After tragedy, hospitals should engage staff on improving safety

The fatal shooting at ChristianaCare Wilmington Hospital horrified staff and local and state officials.

They also said the tragedy underscores the fact that even a place devoted to saving lives can experience the worst type of violence.

Two young men, both 19 years old, were shot inside the Delaware hospital Tuesday afternoon. One of the men died of his wounds, and the other is hospitalized in critical but stable condition, Wilmington police said.

Police arrested the suspect in Philadelphia Tuesday. Authorities said the suspect, John Wallace-Bey, 23, of New Castle, Delaware, will be charged with murder and other crimes. Police said the shooting appears to be targeted but they said the investigation is continuing.

While such incidents inside hospitals are rare, there have been other fatal attacks in hospitals in recent months.

Paul Sarnese, founder and principal of Secured & Prepared Consulting, has spent decades working in hospital security. In the wake of the Wilmington Hospital shooting, Sarnese tells Chief Healthcare Executive® that all health system leaders should take a look at their security measures.

“I always encourage everybody through an incident like that to look at your plan,” Sarnese says. “Review it, update it as necessary, and really ask yourself, are we prepared? Have we done everything we can to mitigate the risk of this happening, and then have we done everything we can to make sure our employees and our patients are safe?”

The former president of the International Association for Healthcare Security and Safety, Sarnese says his heart goes out to ChristianaCare, and he says he knows security leaders in the system. “They have an outstanding program,” Sarnese says.

Talk with staff

Hospital executives should regularly talk with staff members about public safety issues and areas that could be improved, he says.

“It's incredibly important. Your employees will tell you exactly what their concerns are and where the vulnerabilities are within a facility,” Sarnese says.

Health systems that have experienced a shooting or violent incident should reach out to their staff right away to engage them and find out if there are vulnerabilities that need to be addressed.

“Everybody's going to be hypersensitive to what happened, everybody's going to be hypersensitive to security in their facilities, hypersensitive to weapon screening if it's not being done today,” Sarnese says. “So, I think it's really important today, and over the next few days .. to hit it head on.”

Health systems can outline current security protocol and talk about what’s being done to protect staff, but they should also invite staff to share their concerns.

“I think it's a missed opportunity if we don't, for lack of a better description, kind of take advantage of the opportunity to learn from our employees and learn how we can improve our physical environment, how we can improve our preparedness, and really hear that directly from the employees,” Sarnese says.

‘Practice their plan’

Hospitals also need to engage in regular training for active shooters, just as health systems run fire drills and prepare for natural disasters.

“I also think there's a responsibility for healthcare leaders, not only to train and educate, but to practice … practice their plan,” Sarnese says. “Everybody has a policy and procedure, but when was the last time you tested it? Either testing it through a tabletop exercise or a real exercise, a full scale exercise.”

Sarnese says he has worked with systems that do full-scale active shooter exercises on a regular basis. He says there is value in running such exercises on a regular basis.

“We did it every year at every one of our facilities, and it made us all aware what our responsibilities were so we knew what doors we could lock, where we could hide, where our exits are, and I think it gave our staff a higher comfort level,” Sarnese says.

“Unfortunately, active shooter exercises are more foreseeable today than they were 10 years ago. So we have that responsibility to make sure that we're training in exercises, just like we do for fire drills, just like we do for mass casualties,” he says.

Watching patients and visitors

Health systems should also work with staff and encourage them to speak up to raise awareness about a patient, family member or visitor who could be exhibiting concerning behavior or raise awareness if someone is making threats or being hostile.

If staff see someone pacing around or mumbling to themselves, that could be a red flag.

“All employees should have the basic training on how to identify and recognize verbal warning signs and physical warning signs that may lead to violence,” Sarnese says. “And employees need to be empowered. If I see something, I need to say something to do something. So, if I see somebody that's acting that's a little anxious, I have the responsibility to either intervene, depending upon what my role is, or to notify somebody.”

Healthcare security leaders say such training should go beyond doctors and nurses and throughout the workforce, including those delivering meals and other support staff.

Speaking up about staff

Staff need to know that they can also express concerns about their co-workers if they are showing violent tendencies, threatening others or being hostile.

Some employees may be reluctant to bring up concerns about a co-worker, either for fear of retaliation or potentially causing problems for a colleague who may not be violent and is simply going through a rough time.

Sarnese suggests health systems send the message that if a co-worker is struggling, employees can help them by coming forward.

“I always think of good intent, especially in healthcare,” Sarnese says. “There's always good intent. We do things because we care about people. So I think that's the message that leaders need to cascade down to the employees. We want to know because we want to take the appropriate actions to give the employee help,” Sarnese says.

“So I think the message needs to be, to employees: we care about everybody, we care about our patients, we care about our employees. If you see something that's given you cause for concerns, please report it to your leadership. Know that there's not going to be any retaliation, and that your leadership is going to intervene with the intent of helping the person through whatever stress or the anxiety they're going through,” he says.