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Code green: Standing up to hospital violence | Viewpoint


There is a growing movement to establish a code-green protocol that can be called when a patient is belligerent and de-escalation strategies have failed.

Caroline Clouser (Photo: Chubb)

Caroline Clouser (Photo: Chubb)

Hospitals are highly charged environments where emotions often run high.

Even in the best-run institutions, illness, fear, drug reactions, vulnerability, and stress all contribute to agitation and anger that can sometimes break into violence.

Family dynamics can escalate, as can tensions between patients and employees. An unexpected outcome, a billing dispute—even snoring roommate—can be enough to trigger some patients. And patients who come into the emergency room with mental-health disorders or suffering from drug withdrawals lash out for reasons that are not always easy to understand.

Reported acts of hospital violence are already five times higher than other industries, according to Bureau of Labor Statistics data. But the vast majority of aggression is unreported and dangerous, according to the American Nurses Association.

This growing epidemic of aggression is an ugly part of the business, and it has a cost. Medical professionals —particularly nurses—are bullied, threatened, and assaulted on a regular basis and often don’t bother to tell anyone about it because they perceive it’s a part of their job. Nurses and nurse aides report being kicked, choked, spat at and worse.

One former nurse in Massachusetts was pushed to the floor and stabbed by a patient who was later diagnosed with a mental health disorder. She bravely shared her story in the hopes that lawmakers and hospital administrators would finally do something.

So far, it is hard to see much progress. Legislation that would make violence against healthcare workers a federal crime—as it is against airline personnel—has been proposed but remains under consideration in Congress.

Employees and patients are not the only ones in danger from workplace violence.

It can have very real consequences in a matrix of boardroom concerns—from employee satisfaction and performance to hospital reputation to bottom-line items such as penalties and legal settlements. All of these affect the two bottom lines that decision-makers must protect most: the financial health of the organization and the quality of care it provides.

Security is a fact of life in every business, but the hospital is a truly unique setting. Any measures taken need to be done without impacting the patient experience. What do you do if you're in the middle of a surgery and there’s an active shooter? Do the surgical suites lock down? This is not a question any surgical team wants to think about in the middle of a procedure because security and medicine are very different specializations.

Reducing violence requires the expertise of people that live and breathe and think about security every day so healthcare providers can do what they do best: help their patients live and heal.

It is crucial that healthcare organizations demonstrate a zero tolerance of violence against staff, patients and visitors.There are a number of steps that hospitals can take:

  • Begin with an objective risk assessment performed by a security specialist
  • Identify areas of vulnerability
  • Install metal detectors or secure entry and exit points
  • Activate procedures for likely scenarios and conduct drill
  • Encourage staff reporting of acts of workplace violence

One institution in Idaho embeds panic buttons on the ID cards of frontline staff that will alert security if there is an issue.

There is also a growing movement to establish a code-green protocol that can be called when a patient is belligerent and de-escalation strategies have failed. A code-green response team usually includes nurses, doctors, behavioral specialists, and security guards.

The prevention of hospital violence has emerged as a critical safety concern for all hospitals as well as other healthcare facilities.Many hospitals already offer de-escalation training to every patient-facing professional. Aggression is most often directed at bedside staff.

Learning to heed the warning signs, to listen actively and to speak with empathy is a well-tested method to calm a tense situation. Collaborating and maintaining a partnership with law enforcement agencies to prevent violence is also part of a comprehensive Violence Prevention Program.

Every healthcare organization should develop a zero-tolerance approach toward aggressive behavior and encourage the reporting of any activity that threatens or demeans anyone seeking or providing healthcare.

Ensuring that a comprehensive violence prevention program is in place is key. One that is specific to their organization and analyzes potential safety hazards & implements strategies to address them.A successful program starts with an enterprise-wide commitment from executive leaders, senior leaders, managers, and all levels of the organization.

Caroline Clouser is Chubb's executive vice president and head of healthcare industry practice.

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