But Potter says a particular aspect of the workplace violence and assault problem has gone beyond the emergency room doors, and into the behavioral health areas of the facilities, which lately have taken on a much more prominent role: “We’ve had a tremendous increase in the number of behavioral health patients because many states are just closing their mental health facilities,” Potter explains. “There’s basically no other place for them to go — they may sit here for up to 10 days just waiting for a bed in a state mental health facility. That’s just terrible, but it’s a reflection of the times and the finances being experienced on a state level.
“In 10 years, we’ve had two officers injured that required medical attention when dealing with crimes,” Potter continues. “We’ve had 27 officers over that same period of time injured as a result of a physical confrontation with a behavioral health patient. With those patients, you can’t use handcuffs, batons, or any of the police methods, which go against regulations.”
While 27 major incidents involving injury seems like a large number, it is because of a combination of training, technology and deterrence that the number isn’t dramatically higher. Potter, a former police chief and commissioner who has been heading up healthcare security departments since 1990, has spearheaded that effort for Novant Health.
Steps to Prevention
In most workplaces where risk factors can be identified, the risk of assault can be prevented or minimized if employers take appropriate precautions.According to OSHA, one of the best protections employers can offer is to establish a zero-tolerance policy toward workplace violence covering workers, patients, visitors, contractors, and anyone else who may come in contact with healthcare personnel.
“I have a simple view (regarding workplace violence), and it’s reflected in our corporate policy,” Potter says. “It’s a zero-tolerance thing with us, and we take every step possible to prevent it. When something does happen, we immediately move on it and take whatever steps are necessary to deal with it.”
OSHA stresses that a well written and implemented Workplace Violence Prevention Program, combined with technology and training, can reduce violence in workplaces. This can be a separate workplace violence prevention program or can be incorporated into an injury and illness prevention program, employee handbook, or manual of standard operating procedures.
Typical policies include a ban on weapons; stationing security and/or police officers in high-risk areas within the facility; and nighttime parking lot escorts, as the lots tend to be a hotbed of violence. Design considerations include creating waiting areas to accommodate and assist visitors and patients who may have a delay in service; enclosed nurses’ stations; deep service counters or bullet-resistant and shatterproof glass enclosures in reception areas; and to arrange furniture and objects to minimize their use as weapons.
Beyond policy and design, there is technology. Most hospitals use a combination of video surveillance, access control, visitor management and panic/duress alarm technologies. Some facilities have found success in using walk-through metal detectors, especially in the emergency departments. Potter says that while his hospitals do not use the airport-style walk-throughs, his officers carry hand-held portable metal detectors that he says are about the size of a small flashlight.
Training is the Key
At Novant Health, basic training for the majority of employees — particularly those who work in emergency departments, behavioral health and public safety — is the Crisis Prevention Institute’s non-violent crisis intervention course. “For the most part, we restrict our physical intervention when dealing with patients to the techniques taught in that course,” Potter says.
For the hospital’s in-house security force, training is job one, and it has been paying dividends. “Our new officers go through 160 hours of police academy-style training, which is unique to us — most hospitals don’t do that,” Potter says. “That’s the first four weeks of employment, and the last two hours of every day is physical training on how to respond to and deal with a whole range of confrontation situations.
“When I first got here, the officers didn’t have any training,” he continues. “Like every hospital, our budget is under a microscope, but the one thing administration has never asked us to do is cut back on training, because they see the results.”