The murders of four healthcare workers earlier this year, including two physicians, by a patient at a medical center in Tulsa was a grave reminder of an ever-growing epidemic: deadly violence against those dedicated to saving lives.
The epidemic struck close to home here in Austin last year when a beloved 43-year-old pediatrician was killed following a hostage standoff with an attacker, a terminally ill pediatrician the doctor didn’t know, who committed suicide.
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More than seven out of every 10 instances of workplace violence in the U.S. occur in a healthcare setting, according to the CDC. In the past few years, lawmakers and regulators have prioritized the issue. Last year, The U.S. House of Representatives passed the Workplace Violence Prevention for Health Care and Social Workers Act. Among other measures, it requires the Occupational Safety and Health Administration (OSHA) to create enforceable safety standards by 2025.
States also have laws in place to protect healthcare workers. Both federal and state efforts dovetail with those of The Joint Commission, the accrediting body for hospitals, which this year released new standards requiring hospitals to develop workplace violence prevention programs and track data on threats at their facilities.
In my professional career, I have investigated numerous acts of violence as a counter-terrorism agent, and as a security consultant for corporations. One sad fact of violence is that most perpetrators leave clues beforehand, and many incidents could have been prevented if only someone had connected the dots.
Organizations however are primarily reactive in nature. Changes often only come in the wake of tragedy. This moment in time is different because there’s a lot of technology and training in the market that can and should help healthcare organizations tailor proactive and preventative anti-violence programs.
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Human resources executives in the healthcare sector also have a crucial role to play. They’re a vital link between the front-line workers that face violence, and the executives tasked with setting policies to address it.
Training, awareness and data
The foundation of any violence reduction program is broad-based training, awareness and data. These pieces are critical and interrelated.
Research suggests that violence in healthcare goes unreported because some workers accept it as “part of the job.” We should not normalize violence. At a high level, failure to report incidents of violence can undermine anti-violence programs because it hinders data collection that is the basis for targeted strategies.
Such data helps executives identify trends in their facilities, like the time of day that violence is most likely to occur, the departments that face the most risk and even staff members that face a disproportionate amount of violence. Without incident reporting, it’s hard to match resources to risk.
To encourage incident reporting, healthcare leaders need to ensure that their front-line, patient-facing staff members are aware of how to anonymously report behaviors of concern, as well as educated on what types of incidents should be reported. The Joint Commission’s definition of violence, for example, is extremely broad. It includes verbal harassment. But that is important because verbal abuse can precede incidents of violence.
In efforts to stop mass shootings at schools and workplaces where the offender is a known entity, experts have developed behavioral threat assessment models, an interdisciplinary, evidence-based tool that reviews risk factors of potential violence on the part of a specific individual. What we often see in instances of planned violence is a pattern of behavior that includes warnings and implied threats from the perpetrator. This means verbal threats and intimidation should be taken seriously. Whether made by a colleague or a patient, these types of incidents need to be communicated to a team responsible for violence prevention.
Threat assessment training is very good at helping to identify potential planned acts of violence, from families, patients that have been violent in previous visits, stalkers and disgruntled former employees. Threat assessment has its place in a healthcare setting, but front-line staff – especially those in emergency departments – don’t have the luxury of always dealing with known entities.
Training should also take into account risk factors for spontaneous, unplanned acts of violence. Some of this won’t come as a surprise, but it’s important that staff can identify situations where they can ask for assistance before a tragedy occurs. De-escalation techniques and crisis management are also vital skills that can be incorporated.
Holistic approach
Comprehensive security can be a challenging balance for healthcare institutions. By the very nature of what they do, staff needs to be open, supportive and empathetic. But they also need to be on guard for threats. The pressures and stress of the pandemic, exacerbated by political rhetoric, have made threats more common. The Supreme Court’s decision in overturning Roe v. Wade has ratcheted tensions in this sector even higher.
Workplace violence requires a holistic approach. We can teach nurses and doctors how to de-escalate tough situations, employees how to be aware of alarming statements from colleagues and how to encourage them to use an employee assistance program.
But unless there’s two-way communication between front-line staff and the executives that set policies and allocate resources, it’s really difficult for organizations to meaningfully reduce their risk. Security-specific technology platforms can foster communications and data analysis.
Doctors and nurses don’t have to live in a world where security is just good enough when they could do so much better with proven tools, processes and technology.
Photo: okanmetin, Getty Images
Fred Burton is one of the world’s foremost authorities on Protective Intelligence, security and counterterrorism. As Executive Director of the Ontic Center for Protective Intelligence, he spearheads strategic consulting to physical security leaders at major corporations, advising how to optimize their security programs, streamline protective intelligence initiatives and keep their people safe. Ontic is digitally transforming how businesses proactively address physical safety through a unified protective intelligence software platform.
