Posts Tagged ‘security’

Healthcare providers struggle with violence-related risk management

Wednesday, March 23rd, 2016

There’s no question but that healthcare workers face a growing threat of violence from patients while going about their day-to-day jobs. In a 2015 survey, the International Healthcare Security and Safety Foundation reported a 40% increase in violent crime from 2012 to 2014, with more than 10,000 violent incidents mostly directed at employees. High stress, armed patients and visitors, drug and alcohol intoxication, mental health issues and more all contribute to an increasingly dangerous environment. OSHA reports that:

From 2002 to 2013, the rate of serious workplace violence incidents (those requiring days off for an injured worker to recuperate) was more than four times greater in healthcare than in private industry on average. In fact, healthcare accounts for nearly as many serious violent injuries as all other industries combined.

Recently, Susannah Levine reported on the challenge that healthcare facilities face in her Risk & Insurance article, Hospitals Struggle with Security Risks. The article discusses the pros and cons of an armed approach to healthcare security, as well as the insurance implications of various risk management and security measures. Liability insurance may be a determining factor as to whether healthcare facilities opt for armed security or rely on less lethal tools like Tasers and sprays.

“Barry Kramer, senior vice president, Chivaroli & Associates, a health care insurance broker, said that armed security in health care settings is more of a risk management concern than a coverage issue.

“It would be highly unusual for our clients’ liability policies to exclude claims involving security guards, whether or not they’re armed with guns,” he said.

He said many health care risk managers are not equipped to manage exposures associated with licensing and certifying guards or registering the facility’s own firearms.

For facilities that lack the bandwidth to manage, train and track certifications for in-house security staff, Kramer said,third-party vendors, such as local law enforcement or private security companies, can be contracted, since they have firearms experience as well as liability insurance coverage.”

In February, the New York Times discussed various approaches and philosophies that healthcare facilities employ to mitigate risk. The article by Elisabeth Rosenthal – When the Hospital Fires the Bullet – centers on the case of a 26-year-old mental health patient who was shot by police in a Houston hospital. In the course of the article, Roenthal presents various approaches to security:

To protect their corridors, 52 percent of medical centers reported that their security personnel carried handguns and 47 percent said they used Tasers, according to a 2014 national survey. That was more than double estimates from studies just three years before. Institutions that prohibit them argue that such weapons — and security guards not adequately trained to work in medical settings — add a dangerous element in an already tense environment. They say many other steps can be taken to address problems, particularly with people who have a mental illness.

Rosenthal contrasts the approach of Boston’s Massachusetts General Hospital, where the strongest weapons its security officers carry is pepper spray to that of the Cleveland Clinic, which has its own fully armed police force and also employs off-duty officers.

Guns in hospitals

Meanwhile, as risk managers struggle with the dilemma of whether to arm or not to arm, patients and visitors are often armed, enabled by state and local gun laws – just one more factor that healthcare facilities are coping with. At of the beginning of the year, Texas law allows for guns in state mental health hospitals. Campus Safety Magazine reports on how Kansas College Hospitals are preparing to allow guns on campus to comply with a new law. Gun laws in health systems vary by state – while a federal law bars guns from schools, there is no such law about firearms in hospitals.

Healthcare Violence Prevention Resources

OSHA: Worker Safety in Hospitals – Caring for our Caregivers

OSHA: Preventing Workplace Violence: A Road Map for Healthcare Facilities

OSHA: Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

Mitigating Workplace Violence at Ambulatory Care Sites

Emergency Department Violence Fact Sheet

Healthcare Crime Survey 2015

Prior related posts

More perils for healthcare workers

Violence in healthcare: 61% of all workplace assaults are committed by healthcare patients

Report on violence & aggression to Maine’s caregivers; Injuries include bites, kicks, being hit

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Are nurses and health care workers facing more on-the-job violence?

Monday, March 14th, 2011

If you asked the average person to list professions with the highest rates of violent assault, few would put health care professionals high up on that list. But the reality is that when it comes to workplace violence, nurses, nursing aids, and paramedics have the dubious distinction of being very high up on the list; only police and correctional officers suffer a higher rate of on-the-job assaults. And many nurses say that the violence is only getting worse.
In a fact sheet on violence, The International Council of Nurses, a federation of more than 130 national nurses associations representing the millions of nurses worldwide, says that:

  • Health care workers are more likely to be attacked at work than prison guards or police officers.
  • Nurses are the health care workers most at risk, with female nurses considered the most vulnerable.
  • General patient rooms have replaced psychiatric units at the second most frequent area for assaults.
  • Physical assault is almost exclusively perpetrated by patients.
  • 97% of nurse respondents to a UK survey knew a nurse who had been physically assaulted during the past year.
  • 72% of nurses don’t feel safe from assault in their workplace.
  • Up to 95% of nurses reported having been bullied at work.
  • Up to 75% of nurses reported having been subjected to sexual harassment at work.

Last fall, the issue of safety for nurses and allied health professional was brought to the forefront after the deaths of two California healthcare workers in separate incidents. In October, psychiatric technician Donna Gross was strangled to death and robbed at Napa State Hospital. Days later, nurse Cynthia Barraca Palomata died after being assaulted by an inmate at Contra Costa County’s correctional facility in Martinez. The deaths have sparked a new push for better security and stronger worker safeguards, particularly in settings treating prisoners and psychiatric patients.
While the occupational danger in environments like prisons and psychiatric hospitals is recognized and real, these are hardly the only high-hazard settings in which nurses work. Hospital emergency rooms are widely recognized as a hazardous environment, but violence occurs in other wards, too. Last year, the Well, a NY Times healthcare blog, featured an article by RN Theresa Brown entitled Violence on the Oncology Ward. And the CDC recently spotlighted research focusing on an increase in assaults on nursing assistants in nursing homes. In that study, 35% of nursing assistants reported physical injuries resulting from aggression by residents, and 12% reported experiencing a human bite during the year before the interview. There are no healthcare settings that are immune. Assaults routinely occur in general hospitals, in health clinics, and in patients’ homes.
The perpetrators of violence are varied: While many assaults are by patients, friend and family members of patients also can commit the assaults. There are also rapists or muggers who are targeting healthcare settings or solitary workers; drug addicts and robbers, who are looking for medications; and domestic violence brought into the workplace. And it’s unclear why violence is on the rise. Many point to staff shortages. Others see the preponderance of alcohol, drugs, and ready access to weapons as contributing factors; others think that hospital administrators do too little in the area of prevention.
Some are seeking legislative relief that would require hospitals and healthcare facilities to have safety and security plans and training in place. In a posting on KevinMD.com, respected physician Kevin Pho suggests that the rising tide of violence against healthcare workers might be emblematic of a dysfunctional health system, where healthcare is viewed as a commodity, and the caregiver-patient relationship is deteriorating. He says:

“Sometimes the simplest approaches are the most effective. Rather than adding security or installing metal detectors to prevent hospital violence, doctors and nurses could do a better job of empathizing with patients who are under stress when they are hospitalized or are angry because they’ve waited hours for medical care. At the same time, patients must realize that health care professionals are doing the best they can with an overtaxed health care system and should never resort to violence or abuse.”

In HealthLeaders Media, John Commins discusses an innovative approach undertaken by the University of Wisconsin Hospital and Clinics – a program to codify risk of hospital violence.
Recently, the Emergency Nurses Association issued a Workplace Violence Toolkit, targeted specifically at emergency department managers or designated team leaders.

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Thoughts in the aftermath of a tragedy

Wednesday, April 18th, 2007

Our hearts go out to the Virginia Tech community in their time of mourning. What a terrible event and what a sad reminder that life is short and and can be snatched from us and those we love at any moment in the most unlikely of circumstances. Perhaps the best memorial we can offer to the deceased is to redouble our efforts to live with kindness and goodwill. That, and to reach out and hug our loved ones.
Be alert for your employees’ reactions to this event. A horrible incident like this can take a psychic toll on many – even those who are remote observers with no actual connection to the event can suffer emotional stress. This is particularly true for those who have previously been involved in episodes of violence. Events of this nature can rekindle or exacerbate post-traumatic stress disorder for people unrelated to the actual event. For others, it can bring repressed fear and anxiety to the surface. The continual media drumbeat 24/7 and focus on sensational details can add to general distress.
In the aftermath of this and other horrors, we seek to make sense of senseless events. It’s natural that many would look to find someone or something to blame beyond the deceased perpetrator. Right now, many are looking to the university’s security procedures and questioning why the campus wasn’t locked down after the first shooting. That’s a valid question. Of course, it’s easy in hindsight to say what should have been done, but the reality can be more complex, so we will need to wait for the investigation to answer this and many other questions. Certainly, Columbine delivered some hard lessons about how things could have been handled better to minimize loss of life. Recommendations from follow-on Columbine investigations have been adopted by law enforcement personnel nationwide, and may already have saved lives.
The psychology of security
Can a community of 30,000 ever be securely locked down against a deliberate and cunning killer? Bruce Schneier presents a sober look at the issues of risk management and security in his excellent article, The Psychology of Risk. He points out that security is both a mathematical reality that can be calculated and a feeling based on psychological reactions to both risks and countermeasures. In regard to the latter, he notes:

* People exaggerate spectacular but rare risks and downplay common risks.
* People have trouble estimating risks for anything not exactly like their normal situation.
* Personified risks are perceived to be greater than anonymous risks.
* People underestimate risks they willingly take and overestimate risks in situations they can’t control.
* Last, people overestimate risks that are being talked about and remain an object of public scrutiny.

He goes on to present several examples of how and why people exaggerate some risks and downplay other risks, often in complete disregard to the mathematical realities. These perceptions influence our expenditures of time and effort:

“Why is it that, when food poisoning kills 5,000 people every year and 9/11 terrorists killed 2,973 people in one non-repeated incident, we are spending tens of billions of dollars per year (not even counting the wars in Iraq and Afghanistan) on terrorism defense while the entire budget for the Food and Drug Administration in 2007 is only $1.9 billion?”

Noting that absolute security is an impossibility, Schneier frames the matter of relative security as a trade-off. We measure the time, expense and inconvenience of a given security measure against our perception of the risk. If that perception is faulty, it’s an irrational trade off that doesn’t do much to increase our security.
After a tragedy, emotion often prevails over dispassionate rationality. Thus we can’t carry shampoo on planes and we strip down to almost our skivvies in airports. Does that make us safer or does it just make us feel safer? It’s unlikely that any measures can be thorough enough to guard us from a random determined killer in our midst. Efforts might be better spent trying to determine the root causes of why there are so many random determined killers in our midst.
Schneier’s article presents interesting, well-framed ideas in well-written format. Whether you work in the business of risk or just live in a risky world, it’s worth a read.

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