Strongline Companion App: Home Health Safety Without Boundaries

Commure Team

Health equity is a primary focus across the U.S. healthcare system today, with frameworks established by CMS and HHS to help clinicians improve the health of underserved communities while reducing the cost of care. Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) are vital providers of care to those communities who need it most, regardless of their ability to pay. According to HRSA:

• Over 1,400 FQHCs and 4,400 RHCs served over 30 millions Americans in 2022. 
• FQHCs and RHCs provide essential access to high-quality primary healthcare services in medically underserved areas, low-income communities, and rural areas. 
• Cost of care is determined by a sliding scale. Among people who received care at FQHCs in 2021, 20% were uninsured and 48% were covered by Medicaid. 

Technology can help FQHCs and RHCs unlock clinical, financial, and operational efficiencies to advance key community health goals and maximize the efficiency utilization of public grants and other funding mechanisms. Here are three ways that clinical care coordination technology can help meet the needs FQHCs and the patients they serve:

1- Improving Clinical and Business Outcomes with Evidence-Based Patient Engagement

Digital patient education and appointment reminders can help improve clinical outcomes by guiding patients on evidence-based clinical journeys to achieve outstanding clinical outcomes, boosting preventative care goals, and patient care adherence to prescribed therapies. Failure to complete preventative health screenings that are essential for early detection of cancers and other diseases that can disproportionately impact communities that FQHCs serve. 

For example, studies have shown that women with public or no insurance are more likely to be diagnosed with breast cancer at a later stage and have more aggressive pathology than those with private insurance. Medicaid-insured patients also have lower breast cancer screening rates and larger time gaps between mammograms. To help fill preventative care gaps, FQHCs can leverage personalized evidence-based patient communications which have been shown to increase patient adherence with critical screenings that can help save lives, such as mammograms. 

Commure Engage is working with Cornell Scott-Hill Health Center (CSHHC) on a multilingual, breast cancer screening program and enterprise-wide appointment reminders. A similar program has been proven to have success reducing the no-show and same-day cancellation rates for breast cancer screenings by 54% at Yale New Haven Health System (where CSHHC is affiliated). 

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Beyond improving outcomes through preventative care, clinical care coordination technology plays a critical role in the long term management of chronic diseases by providing ongoing education, remote patient monitoring, and AI-supported timely intervention. By reducing no-shows and improving patient care plan adherence, FQHCs can optimize the efficiency of their resources and precious provider time. This is essential for nonprofit organizations dependent on public funding and grants. 

Additionally, technology such as AI-powered revenue cycle management solutions can also help automate the processes of getting reimbursed properly for the cost of delivering care –– an especially complex process for FQHCs who provide care on a sliding pay scale for Medicare and Medicaid populations. 

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2- Scaling Population Health Initiatives to Address Public Health Concerns

The behavioral health crisis, including the opioid epidemic, and persisting health disparities related to social determinants of health, including the digital divide, are costly challenges facing FQHCs, RHCs, and the U.S. at large today. In terms of cost of care, a McKinsey analysis revealed that 60% of overall national medical expenditures are driven by the 23% of members who have mental or substance use disorders. This makes sense because symptoms of mental health and substance use disorders can hinder how patients approach and experience the medical care they need. Additionally, nearly 70% of patients with mental health or substance use issues also have a medical comorbidity. 

FQHCs and RHCs can leverage automated patient engagement and clinical coordination technology to better integrate behavioral health factors into overall patient care. Patient engagement technology can be used to scale behavioral health risk assessments such as the PHQ-9, ASAM, SRA, and others to patient populations at large, and specific tools like The Edinburgh Postnatal Depression Scale (EPDS) in maternal-fetal health. FQHCs and RHCs can then prioritize targeted follow up and digital navigation pathways for individuals who are most at-risk, and facilitate coordination between primary and behavioral/mental health care. 

Research suggests that up to 80% of all health outcomes – good or bad – are due to Social Determinants of Health, factors that deeply interconnect  public health with individual health and wellbeing. For example, socioeconomic status is a known determinant. 6 in 10 adults with Opioid Use Disordered are considered low-income, and nearly 1 in 5 are uninsured, underscoring how the population FQHCs serve are impacted by the opioid epidemic. Life expectancy can vary dramatically based on zip code; in one example in Washington, D.C., a difference of 10 miles translated to a gap in life expectancy by 33.5 years. 

Community resource centers can help fill critical gaps related to social determinants of health. FQHCs can leverage technology to help streamline the process of connecting patients with community resources to meet their individual needs. For patients with Opioid Use Disorder (OUD), this could entail connecting the individual with stable housing, settings that provide Medications for Opioid Use Disorder (MOUD), or other treatment programs like Digital Therapeutics for behavioral and mental health like ADHD or Depression.

3- Increasing Access and Closing Care Gaps with Digital Health Tools

The pandemic dramatically accelerated the adoption of telehealth. Patients have spoken loud and clear that they are going to consume healthcare when they want it and where they want it, and that is largely in the home. Their expectations around digital engagement are here to stay. FQHCs and RHCs should be embracing these technologies to expand access to the communities they serve. With CMS loosening reimbursements on Medicare and Medicaid coverage for telehealth appointments that is more feasible. In communities and geographic areas with limited provider coverage, such as rural communities, digital health tools like virtual health appointments, remote therapeutic monitoring, and hospital at home can fill critical gaps to educate and engage patients along their health care journeys. 

While digital tools hold great potential, digital access is now recognized as a Super Determinant of Health. Multiple Federal and State initiatives exist today to bridge the digital divide. Among low-income adults (households below $30K/year), 4 in 10 don’t have access to broadband services or a desktop/laptop computer, and 1 in 4 do not own a smartphone. RHCs and FQHCs require creative partnerships with payers, payvidors, digital health companies and telecom providers to ensure that their communities have access to the essential resources like mobile phones and basic broadband internet access to be able to engage with state of the art clinical medicine using evidence-based digital health tools. 

Creating Affordable, Equitable, and Enjoyable Care For All 

Now more than ever, the entire healthcare industry must think in terms of creative technology uses and innovative partnerships in order to make real strides on our shared goal of health equity. FQHCs and RHCs serve critical missions to improve the health of communities who need it most. Commure is proud to be one such solution provider to deliver automated clinical care coordination and revenue cycle management technologies that can power the clinical, financial, and operational efficiencies to advance key community health goals.

Jeanne Venella, DNP, MS, CEN, CPEN
Chief Nursing Executive / Strategic Advisor - Commure Strongline

Those that know me know that as a nurse leader with over three decades of experience in Adult and Children’s Emergency Departments, I am passionate about three things:

1. Shaping the future healthcare workforce by educating the next generation of leaders and medical staff.
2. Combating workplace violence (WPV) in healthcare settings, a growing and unsustainable epidemic. 
3. Baseball and the Philadelphia Phillies.

‍Having experienced violence myself as a nurse at work, I do not list baseball and WPV together to be trite. Rather, I believe sports are more than just entertainment. They offer a framework to help us to understand leadership, teamwork, and the world around us.

Thus, in the spirit of combining my three passions, I believe we can leverage key principles from the teachings of Jeff Angus in “Management by Baseball,” to create a winning game plan to address WPV in healthcare. As leaders, we have the unique responsibility and opportunity to foster a positive, collaborative, and safer work environment for teams everywhere. 

First Base: Understanding the Current State

Angus explains how managing the mechanics of baseball is similar to other complex problem-solving. It starts with having a clear picture of the business, management, and the team. Baseball organizations rely heavily on data and analytics to make data-driven business decisions, set objectives, and communicate transparently across the organization.

The picture is clear in healthcare: WPV is permeating the playing field for healthcare staff everywhere.

• 82% of nurses have experienced at least one type of WPV within the past year.
• 5% YoY increase in incidents of WPV in healthcare from 2022 to 2023, reaching an all-time high. 
• 21% of WPV victims require more than 31 days away from work, another 20% require 3 to 5 days away from work.
• WPV incidents occurred most often on psychiatric units, the ED, adult units, pediatrics, and perioperative units, respectively.

Exposure to WPV has a significant impact on staff, impairing effective patient care and leading to psychological distress, job dissatisfaction, absenteeism, high turnover, and higher costs. 

Second Base: Creating a Team-Based Approach to Address Workplace Violence

A foundational component of any baseball organization’s success is encouraging a multi-disciplinary, team-oriented culture where every member understands their role and works toward common goals. 

Leaders of healthcare today must take the same approach to achieve our common objective of combating workplace violence head-on. To do so, health systems must bring together diverse work groups with representatives across various parts of the system. Responsibilities of the interdisciplinary workplace violence committee include:

• Establish a baseline across each facility, department, unit to assess incidents of WPV, even analyzing by patient cohort or time of day or night.  
• Identify and develop targets for reducing the incidence rate of WPV.
• Review the current reporting process and identify what measures to improve or implement.
• Evaluate appropriate interventions and tools, and develop standards, processes, and strategies to prevent and reduce WPV.
• Implement an agreed upon approach to introduce new processes to the organization, using a staged or phased approach.

Third Base: Leading With Authenticity 

Authentic leadership, or as Angus describes, a leader who is acutely aware of him or herself and leads with empathy, plays a crucial role in bringing the best out of team members and creating a positive team culture.

Similarly, authentic leadership from healthcare’s frontline and senior leaders  is essential to reducing workplace violence by fostering a culture of trust, open communication, conflict resolution, and support. Team members should trust that they can report their experience and won’t be blamed for what happened or shamed into thinking it’s “just part of the job”.

Reducing and preventing WPV is just half of the problem, WPV management requires having the proper plan in place to respond appropriately when staff are impacted. This means knowing when, where, and to whom an event has occurred. Highly effective workplace violence prevention programs empower staff to report their experiences. Best practices to operationalize and enable include:

• Establishing a process to report incidents in order to analyze incidents and trends
• Promoting empathetic leaders who are trained on how to respond when a staff member comes to them 
• Supporting victims and witnesses affected by workplace violence, including trauma and psychological counseling, if necessary 
• Reporting workplace violence incidents to the governing body

WPV management is a classic example of interdisciplinary leadership, involving clinical, HR, security, legal, and other departments. The scope of this work goes beyond merely responding to incidents  to laying the foundation for continuous improvement, leveraging hard data to make decisions for staff  safety and response processes.

Home Plate: Adopting New Strategies and Tools to Address Workplace Violence

As a response to declining viewership, baseball has adapted its strategies in recent years and to improve the game, changing its rule to include a pitcher’s time clock and lowering the pitcher’s mound. The result has been an increase in fan engagement, reviving ticket generation and bringing in new audiences.

Healthcare’s governing bodies are also adapting to the epidemic of workplace violence. In 2022, The Joint Commission (TJC) mandated new and revised workplace violence prevention standards that will apply to all Joint Commission-accredited hospitals and critical access hospitals to assure organization’s take a systematic approach to reducing WPV.  

There are three new elements of performance (EPs) and two revised EPs to its requirements. These EPs, which fall within the “Environment of Care” (EC), “Human Resources” (HR), and “Leadership” (LD) chapters, directly address workplace violence.

New tools for healthcare organizations such as Commure Strongline wearable staff duress badges put the power in their employees’ hands. They feature discreet panic buttons that empower your staff to call for help at the first signs of distress: immediately providing security and nearby staff your name and precise location to enable early intervention and de-escalation.

Make it a Grand Slam: Don’t Wait to Address Workplace Violence 

Bringing together these lessons from baseball, we understand that success in healthcare requires acting today to address workplace violence. 

As leaders, we have the unique responsibility and leadership position to foster a positive, collaborative, and safer work environment for healthcare teams everywhere. This is the same objective that every baseball management team aspires to as well. And it’s not just good for the team, it’s good for fans, which is good for business.

Keeping your staff safe is not just a moral imperative, it’s a business imperative, and foundational to healthcare itself. When staff feel secure, they can flourish in their roles, leading to enhanced patient satisfaction and delivery of high-quality care.

Ronald A. Paulus, MD
Strategic Advisor - Commure Strongline

After retiring as the CEO of a nationally recognized health system in 2019, I’ve dedicated considerable time and energy to keeping our team members safe for one primary reason: healthcare is one of the least safe places to work, both in the US and globally. In fact, US healthcare workers are four times more likely to be exposed to workplace violence than police officers or prison guards.

As leaders responsible for so many different things, I understand it is natural that we might feel overwhelmed at times by problems as complex and widespread as healthcare workplace violence. Yet no matter the scope of that challenge, we each bear the paramount responsibility of keeping our patients and team members safe.                

The Hidden Costs of Workplace Violence in Healthcare

Workplace violence not only extracts a heartbreaking human toll, but is also unsustainably costly for healthcare organizations (exceeding $800 million annually in 2017), especially given our unprecedented staffing crisis. Workplace violence associated costs include:

• Harm to Staff Emotional Wellbeing: Those exposed to workplace violence are 2-4x more likely to report high levels of PTSD, anxiety, depression, and burnout.
• Staff Time Away from Work: Violence-related injuries are four times more likely to result in time lost from work compared to other workplace injuries.
• Elevated Staff Turnover: Nurses’ perceived safety of their work environment is the top factor influencing whether or not they will stay in their current patient care role.
• Costly Fines and Fees: Workplace violence events frequently lead to regulatory scrutiny, fines, litigation expenses and settlements.

How Patient Safety Applies to Workplace Violence in Healthcare     

Fortunately for all of us, lessons learned from the patient safety movement provide a clear approach to tackling the complex and systemic problem of workplace violence. 

Recall that we faced an equally alarming and seemingly insurmountable challenge in patient safety when To Err is Human was published in 1999 creating a firestorm by calling out that potentially avoidable medical errors killed up to 98,000 Americans annually.  Even after this watershed report, many hospital and health leaders failed to take action to transform patient safety. To many, the problem seemed too daunting and amorphous and it took nearly a decade after that seminal moment before the industry initiated powerful collective action.

In 2012, the Patient Safety Movement Foundation was established to develop an action-oriented approach to eliminating preventable patient deaths. And by 2020, it had reached nearly 4,800 hospitals collectively saving more than 350,000 lives.  The movement’s powerful recipe for change is directly applicable to our fight against workplace violence.  Using their model, we can tweak it to guide our response to workplace violence as follows: 

• Broadly raise awareness about the frequency, severity, and preventability of WPV.
• Call for national leadership and coordinated efforts to set goals, influence policy, develop safety standards, and support training and research on safety best practices.
• Establish a shared commitment from health system leaders to markedly reduce WPV. 
• Emphasize that WPV stems primarily from faulty systems, processes, conditions and technology (or lack thereof) rather than individual behavior.      
• Promote a cultural shift to openness and transparency about WPV events (or precursors) rather than blame and punishment. 
• Advocate for better incident reporting systems, both mandatory and voluntary, to get data-driven insight into where and why violence occurs and inform strategies for improvement. 
• Perform root cause analyses for each significant violent event to identify opportunities for prevention. 
• Implement best practices and technologies that have been shown to improve worker safety and outcomes.

When healthcare leaders came together enabling collective action on patient safety, we saw tangible change –– hundreds of thousands of lives saved that would otherwise be lost to medical errors.  It’s now our collective obligation to replicate that same approach today to form a movement to eliminate workplace violence.

Preventing Workplace Violence in Healthcare with a Tech-Enabled Approach

One key reason the Patient Safety Movement saved lives was by spurring the adoption of new technology. Tools like medication barcoding, clinical-decision support, and clinical alerts flagging deteriorating patient condition or potential sepsis (with associated clinical protocols) all played key roles in keeping patients safe. 

But the most common tools deployed in the fight against workplace violence today, such as fixed panic buttons and enhanced security cameras, routinely fail to make an impact and do not proactively de-escalate violence. Other partially effective tools, such as those leveraging nurse call systems or hard-wired RTLS systems, typically cover only a fraction of staff and exclusively interior space. To complement a multi-pronged workplace violence prevention program, an optimal staff-safety technology solution must have five core characteristics:

1. Prevention & De-escalation: The system must enable a team member to signal the need easily and discreetly for help early in an escalating situation.  Because de-escalation is so critical, this capability and associated staff training to “press early and often” are essential.‍
2. Real-Time Location Services: When a duress alarm is activated, the system must trigger an alert that identifies the specific team member under duress by name and location, and also provide continuous location updates to all alerted team members until the event is resolved.‍
3. Customizability: The system must notify security, nearby colleagues (who are best positioned to assist with early de-escalation), and subscribed team members via a variety of alerting mechanisms that fit the organization’s existing workflows (e.g.,  hand-held devices, hands-free communication badges, etc.).‍
4. Universal Coverage and Ease of Use: Protection must be provided to all staff in all locations (both indoors and outside in garages and walkways, etc.) without the need for any action or configuration on the user’s part when moving between sites (for instance, from a hospital to an ambulatory clinic, or from one hospital to another).  ‍
5. End-to-End System Monitoring: The system must be affordable, easily installed, and produce minimal disruption to clinical, operational, and information technology resources, while being monitored around the clock to ensure continuous availability.

Designed from the ground up by health care team members to protect health care team members, the Commure Strongline staff safety system meets all of these tests and more. 

Inspiring Hope: Patient Safety’s Roadmap for Workplace Violence in Healthcare

The systematic approach that ultimately mitigated the patient-safety crisis provides important lessons and a roadmap for addressing today’s healthcare workplace violence crisis. It also provides an important reminder of the power of collective action and why we can't afford to wait to take action. Beyond its tragic human toll, workplace violence is also incredibly costly due to staff turnover, time lost from work, workers compensation claims, jury awards, fines, regulatory friction, and even impaired patient satisfaction and clinical outcomes. It is far more effective to use our resources to fund evidence-based strategies to mitigate and ultimately eliminate workplace violence.

By following the lessons learned from the patient-safety movement, we as healthcare leaders can help tame the scourge of workplace violence permanently. That opportunity and our collective responsibility provides a poignant call to action to join the movement to eliminate workplace violence in healthcare.

Please visit Commure Strongline to learn more about their innovative system and schedule a demo to see how these solutions can benefit your organization.

Andrea Mazzoccoli, RN, MSN, MBA, PhD ,FAAN
Chief Nursing Executive / Strategic Advisor - Commure Strongline

The role of a Chief Nurse has never been more complex or demanding. As healthcare rapidly evolves, Chief Nurses are tasked with advancing nursing standards, ensuring quality outcomes, and creating environments where their teams can thrive. To be effective, Chief Nurses must advocate for a workplace that supports their staff’s well-being, provides growth opportunities, and ensures nurses feel valued and heard.

A key challenge in this leadership is the interrelationship between three critical issues: workplace safety, workforce stability, and overall well-being. Addressing these factors is essential not only for retaining top talent but also for ensuring positive patient outcomes.

The Impact and Prevalence of Workplace Violence in Healthcare

While there is growing awareness of the epidemic of workplace violence, this problem is not new. As a nurse leader with decades of experience, this is something I see nurses having to endure on a daily basis. Press Ganey recently quantified this, finding that nursing personnel faced over two assaults every hour on average during Q2 2022. This staggering number equates to nearly 57 assaults daily, 1,739 monthly, and over 5,200 per quarter. 

The World Health Organization shared recent data that 1 in 4 patients are harmed in hospital or ambulatory settings. Workplace violence isn't just a safety concern—it’s also closely tied to staff morale and patient care. Staff safety and patient safety are inextricably linked. Hospitals with high workplace safety ratings typically demonstrate stronger patient safety cultures. Conversely, environments where violence is prevalent often see lower employee engagement, higher medical error rates, and adverse patient events. 

Nurses who experience violence are also more likely to suffer from emotional exhaustion, which negatively impacts patient safety perceptions. When nurses feel unsafe, they’re more likely to disengage and even consider leaving the profession altogether. In fact, according to National Nurses United (NNU) 65.3% reported anxiety, fear, or the need for increased vigilance at work; 33.4% experienced physical injury or other physical symptoms; and 37.2% considered leaving the profession entirely.

These challenges highlight the importance of creating safer work environments, not only for the well-being of nursing staff but also for maintaining the high standards of patient care that hospitals strive to achieve.

The Chief Nurse’s Role in Leading Workplace Safety Solutions

Workplace safety is a multi-disciplinary challenge, requiring collaboration across departments such as safety/security, information technology, operations, and clinical teams. However, Chief Nurses play a particularly critical role, as they are responsible for guiding the professional actions and interventions of nurses at the point of care.

For any workplace safety solution to be effective, it must have the Chief Nurse’s leadership. By championing workplace safety programs and ensuring that nurses have the tools they need, Chief Nurses can drive meaningful change. The ultimate goal is to create an environment where nurses can provide safe, high-quality care without fear for their own safety.

Developing Effective Workplace Safety Solutions

Building a comprehensive workplace safety program involves multiple layers:

1. Leadership Commitment and Employee Participation
2. Worksite Analysis
3. Hazard Prevention and Control
4. Safety and Health Training
5. Measurement, Analysis, and Program Evaluation

These foundational elements must be paired with practical, technology-driven solutions that empower healthcare staff. One such approach is implementing reliable systems that promote de-escalation, offer early notification, and enable rapid response to threats.

Creating a Safer Future with Workplace Safety Technology

As healthcare rapidly evolves, workplace safety must remain a priority, and Chief Nurses are essential to leading this charge. Investing in workplace safety technology solutions is not just about preventing incidents—it’s about empowering nurses to deliver the best possible care in an environment that values their safety and well-being. With strong leadership and powerful technology solutions, healthcare institutions can create safer spaces for both staff and patients.

Commure Strongline is leading the way with its cutting edge duress-alerting system. By providing visibility into real-time locations of staff members in distress, Commure Strongline ensures that help is just a button press away. This allows nurses to focus on delivering patient care and not worry about whether they are safe in the workplace.