A perspective of care and welfare is the ideal foundation for true safety and security, but many health care orgs need a paradigm shift to truly sustain a culture of safety.
CPI’s founder, AlGene Caraulia, Sr., has shared that key values of violence prevention crystallized for him when he was brought in to train psychiatric staff in de-escalation techniques. When he observed staff rapidly opting to manage disruptive patient behaviors with chemical and physical restraints, he realized that an emphasis on attempting to control or suppress behavior, versus facilitating supportive de-escalation, was taking the focus away from the larger goal of patient well-being. Professionals who were charged with caring for a patient’s mental health were more focused on applying force instead of therapeutic support.
As he tells it in his 2017 interview
, by re-framing the conversation to focus on the importance of care and welfare, Caraulia was able to support a staff paradigm shift from dominance and force to true safety and security.
The need for a paradigm shift is as critical now as it was nearly 40 years ago when CPI training was first introduced. Security professionals and clinical professionals are tasked with two seemingly divergent responsibilities that have the same end goal: to create sustainable cultures of safety where staff are empowered to deliver quality care, and patients are secured to receive the best possible outcomes. Bridging these two worlds starts with letting go of some long-held assumptions about the role of security in health care
, and focusing on the larger values that we can agree must be paramount—Care, Welfare, Safety, and Security℠
Collaboration across departments requires letting go of long-held assumptions and empowering staff to participate in meaningful violence prevention.
“We’re all trained, experienced officers, and we realized that the best skills are the verbal skills—and not the hands on.” When CPI talked to
Don Costa, manager of the protective services department at Yale-New Haven Hospital, he clarified that successfully bridging the relationship between security and psychiatric departments in his hospital was rooted in the common ground of practical prevention.
Building sustainable collaboration within a culture of safety can be accomplished through employing a common language of best practices that span roles and departments. But teamwork can be hindered by the belief that some roles or departments are so fundamentally and culturally different that it’s impossible to be on the same page.
Breaking down this siloed thinking starts with changing our perceptions of ourselves. Regardless of where we work within an organization, we each can facilitate meaningful violence prevention through collaboration. But we must be willing to explore our roles—and the roles of others—with a fresh perspective that considers what’s possible.
Global Professional Instructor Dave Vargas, who also works in law enforcement, echoed the need to adjust commonly held beliefs about the role security departments play in clinical settings, particularly in challenging security experts to evolve their own thinking about intervention and the use of force. He tied it to the experience that many law enforcement and military professionals have as they add years of experience to their foundational training. “I think that when most police officers are trained, when they go to the police academy, that they train the officers to take the enforcement action. It takes a few years of experience and being a more veteran officer, and maybe for some it takes a few more years than others, to realize that really it's not just about enforcement action—it's about taking that corrective action.”
Learn more about how Don Costa developed a successful collaboration between Security and Psychiatric departments at Yale-New Haven Hospital.
Staff-wide training supports the adoption of common language and universal best practices that give every staff member, patient, and visitor a valued role in the culture of safety.
Exploring the notion that Integrated Experiences span from individuals to departments opens new avenues of possibility for practical violence prevention. Sara Holland has worked extensively to implement meaningful safety training into the health care setting, and as both a nurse and CPI Certified Instructor, has led a successful collaboration between security and clinical departments in her hospital. For example, her hospital saw a 55% reduction in Code Greys after implementing org-wide training that included every
layer of staff—not just those departments that are traditionally assumed to have the highest risk of challenging and disruptive behaviors.
that the concept of the Integrated Experience helps shatter assumptions and stereotypes that keep staff from successfully preventing or safely intervening when confronted with challenging behavior. In fact, since her interview, she has facilitated meetings between her hospital's Security and Psychiatry departments to establish strategies for improved collaboration that have contributed to improved workplace violence prevention.
“One of the reasons that we chose to do that was because at any given time, people are in and out of the hospital. And there may be an issue where someone from the lab will have to step in and help someone from the emergency room and the waiting room, or you might get someone from one of the outlying clinics who's here for training and comes across this situation where now they can step in and help out. We wanted everyone to have the same skills, to have the same opportunity to learn at the same level because, as you know, if you’ve got two people who don't have the same training and they try to help, somebody can get hurt. It actually gets worse than not having any training at all.”
Learn more about how Sara Holland helped her hospital achieve a 55% reduction in Code Greys by developing a successful collaboration between Security and clinical departments.
Even if you’re not in a leadership role, you can take meaningful action to improve collaboration and lead culture change. Try these 4 tips.
If you’re ready for a more robust culture of safety at your hospital, you can take these steps immediately:
1. Share best practices with your coworkers that can be used right away.
The Joint Commission recommends CPI’s Top 10 De-escalation Tips (available as a free download next to this blog post!
) as an immediate tool that anybody can use to stay safer on the job. These are simple strategies for effectively defusing challenging and disruptive behavior before it escalates into physical violence.
2. Find out what other organizations are doing to measurably reduce incident rates, cut lost time, and keep staff and patients safer for the long-term.
As agencies like OSHA continue to assess org performance when it comes to violence prevention, security directors and hospital administrators have achieved results that can be replicated. Getting their firsthand insights and the metrics that document their success
is a solid way to lock in your leadership’s attention and make the case for teamwork across departments.
3. Get informed about the training solutions that fit various departments’ corresponding levels of risk AND fulfill regulatory guidelines by achieving measurable results.
Training is the best way to foster collaboration and get staff across an organization on the same page about violence prevention
. But who’s really at the most risk, and what type of training solutions are going to be the most effective for them? Knowing these answers
will guide a conversation to a conclusion where decision makers can take action.
4. Lead by example—if you want your organization to shift their paradigm, make sure yours is shifted, too.
Organizational cultures can exist by default, or by design
. If you want to facilitate an environment of safety and caring, even the simplest choices can have a profound impact
on your peers. Your behavior has the power to impact what others say and do—have you owned your side of the Integrated Experience
As person-centered care moves from best practice to regulatory requirement, a meaningful culture of safety is more critical than ever.
Across health and human services fields, standards are evolving to require
a truly person-centered approach in achieving optimal outcomes for patients and clients, instead of just recommending it. Facilitating services that are maximally responsive
to every person’s unique needs, values, and preferences requires a supportive team dynamic among care professionals and org staff. Accordingly, Environment of Care standards have continued to evolve
to include thoughtful and effective security programs that are inclusive of staff across an organization.
A unified approach that shares a common and approachable language, bolstered with supportive and constructive behaviors, has never been more essential to achieving sustainable safety and security for individuals and organizations. Across the US, a handful of states have adopted legislation that requires meaningful violence prevention training for health care staff
—and professional organizations are continuing to lead the charge for further implementation of such standards.
It’s no longer just a promising idea for security departments to evolve their own long-held beliefs, and clinical and administrative professionals to explore the potential for positive collaboration with their protective services staff. Because the rate of violence against health care workers continues to soar and patient outcomes are impacted by the stress placed on staff, regulatory agencies are now demanding that person-centered approaches that value the care and welfare of both staff and those they care for be reflected in the safety and security strategies of their organizations.
When you shift your paradigm, real change is possible. As AlGene Caraulia, Sr., recalled:
“As I was teaching staff how to protect themselves, all of a sudden it occurred to me that I was teaching them something that was incorrect. I was not teaching them what was the essential core of what they were doing as mental health personnel…It eventually got to the point where it made sense to me that they were not there to learn how to defend themselves. They were there for the care and welfare and safety and security of the person in their care…Once that occurred to me, it was clear to me that we were not there to teach staff any violent methods.”
A culture of safety starts with a paradigm of nonviolence. Have you set the stage for a successful collaboration between security and clinical staff for violence prevention at your organization?
For an inside look at how collaboration can drive meaningful change, check out Episode 65
of our podcast, A Team Approach to Stopping Workplace Violence in Healthcare Settings.