Lessons from a hospital tackling gun violence

Aiming to reduce gun violence in the community, a New Orleans hospital is seeing encouraging results from an intervention program to help victims and their families.

University Medical Center New Orleans, which is part of LCMC Health, launched its program more than two years ago. The hospital’s violence intervention team, which includes those with personal experience with gun violence, helps support victims and aims to help them recover and find a fresh start.

We spoke with Dr. Annelies De Wulf, an emergency room physician and director of violence intervention services at University Medical Center New Orleans, about the program.

She shares her perspective on what has made the program sustainable, and also offers some guidance for hospitals and health systems looking to launch similar programs to reduce gun violence in their communities.

Some key steps:

• Get a champion: The program needs a leader to see it through.
• Executive support: The backing of key leaders in the health system is critical.
• Embed the team: The violence team at UMC New Orleans works with doctors and nurses, assists victims, and can defuse tensions between families and clinicians.
• Finding help: The UMC New Orleans program is supported by city funding. There may be funding to help.

Here’s the transcript from part of our conversation with Dr. De Wulf on the UMC New Orleans program and her insights and suggestions for other health systems.

Q: You mentioned learning some lessons along the way as you were standing up the program over the last couple years. What have been some of the key lessons that you've learned as you stood up the program and now that you're hitting your stride?

Dr. De Wulf: “So, I think I knew this, but there's nothing like the actual experience of it, of how powerful having your peers are in your life. For years, I would talk to people about gun violence, and nobody really wants to hear it from me. Not because I don't mean well, but just because that ability to relate to what is happening and what those challenges are just isn't there. So I learned that I need to trust my team when they tell me this is working, this is not working, that we need to adjust to make it work for them. Because when they believe in it, it's powerful, and if not, it just doesn't go.

“I think one of the things that was a really big lesson, and something that is important in this space of violence reduction in hospitals, is that our team became allies in the actual healthcare planning. So when our team is there for the trauma rounds, if our team is working with the nurses and says, ‘Hey, if this person has a challenge, call me,’ that makes a really big difference.

“When our medical teams in the emergency department are too busy to spend time with the family, because gunshot wounds tend to come in in clusters, being able to have these extra people on the team who can work with the medical team and act almost as a liaison, has been incredible for reducing some of the hostility that can sometimes happen between medical teams and patients and their families. Really incorporating prevention into the actual planning is also a medical thing. So it's been interesting to see that develop more than I had expected.”

Q: I would suspect that it might not be the easiest task in the world to find people wanting to be on this team. It's tough to recruit and retain folks in healthcare, but for this team, I would suspect it might be a little more challenging to find the right people.

Dr. De Wulf: “It's a very specific skill set, and so we do a lot of interviews for the few positions that we have, because being able to work with varying levels of communication and professionals, and being highly functional, being able to use a computer, being able to do all the professional piece, but then also being extremely relatable to people who may not necessarily have the same educational background as the rest of the medical teams, can be hard.

“And one of the things we really need is for people to be empathetic and for people to be able to relate and to kind of put their heart and soul into it. That means it's not like every other job. That means you need to be passionate about stopping gun violence specifically. So people come into this with lived experience of having lost loved ones, having sustained injuries. They need to have the passion for it; otherwise it's a tough connection.”

Q: Was it tough to get buy-in at first? It’s not like hospitals don't have plenty on their plate as it is, but to take on this challenge as well. I mean, obviously it really does potentially help improve the health of the community, but did it take some work to get people on board with launching the program?

Dr. De Wulf: “Certainly. I think these are investments, and they're long-term investments. We know that the population that gets shot tends to be un- or underinsured, and hospitals, on average, recoup about 30% of the costs of that care. So if you look at the long view, then reducing even a few gunshot injuries in a year will pay off the program.

“But so often hospitals are looking at much shorter timelines, and so the cost piece is real. We are fortunate to have a good relationship with our health department, so we've been able to get some external funding from the city, which has really been the difference-maker in being able to start this.”

Q: What advice would you offer other hospitals and health systems that want to launch similar programs? How can they make sure that they are built to succeed?

Dr. De Wulf: “I would say what I've realized is that without very senior-level administrative support and a very good, strong team, it won't work, because challenges come up. So having a lot of patience and a lot of empathy for all sides of this is key. If you can get other stakeholders involved, such as within the city and within a larger ecosystem of violence reduction, that really builds some stability when things can get tricky.”

Q: For hospitals that may not have a ton of resources, that might want to do something like this but don't have the money they'd like to throw at it, or might be in a situation where their local city or county government isn't able to help, are there things they can do, even within the constraints of their resources, that can make a difference?

A: “Yeah, I think so. Many cities that are highly impacted by gun violence do have community-based violence intervention programs. We're lucky that we have both; we have one in the community and one in the hospital, and we work closely together. But if you don't have the luxury of having an in-hospital program, then being able to refer to that violence intervention program, developing protocols so that perhaps they can come into the hospital, is one way to bridge that gap. It takes a champion in the hospital to be able to see that through, but it can make a big difference in people's lives.”