In this blog, hear from a former health system CEO about the important lessons healthcare can apply from the patient safety movement to tackle workplace violence in healthcare.
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:
- 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.
- 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.
- 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.).
- 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).
- 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.
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