Fighting Violence in Health Care Settings
Violence in health care settings occurs with rising frequency, costing facilities, insurers and society dearly, but many incidents can be deterred – and many facilities already have the tools to exert the deterrence.
As bearers of bad and even heartbreaking news, doctors and other caregivers are at high risk for assaults and “active shootings.”
With 154 hospital-related shootings between 2000 and 2011 that left 235 dead or injured, according to the American College of Emergency Physicians, “we’re on notice for the potential for violence,” said Pamela Popp, executive vice president/chief risk officer, Western Litigation.
Health care workers are injured through violent acts at more than four times the national rate, according to the Bureau of Labor Statistics. FBI statistics show a rising trend in active shooter incidents in health care settings, from 6.4 per year between 2000 and 2006, to 16.4 per year between 2007 and 2013.
Those are scary numbers. But there are tools to forestall violent acts in hospitals and some of them don’t cost that much.
“Empathetic communication is key,” said John Walpole, area senior vice president, Arthur J. Gallagher & Co. The techniques that help hospital medical staff de-escalate situations and repair broken conversations can also help front-line employees.
“We can’t wait for something to happen. We have to have a prepared response.” — Pamela Popp, executive vice president/chief risk officer, Western Litigation
“The good news is that organizations can use their own low-cost resources,” he said.
“They don’t always need to bring in expensive trainers and consultants.”
Organizations can benefit from training everybody who comes into face-to-face or phone contact with patients and relatives.
That could include contractors, social workers, facilities staff, superintendents and engineers — who double as security staff in small facilities — food service personnel and triage nurses.
Receptionists are a particular target of people who arrived angry or became frustrated by long waits in a hospital lobby or emergency room and should definitely be included in such training.
Workers welcome training in this regard, Walpole said.
The journal “Prehospital and Disaster Medicine” reports that emergency medical service responders “felt better prepared to respond to an active shooter incident after receiving focused tactical training.”
Taking Corrective Action
Complacency is dangerous, Walpole warned, and risk managers shouldn’t assume their facilities are doing everything that can be done to keep employees safe.
“Run a drill, take corrective action and then test it with another drill. Keep monitoring.”
Hospitals have considerable experience with infant abduction drills, he said, and now those processes must be applied to emergency room violence and active shooter scenarios.
“We can’t wait for something to happen. We have to have a prepared response,” Western Litigation’s Popp said.
That means, she said, that senior management should dedicate security resources. Even if organizations can’t afford onsite security personnel, they should talk to their crime, malpractice and general liability carriers about prevention, both through incident de-escalation and securing the facility.
They may qualify for grants through Homeland Security and FEMA programs.
“Risk managers may assume they have it under control,” but after a safety audit may “find they’re not quite as prepared as they thought.” — Beth Berger, managing director, healthcare practice, Arthur J. Gallagher & Co.
Insurance brokers, carriers and consultants also play a role in workplace and patient safety training, said Beth Berger, a managing director with Arthur J. Gallagher’s Healthcare Practice.
But Berger said the broker community doesn’t always offer these services and clients often don’t ask for them.
“There should probably be more discussion up-front with brokers and carriers,” she said.
“Risk managers may assume they have it under control,” but after a safety audit may “find they’re not quite as prepared as they thought.”
Government agencies and nonprofit organizations, including the Occupational Safety and Health Administration, the Centers for Disease Control, the Joint Commission and the American Hospital Association, also offer free or low-cost resources.
Which Coverage Responds?
While active shooters grab headlines and represent a very real threat, they are hardly the only source of violence in U.S. hospitals and other health care facilities. Which coverage responds depends on the situation: where the incident occurred, who perpetrated it, and who or what was injured or damaged.
In a true crime situation, Popp said, the general liability or captive coverage could respond, assuming one or the other covers crime. If not, facilities can buy violent and malicious acts (crime) coverage, which picks up expenses that wouldn’t fall under a property policy.
“Total losses in an incident are hard to calculate and often underestimated.” — Pamela Popp, executive vice president/chief risk officer, Western Litigation
In patient-on-worker crime, workers’ compensation responds. If other patients are hurt in the event, general liability responds, as is the case with property damage (such as cars caught in the crossfire during a parking lot shooting).
In some cases, losses won’t be covered, and facilities should expect to make payments from the operations budget.
The scenarios are endless, said AJG’s Berger. A stranger with criminal intent mugs a visitor in a parking lot. A grieving relative assaults a nurse. An agitated and disoriented senior in a nursing home strikes a nurse.
Then, there’s worker-on-worker assault, or the angry ex-spouse marching in with a weapon. If an innocent bystander becomes collateral damage in any of these assaults, the insurance questions multiply.
When working through a violence prevention plan when an incident is still theoretical, Popp recommends identifying which coverage will apply in a variety of scenarios.
“After an event, there’s so much chaos and emotions are so high that you’ll be too distracted to figure it out then.”
Total losses in an incident are hard to calculate, Popp said, and often underestimated. The cost of medical care for an injured staff member averages $90,000, and the total cost of an incident could easily reach $500,000 to $1 million when the myriad, often-forgotten peripheral expenses are included.
Popp calculates the total cost of a violent incident by including treatment for:
- Injured staff members (workers’ compensation)
- Non-employees and patients (general liability)
- Patients (professional liability)
Peripheral expenses may include:
- Property damage (general liability)
- Emergency response, such as police
- Business interruption and lost revenue
- Media, such as public relations and crisis management agencies
- Lost time from work for injured and traumatized staff
- Staff counseling
- Potential litigation
Violence in health care settings is “a big problem” from financial and social risk perspectives, Popp said.
Leaders should ask themselves, ‘Is our facility safe? Are we at least keeping up with safety standards of other facilities in the area?’ ” Failure to do so, she said, not only violates the social contract that says that hospitals are safe places, but it also casts uncertainty on insurance coverage.
“We can’t tell ourselves, ‘It won’t happen here.’ ”