over in an emergency?
“A safety culture needs to be prevalent every day so people get used to it. Otherwise, emergency protocols will be forgotten in the moment,” says Piett. “Safety needs to be part of the daily operational workflow.”
Changes that make an impact
In many ways, improving personnel safety is a matter of removing additional risks so that the unremovable ones can be addressed as they arise.
“When we work with first responders, we hear: There are risks with my job, but can we eliminate the risks that don’t need to be there?” says Piett. “The answer is yes: You’re running into a burning building, so let’s make sure your radio works.”
These solutions don’t necessarily require expensive fixes, either. “It requires us saying it doesn’t have to be this way and we can fix it,” says Piett. “I want to make sure I watch out for risks and report them.”
Healthcare workers are tough by nature, and many hold the view that risks are just part of the job, but that’s a fallacy, Piett notes. “Most people in healthcare are empathetic and care for others, but that does not mean that workers should accept risks that impact their personal safety or the well-being of others,” says Piett. “If I could wave a magic wand, I’d make it so that everyone took a more active role in safety. We can all contribute to helping others.”
Many tools exist to enable better reporting, faster action, and better analysis to prevent future incidents, he says. “There are simple tools that allow employers to communicate risks and make it easy to set up anonymous reporting,” says Piett. “These are low-tech solutions that will allow staff members who see things every day to communicate effectively and efficiently. We simply have to provide workers with the right solutions to communicate.”
The key to this is making sure there’s no fear of repercussion for reporting, Piett notes. “If we enable employees to report safety concerns and explain no one is going to be targeted for calling out suspicious behavior, staff will be more apt to take positive, proactive action,” he says. “Active shooter uses cases get more press attention, but there are emergency incidents happening all the time in hospital settings that warrant our attention and action.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at firstname.lastname@example.org. This story first ran on PSQH.