Reflecting the urgent need to rein in workplace violence, the Joint Commission, a healthcare safety non-profit, released new workplace violence prevention requirements that will go into effect for accredited hospitals beginning in January 2022. These standards offer a solid roadmap to meaningful workplace violence reductions. They will require hospitals to develop a workplace violence prevention program with processes for handling workplace threats and violence; provide training to employees on how to report threats and violence; conduct an annual analysis of their workplace violence prevention program; and drastically increase their collection of physical security data, as well as their capacity to analyze it for insights they can use to improve safety at their facilities.
Two types of violence
But is it even possible to prevent violence in the workplace? The answer is yes — if you understand the two major types of violence and how they happen.
On the one side are the impulsive, unplanned acts of violence. These acts tend to be spur-of-the-moment and happen when a person reacts strongly, often noting afterward that they became violent because they felt threatened in some way. Think of an agitated patient or their family. Healthcare professionals are certainly not strangers to these types of incidents.
The second category is that of targeted violence or predatory violence, like the shooting at Jefferson University Hospital, mentioned at the start of this article. Acts of targeted violence are planned in advance and may be seen in cases involving a grievance between colleagues, a disgruntled former patient, a hostile termination, or any number of factors. Those who carry out targeted acts of workplace violence often show some signs beforehand that they are thinking about or planning to engage in violence. They tell other people about their violent plans; post warnings on social media, or engage in planning or preparatory behavior that others around them observe.
Putting knowledge into action
The goal of any hospital security program should be to attain a level of proactivity that can recognize warning signs of potential violence and mitigate them.
For spontaneous acts of violence, hospital security teams should examine patterns of where and when violence can occur. In the emergency department, labor and delivery? Late night, early morning, weekends? Tracking these types of statistics can help inform staffing levels and access control policies. Hospital security executives should also look outside the walls of their hospital for risk assessment. Has the community faced any recent economic turbulence or another major shock that could lead to increased violence?
Countering predatory violence
Though they are overshadowed in terms of volume, predatory acts of violence can have a devastating impact on healthcare workers because, by their very nature, they are planned for maximum effect.
To counter acts of planned or predatory violence –– such as a hospital shooting or stalking of a healthcare provider –– a generally recognized best practice is having a behavioral threat assessment team or program. In fact, one of the new Joint Commission requirements focuses on developing and operating such a program.
Behavioral threat assessment is a fact-finding process that examines threatening behavior, whether it’s a statement, a social media post, a gesture, etc. Built on decades of research into workplace shootings, assassinations, stalking, and other types of predatory or targeted violence, it is a process that seeks to determine whether the person who made that threat is likely to carry it out.
While the concepts can be relatively easy to master, behavioral threat assessment programs usually feature a few components. As detailed in the Joint Commission requirements, hospitals should establish a multidisciplinary team, with policies, processes, and training for the team on how to handle threatening behavior and workplace violence. This team should be capable of conducting threat assessments and acting as a central intake for any reports.
Once a team is up and running, staff across the organization should be trained on what behaviors to look for and report to the team. This training should occur periodically as a regular reminder to all employees to report threats and other behavior that impacts safety.
Encouraging reporting and tracking these incidents will require significant amounts of effort and teamwork across the organization, but the potential payoff in enhanced safety is enormous. It is imperative that workplace violence in healthcare be stamped out for the benefit of patients, healthcare workers, and their families.
