Addressing workplace violence in healthcare requires a holistic approach to protect care teams and patients

12.10.2024

by Liz Boehm
Executive Strategist, Human-Centered Research

It's an all-too familiar scenario. A nurse is tending to a patient when suddenly the patient physically strikes her, breaking her nose and shattering her sense of safety. Or a physician is visiting a patient’s room when the family, distressed about their loved one’s prognosis, lashes out with threats of violence. For too long, violence has been viewed as "part of the job” in healthcare, where patients and families are often dysregulated by illness, substance or stress. The frequency and severity of workplace violence (WPV) incidents have risen significantly over the past several years, making it challenging for healthcare organizations to maintain the safe and supportive environments that healthcare team members deserve.

To learn moreabout this epidemic and how security personnel and other care team members are addressing it, I invited Todd D. Miller, CPP, CHPA, System Vice President of Security for SSM Health, to join me on the Caring Greatly podcast. During our conversation, Todd shared key strategies for enhancing workplace safety, including de-escalation, trauma-informed care and attending to the wellbeing of security teams. With 23 hospitals and more than 650 outpatient clinics under his purview, Todd brings a wealth of experience from his role at SSM Health and his time as a Special Federal Officer with the FBI’s St. Louis Safe Streets Task Force.

De-escalation and training for prevention

As Todd emphasized, WPV is not an issue that only security professionals are addressing. It’s a system-wide crisis that is a top concern for most, if not all, the healthcare leaders I talk to in Heart of Safety Coalition and beyond. As hospitals and health systems embrace trauma-informed leadership and care principles, more security protocols are including de-escalation strategies as a way to manage potential threats and minimize physical interventions.

De-escalation is about reading people’s behavior – sometimes subtle shifts in tone, often rising anger – and responding in ways that support connection and help to lower the emotional temperature of a situation. Todd stressed that situational awareness is key for all healthcare workers, not just security professionals. His team collaborates closely with staff across facilities to raise awareness of early warning signs and train them in de-escalation techniques.

And the onus is not just on care team members. Todd also advocates for Crime Prevention Through Environmental Design (CPTED) in any new building design. This involves designing and organizing physical space, lighting and other environmental factors to reduce opportunities for violent incidents. In addition, technologies such as surveillance and communication systems play a crucial role in maintaining a safe environment.

Evolving role of security professionals

As SSM and other health systems have embraced more de-escalation strategies and trauma-informed leadership, security roles have also evolved. According to Todd, the profile of effective security professionals now combines traditional security skillsets with a capacity for building connection and empathy with care teams and the patients and families with whom they interact.

His team receives regular hands-on training in communication, empathy and trauma-informed responses, ensuring that security officers can effectively connect with patients and families while managing risks. The ability to read emotional cues and establish trust with vulnerable individuals is just as critical as physical defense skills, and it helps security and clinical team members align around the same intent, goals and language.

Protecting security team wellbeing

In addition to their role as protectors, security professionals must also be protected and supported. Todd and his leaders provide resources for security team members, including post-incident debriefs and mental health support. He explains that witnessing or being involved in violent situations can take a toll on anyone and creating a culture of safety, where security officers are encouraged to express their emotions and seek help, is essential for long-term success.

What's next?

As incidents of WPV continue to rise, organizational leaders will be challenged to extend de-escalation skills and security knowledge and infrastructure beyond traditional hot spots such as the emergency department and behavioral health settings. SSM’s approach of marrying security skills with core care skills such as trauma-informed responses and caring responses to those who experience violence creates a culture in which all team members are aligned for effective response.

The next priority is setting and communicating clear expectations for patients, visitors and employees about appropriate and acceptable behavior. Consistent enforcement of clear patient codes of conduct, together with an audit process that ensures that these rules and guidelines are applied equally to all members of the community, has the potential to shift the culture in healthcare to one in which verbal assault, racism, physical violence and other inappropriate conduct is not tolerated. And that would make healthcare better for all.

Addressing workplace violence in healthcare requires a holistic approach to protect care teams and patients

12.10.2024

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