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Better communication can curb anger and violence in hospitals


Some patients get agitated, and aggressive, when they don’t feel heard. Marisa Randazzo of Ontic shares some advice on easing tensions before they escalate.

Many angry encounters in hospitals, including those that end in violent episodes, stem from failures in communication.

Some violent attacks arise because patients or family members don’t feel as if healthcare workers are hearing them, says Marisa Randazzo, executive director of threat management at Ontic, a security firm that works with hospitals and health systems.

“So often, when we are in our interaction with someone who is getting agitated, it is because the person on the other side of that interaction doesn't feel heard,” Randazzo says.

Doctors and nurses have been assaulted with alarming frequency in recent years. Over half of emergency physicians say they have been physically assaulted. Even before the COVID-19 pandemic, clinicians dealt with more workplace violence than other industries. But doctors, nurses, and healthcare workers have all said violence has risen in the pandemic.

Ontic talked with Chief Healthcare Executive about the role that better communication can play in reducing the risk of violence to healthcare workers.

As Randazzo says, “Bad things can happen when there isn't good communication.” (In this video, Marisa Randazzo shares some communication tips with Chief Healthcare Executive. The story continues below.)

‘Stop talking and listen more’

There’s no reason a patient, family member or loved one should assault a healthcare worker. But clinicians need to understand people aren’t at their best if they are in the hospital or caring for a loved one who has been hospitalized.

They’re worried about their health, or the recovery of a loved one, and those concerns are intensified if the patient is a spouse or a child. They may be worried about the costs of the hospital stay.

In those situations, Randazzo says healthcare workers can help defuse tensions by making sure that the patient or loved one knows that someone is listening.

“When I'm in an interaction where I feel like it's getting volatile or heated, I tried to stop talking and listen more, and ask them … ‘Can you repeat that? I want to make sure I understand what you're saying’,” Randazzo says. “The more I understand what you're saying, the more I may be able to do to help. You're not over-promising, but you are trying to take the temperature down.”

Healthcare workers and managers should also pay attention to how loud they are talking to the patients, noting that it’s human nature to match the volume and intensity of the other person or people in a conversation.

So if the patient or loved one is getting agitated, the healthcare worker is likely getting irritated as well.

“In a situation that's starting to escalate, one tactic I've learned to do is to try to slow down the pace of my talking, take the volume of my voice down, and just try to slow things down a bit,” she says. “And oftentimes, the person on the other side will take a breath, and start to match that pace as well.”

Hospitals and health systems should train their staff in de-escalation techniques, Randazzo says, and she stresses the training shouldn’t be limited to security personnel. Doctors, nurses, custodians, and even volunteers could benefit from de-escalation training.

The Joint Commission offers suggestions on de-escalation steps aimed at emergency departments and inpatient psychiatric facilities. Those steps include maintaining a clear, calm voice, using non-threatening body language, and expressing support for issues and problems.

Health systems should encourage practicing and discussing de-escalation techniques, the Joint Commission advises.

All staff should be trained in recognizing if patients or family members are getting angry or agitated, and express those concerns to nurses so there’s an opportunity to reduce tensions, Randazzo says.

Assigning case managers

Many doctors and nurses do their best to talk to patients and loved ones, but they have limited time because they are caring for other patients. As some nurses have left hospitals during the pandemic, those who are still working in health systems say they are picking up more patients, adding to their considerable workload.

Family members of patients understandably get anxious, and angry, when they are trying to get information but their doctors and nurses are being pulled in different directions.

In some instances, doctors and nurses sometimes communicate in medical jargon that patients and family members don’t grasp.

In reviewing some difficult situations, Randazzo says, “One of the key culprits is insufficient communication in non-medical terms with family members.”

In one situation at a health system where tensions rose, Randazzo said the organization discovered that while the medical team members were all on the same page with the treatment plan and timeline, the patient and family members didn’t receive that information.

“It was communicated with medical terms rather than non-medical terms, or insufficient timeline, or families didn’t feel they could ask questions or weren’t given time to ask questions,” she says.

Hospitals can look at ways to improve communication to patients and family members, and give them more mechanisms to ask questions and raise concerns, Randazzo says.

Hospitals could consider assigning case workers to help families with questions or to translate complex health information and treatment plans in ways those without medical degrees can understand.

Case managers can give patients a resource to direct their questions, and may be easier to reach than physicians, Randazzo says.

“Doctors are there to give medical information and often have to do it quickly,” Randazzo says.

“If hospitals or healthcare facilities can look at who do we have that might be here to translate that information, help explain what a patient and their family just heard, help to be a bridge for follow up communications, all of those simple tools and tactics can help to enhance communication, and then reduce the likelihood that lack of communication or frustrated communication could lead to hostility or even violence.”

Diversity helps

Healthcare workers can run into difficulty when communicating with patients and family members who don’t speak English, or it’s not their most comfortable language.

It’s yet another reason why hospitals must strive to build diverse staffs, Randazzo says.

“Diverse staff can help in any employment setting for a whole variety of reasons and diversity around language fluency can be particularly helpful for hospitals and healthcare facilities,” she says.

If there aren’t workers on staff or on shift who speak the language used by a patient or family member, healthcare workers can still use translation tools such as Google Translate to help facilitate a conversation, Randazzo says.

Case managers can also use translation tools to provide written explanations of the care that was delivered and treatment instructions in the patient’s native language.

“Any effort and any tool that can help to reduce communication, misunderstandings and barriers is going to be particularly helpful in situations where there is concern about life and about well-being, and people who may be operating at a level of real stress around those issues,” Randazzo says.

More resources

The Joint Commission offers standards on workplace violence prevention

The American Hospital Association offers resources to reduce violence

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