6 Critical Steps to Reduce Violence in Health Care Facilities

For violence against health care workers to be managed, the profession needs to stop accepting violent acts as simply being a part of the job.
By: | November 15, 2018 • 6 min read

Diane Doherty, vice president of health care for Chubb, has been monitoring the disturbing trend of violence against health care workers for years. Here are her comments on what should be done to curb the ever-present threat of violence against caregivers.


The reality is acts of violence in hospitals continue to be on the rise. And it’s not just in certain states; it’s nationwide and it includes hospitals and the ambulatory care settings. We are seeing it in private practices and urgent care centers.

I always say it is not a concept that people would associate with health care. But bad things can happen anywhere — look at this month alone with that horrible incident that occurred in a country music bar in California. And we see violence in schools, but the health care setting is absolutely no exception.

Our concern is that some hospitals might not be prepared to handle it, and we want to make sure it gets on the radar of all hospital executives, including the hospital personnel.

Health care workers are victims of workplace violence four times more than any other industry. That is pretty significant. The physical and verbal encounters have in the past been thought of as being restricted to the emergency room. But they’re not. It’s not just the emergency room or the behavioral health facilities.

And we are finding that the threats of violence come from many different sources. It’s not just patients; it’s visitors; it’s family members; it’s disgruntled employees; it’s even the random person who walks onto a hospital campus, perhaps even a drug seeker.

There are certainly ways in which hospitals must protect their patients and their staff in having a violence prevention plan in place. I crafted six steps that should be part of that violence prevention program.

1) Establish a zero-tolerance policy against violence against staff members and visitors.

The first and the key step is that hospitals and health care organizations must demonstrate a zero-tolerance policy against violence against staff members and visitors. And when they say that, they have to have C-suite buy in. They have to be able to allocate critical resources to prepare for and to prevent acts of violence.

Diane Doherty, vice president, health care, Chubb

The resources could be in training. That is why it is so important to conduct safety assessments, because that is where we’re going to pick up those unique findings — things we didn’t think about.

And it is a way to get a multi-disciplinary committee to focus on ‘maybe there is an entrance or an exit that isn’t locked the way it should be.’

You would be amazed what you find when you conduct a safety assessment. That also means comprehensive violence prevention policies and procedures and also threat management programs that should be overseen by an interdisciplinary committee.

And part of that should be sharing the lessons learned from significant events to see if they can be used to prevent such incidents in the future. That zero-tolerance policy is first.

2) Conduct a threat assessment.

We know that all hospitals have some sort of a violence prevention program. But in light of the world we are living in today, I always say, is it enough?

Safety assessments don’t have to be complicated. They can shine a light on certain specific areas of exposure. There is no hospital that is the same; they are all going to have different areas of safety exposure.


At Chubb, we provide a safety assessment tool that is not complicated. It can help hospitals with some of their safety initiatives, even working with them if they need some structural changes or other modifications. They need to be conducted in locations where the staff work alone or they may become trapped or isolated.

It is important too that the safety assessment has to include the offsite structures, such as the parking garage or the lots that also may present unique exposures.

3) Educate and train the staff.

And not just in the high risk areas like behavioral health and security. You really need to make sure your front-line employees, such as your receptionists, your admitting personnel, registration, even your patient representatives and customer service folks are trained in how to react to violent behavior.

I talked about safety assessments. It is important to educate the employees based on the results of that self-assessment. Conduct drills, and definitely encompass procedures for hostage handling or a bomb or a terrorist threat. That’s the world we are living in today.

It’s horrible to say it. Every time I say it, I cringe. But that’s our reality.

4) Encourage reporting of acts of violence in the workplace.

Make it mandatory for employees to report acts of violence in a non-punitive environment through their internal incident reporting.

We know that historically acts of violence go significantly under-reported. There are many, many reasons for that.

I think the biggest reason is that health care professionals perceive it as part of their job. And they just accept it. One of the analogies, and I find it ironic, is if somebody assaults a police officer there are ramifications. But if somebody hits a nurse, it’s in a day’s work. It is really important that staff is encouraged to report these acts of violence so that appropriate measures can be taken.

One of the analogies, and I find it ironic, but if somebody assaults a police officer there are ramifications. But if somebody hits a nurse, it’s in a day’s work.

I think there are a few more reasons why.

The first, as I mentioned, is that it’s part of the job. It is all in a day’s work. There also may be fears that if health care workers report an incident, it may be a poor reflection on their job performance. The supervisors may blame the employee for not controlling it before the outburst occurred.

It could be fear of retaliation — the employee having to worry about being attacked on the way to the parking lot. Or in some cases, maybe it’s just a lack of policies. Or a lack of clarity in policies.

In some cases, it is getting better, because violence in health care has been highlighted in the past five years. We hope that continues.

5) Avoid using obscure code language that may be confusing to some.

In hospitals you may hear someone call “Code Blue,” “Code Red,” “Code Green,” “Code Gray” and so on.


They all have different meanings. Unfortunately, they can cause someone to run into an event, rather than from it. I think the use of plain language eliminates the ambiguity and can direct action that’s helpful in a time of a crisis.

All hospitals have a crisis response team, and I think they need to look at their own policies and procedures and how they call the codes for security or for a violent incident.

You want to make very certain staff and visitors understand the type of encounter that is occurring. And we suggest the effective use of plain language.

6) And lastly, collaborate and maintain partnerships with law enforcement agencies.

And in doing so, you can develop regular meetings to review violence prevention plans, to develop solid comprehensive communication, ensure that interactions are aligned.

And it is very important if there is an event that a post-incident evaluation be conducted. &

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.


That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.


Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]