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How many times have you seen this happen? An awful instance of workplace violence by a patient at a hospital makes the local or national headlines. The media takes the story and runs with it. Then the impacted hospital puts out the standard issue response that goes something like this: “At [insert hospital name here], we take the safety and security of our staff, patients, and visitors seriously. We are investigating this incident and cooperating with local law enforcement. In response to this incident, we are adding more security officers, installing security cameras, adding panic alarms and [insert additional security theater measures here].”
Sound familiar? I just wrote that blurb from memory because I’ve read it so many times. Here’s the problem with that statement- while it may appease the public, the clients of the hospital, and maybe some employees, it represents a problem with the mindset that some healthcare organizations have regarding workplace violence. You see, the statement suggests that these measures are what actually will help stem the issue of workplace violence by patients. How many times have you seen footage of violence in a hospital recorded on security cameras? What about panic alarms? Do those prevent violence or simply provide a means to report it once it is already happening? I think you get the idea here. All of these measures are an important part of the layered approach to providing security within the hospital, but they don’t necessarily get to the root of what causes patient violence, which is the most prevalent type of violence in hospitals.
The root of patient violence is clinical in nature and, therefore, must be addressed at the clinical level. The vast majority of patients who assault staff don’t do it because they are sadistic, violent people who like to hurt others- they do it because their underlying condition causes them to act out aggressively. For example, a 2014 study from the Journal of Hospital Medicine found that “Delirium affects up to 82% of critical-care patients and 29% to 64% of general medical patients…” The study found that “Delirium preceding...combative behavior was present in 50% of patients with combative behavior requiring intervention…” So, what does this mean for violence prevention and mitigation? It means that assessing and treating patients for delirium can help mitigate violence against caregivers. This is just one example of a clinical intervention that can prevent violence.
“The root of patient violence is clinical in nature…”
Have you seen any studies that have statistically indicated that security cameras prevent violence lately? I didn’t think so. What about panic alarms- any research on how they prevent or mitigate violence? These are both helpful tools as part of a layered security approach, but they don’t prevent violence.
What does this all mean, then? It means that, if hospitals truly want to prevent and mitigate patient violence at its roots, the focus of these efforts must shift to a clinical-focused strategy and away from a security-focused one. Here are just a few examples of these clinical-focused efforts:
Behavioral Emergency Response Team (BERT)- This is a multidisciplinary team that intervenes in situations where a patient requires de-escalation or proactive measures, such as a better medication strategy, an acute care plan, or more.
S.A.F.E. Response- A comprehensive, multidisciplinary program to prevent injury from violence using training, standardized interventions for clinical conditions affecting safety, and a clinical debriefing process.
Project BETA - Project BETA (Best Practices in the Evaluation and Treatment of Agitation), Developed by the American Association of Emergency Psychiatry (AAEP) details guidelines for non-coercive, collaborative approach to managing acutely agitated patients based on on the best available evidence and expert consensus recommendations.
Don’t get me wrong, violence is a whole hospital issue that requires a collaborative, multidisciplinary approach with executive-level buy-in and visible support from the top. However, the focus of the prevention and mitigation efforts must shift to evidence-based clinical strategies - like those noted above - that are implemented in collaboration and communication with security and other services.
“Violence is a whole hospital issue.”
This approach aligns with my recent article advocating for the development of a Safety from Violence Officer (SVO) role to lead workplace violence prevention and mitigation efforts. A clinical-led, multidisciplinary, evidence-based approach to tackling the growing issue of violence is not as easy or as quick as adding cameras, panic alarms, and extra security coverage, but the payoff for staff and patient safety is sure to be much greater.
What are your thoughts about this approach? I’d love to hear from you.
