There are simple steps you can take right away toward hospital violence prevention.
I’ve worked with many hospitals and health systems in my capacity as a CPI Global Professional Manager and Instructor over the last 15 years. I recently walked through a facility that hadn’t yet implemented our violence prevention training, and I challenged its staff to examine their space through CPI-tinted lenses.
It’s kind of like X-ray vision — except that instead of broken bones, you can spot opportunities to create a culture of safety. It’s surprising how many hospital violence prevention strategies are right in front of you — I spotted 10 just walking the halls.
But don’t worry — doing something about these missed opportunities is easier than you think. We’ve been helping hospitals just like this one create cultures of safety for over 35 years.
Hospitals can be expansive facilities with complex org structures, something I know well from many years working on-site with staff to implement violence prevention training. So, this won’t be an exhaustive tour, but it will be a mindful stroll.
Engagement starts at the entrance
Let’s start by walking through the main entrance of the hospital. I’ve got a backpack, a bag, and a beverage. It looks like there’s a check-in/security desk, but the gentleman posted there doesn’t look up when he asks for my name. There’s a list of scheduled visitors, but my name isn’t on it. He seems annoyed that I’m not on his roster, but unfazed. He hands me an ID badge — after handwriting a notation on it — and points me to the elevators.
I can already check off two missed opportunities to keep this hospital safer:
1. An opportunity to assess who’s entered the building and constructively engage with them.
A person’s nonverbal behavior will convey a message. By not making eye contact or speaking with me, this staff member missed a critical chance to assess my appearance and behavior as I entered the facility. Additionally, a person carrying as much luggage as I was might warrant a bit of extra assessment.
Eye contact and social engagement can make the difference between de-escalating somebody who’s on the verge of disruptive behavior, versus someone who enters a facility unnoticed and instigates a major incident.
2. An opportunity to acknowledge and support an individual who may be in distress.
Today, I was at the hospital for work-related purposes. But due to a chronic case of clumsiness, I’ve been to hospitals for other reasons as well. In none of those instances did I wake up and add “injure self and go to hospital” to my to-do list.
Photo: Sopotnicki / Shutterstock
I also know that the vulnerability of being a patient tends to make me agitated. When staff greet a distressed individual with a supportive behavior, they’ve taken an immediate step to de-escalate them. We call this the Integrated Experience, and it’s a proven strategy for violence prevention.
Make your rounds mindfully
Let’s keep walking. We’re at the elevators, so let’s head for a meeting room on another floor of the hospital. This would be where I might facilitate an on-site training for nursing or security staff — and normally it’s set up well in advance of my arrival. But for the sake of this experiment, I’ve decided to take us on a wrong turn.
I’ve now gotten us lost inside of the hospital, but because I’ve got that visitor badge on, none of the staff passing me by give me a second look — so I’m still wandering.
And just like that, three more missed opportunities have racked up:
3. An opportunity for continuous, collaborative assessment.
OSHA (Occupational Safety and Health Administration) has identified unrestricted movement of the public through hospitals [PDF] as a key risk factor for workplace violence in health care. But I’ve given hints to staff passing by that I might not belong in this space — the more lost I get, the more worried and distressed I look.
Just because I made it past security doesn’t mean that other staff should assume my presence is appropriate. Staff shouldn’t be hesitant to act when they see somebody unfamiliar.
“Acting” might mean approaching the unknown person and supportively asking, “Can I help you?”
Or, if you have a gut feeling that something is wrong, “acting” might mean contacting security with location details and a description. Healthcare professionals will know what to do when they’re adhering to a protocol that protects anyone who might be at risk if a situation escalates.
4. An opportunity for a team approach to safety.
One of the benefits of CPI's Nonviolent Crisis Intervention® training is that it gives hospitals a common language. This is a major element in increasing staff safety and morale and ensuring fidelity of process across a facility.
How often do we hear staff members refer to themselves as “just” security? Or “just” behavioral health? These kinds of divisive statements are telling. If you’re hearing this kind of language at your hospital, seize the opportunity to shift paradigms by changing your language. Try saying, “We are all ABC Health.” And then take a hard look at where those statements come from — that’s where bridges between staff and team intervention strategies still need to be built.
5. An opportunity for patients to benefit from a focused staff commitment to their hospital’s culture of safety.
Every staff member must support their colleagues if a culture of safety is to thrive. With the right training, this mentality becomes an integral part of a safe and caring work environment, which tees up better outcomes with anxious, frightened, and hurting people that hospital staff encounter.
In so many hospital mission statements, staff professionalism and caring are exalted as paramount. A supportive approach is a way of living your mission statement; it saves time, effort, and money; it raises HCAHPS and other audit scores; and it actively facilitates ongoing violence prevention. That converts to a measurable difference in expenses — fewer worker compensation claims, less staff time out of work, less money spent on temporary staff, and an ultimate reduction in overall staff turnover.
Photo: Jacob Lund / Shutterstock
Take a person-centered approach, with your patients and your staff
Back to our stroll. Once again, I’m wandering the hallways, and this time, I’m in search of a lounge or a cafeteria — I’m ready for a break. I see a group of staff being led through what looks like their orientation — and they’re not the first bunch I’ve seen being led about in this manner. I ask a senior administrator about all these groups of staff going through orientation.
“We have a lot of turnover here. It’s just the nature of the business,” she tells me.
I’ve heard this before — but it’s not necessarily true.
Accepting high turnover as a cost of doing business in healthcare deprives a culture of safety of a critical element that supports professionals in long-term, healthy careers. My colleague is missing a few critical opportunities with her current mindset:
6. An opportunity to reduce attrition, and organically build rapport within departments and between departments — that lasts.
To accomplish most of the strategies already listed, there needs to be trust formed between departments. Having consistent staff working in those departments will help establish that trust. Staff retention also allows for colleagues to experience and apply best practices to workplace processes, improving how different departments work together. When departments collaborate smoothly, communication improves and incivility decreases, leading to fewer critical errors that can threaten the safety of patients.
7. An opportunity to deepen awareness of the roots of disruptive behavior within a healthcare facility.
When there is a level of consistency and familiarity, then the unfamiliar begins to stick out — which means we recognize the unusual earlier — and have a better chance to de-escalate these Precipitating Factors before they can culminate in violence.
8. An opportunity to provide person-centered care.
Knowing your patients is critical to violence prevention. Some staff have a few days to get to know the patients, others may only have a few hours. But if we are paying attention, even lesser amounts of time can be enough. Encouraging staff to build a rapport with individuals when they are in crisis can be the most effective way of preventing future escalation and reducing the risk of violence or incivility, which allows patients and their families to participate in and benefit from your hospital’s culture of safety.
Fewer injuries, higher staff morale, higher levels of retention, higher patient and staff satisfaction scores, and better compliance with industry best practices and regulations — all are products of a robust culture of safety that culminates in the highest quality, patient-centered care.
And with the money saved, hospital administrators can invest in keeping up with current best practice trends and issue-specific training to further boost these positive outcomes.
For a safe hospital, make violence prevention a matter of policy — not just best practice
While I’m sitting here, I take a closer look at my visitor’s pass. I accepted it without much thought, but now I notice that the stamped date was adjusted by hand. I realize that visitor’s passes are costly to produce, and staff can recycle these to save on expenses. Wearing it, I don’t get a second look from security staff that I pass. But how do they know I didn’t change the date on my pass myself? What’s been missed here?
9. An opportunity for other departments to know with certainty that initial security measures have been taken because it’s a policy, not just a best practice.
Health care workers deserve to feel safe at work. They’re already working to be supportive to their patients — they might even be de-escalating their patients. Their on-the-spot assessments and interventions can only work effectively if the initial contact with a patient or visitor goes according to your facility’s security policies.
(Don’t have written policies regarding preventing workplace violence incidents? Our training will help you develop one.)
10. An opportunity to train staff across your facility in recognizing a potential crisis — and responding effectively to reduce the risk of harm to staff and patients.
We can’t lay the task of hospital safety on the back of the security department alone. Staff are only as safe as their training empowers them to be, and can only be held accountable for the training that they’ve received when it comes to doing their part in maintaining a safe hospital.
Imagine what it would be like if all staff were trained in a professional response that embodies their hospital’s mission statement? The hospitals with the highest HCAHPS scores — and the best reputations — do this regularly. They don’t cut corners. And interestingly, their training saves them enough money that they don’t have to cut corners.
Going without violence prevention training is going to cost you. And cost you. And cost you some more.
Now that you’re beginning to see the missed opportunities that can inhibit a culture of safety from thriving in healthcare settings, what can you do about it? And why is it so critical that you do something about it now?
The bottom line is that no hospital can afford to take this level of risk. It may feel like what you can’t see can’t hurt you, but when you crunch the numbers, going without an evidence-based workplace violence prevention program is a gamble your org won’t win.
Consider your nursing staff, for example. Nursing has long led the highest rates of reported workplace illness and injury in data collected quarterly and annually by OSHA. It’s estimated that the average cost of turnover for a bedside RN ranges from $37,700 to $58,400 resulting in the average hospital losing $5.2M – $8.1M [PDF].
If you added in other annual costs, like hospital workers’ compensation claims, you’re facing steep, unrelenting expenses and a continuum of unchecked risk to your hospital, its staff, your patients, and their families — all of which could be mitigated by empowering staff like your nursing department with Nonviolent Crisis Intervention® training to help them identify potential risks, intervene in crisis situations effectively, and safely disengage from assaultive behavior.
Do your staff face verbal abuse from patients? Check out CPI Verbal Intervention™ Training.
I’ve written at length about how the initial investment in certifying your own key staff members to instruct CPI training in-house can add up to tremendous savings over time — I’ve even talked about how the fundamentals of our evidence-based violence prevention training enhance your facility with outcomes like improved HCAHPS scores. In fact, there are more positive benefits to hospitals that implement CPI training as a comprehensive violence prevention solution than I can possibly fit into one blog post.
But my challenge to you is to notice the many opportunities to create a culture of safety that your hospital might be missing — and to make the commitment that you won’t let any more of them pass you by.