Workplace violence occurs at rates more than four times higher than in other industries, says Scott Cormier, vice president of emergency management, environment of care, and safety with Medxcel, a healthcare facilities management company based in Indianapolis. Patients and family are under stress, and often take it out on the physicians, nurses, and other employees.

“We are seeing that what we’ve been doing for decades in healthcare — taking de-escalation cases and writing policies — doesn’t work. Organizations will have an incident in which someone is injured, they’ll throw some money at it to do some training and write another policy, then they move on until the next incident,” Cormier says. “We need a paradigm shift. We need a sustainable process that actually helps protect our workers rather than just going through the motions after an event.”

Eighty percent of workplace violence in healthcare comes from patients, but the rest involves co-workers and outsiders such as vendors, Cormier notes. Any solution must begin with collecting data on how violent incidents occur, he says. That should include near misses.

Cormier recalls working in an ED where it was an accepted part of the job that patients and family members would occasionally become violent. People swung fists at him regularly, but unless the blow landed and caused injury it wasn’t reported. If he ducked and the punch missed, that was a good day and there was no report.

“We need to collect that data, and we have to make it easy to collect that data,” he says. “If your employee has to spend 10 or 15 minutes on a website reporting that incident, they’re not going to do it.”

Once data are collected for a baseline, the paradigm shift can begin, Cormier says. The first step is training, but not just a handful of high-risk employees, he says. “We should be training the whole hospital. Everyone needs to be trained in how to recognize the potentially violent person and how to respond in a constructive way,” Cormier says. “Think of all the people a patient encounters on a visit to the hospital — the volunteers, registration people, triage nurses. All of those people are typically not trained in workplace violence, but they should know what to do when they see someone in the waiting room who is escalating and how to respond quickly before it gets worse.”

The training must not be burdensome, Cormier says. An intense, full-day seminar not only takes the employee away from job duties, but it also overloads them with information that they will file and try to remember months later when needed, he explains.

“A better approach is to use shorter classes of maybe two hours, with monthly updates,” Cormier says. “A team huddle also is a good opportunity once a month to talk about what we learned about workplace violence and how to prevent it. That way, it’s kept at the front of your mind and you don’t have to dig back so deep when something occurs to try to remember the right response.”

Cormier recommends a team approach that includes risk management, human resources, behavioral health, critical care, and surgery leaders, as well as representatives of the workers who have day-to-day interaction with patients but typically are not considered frontline caregivers. Those include housekeepers and administrative clerks.

The plan should involve developing a threat assessment team that can respond at any time, around the clock and on weekends, to situations in which staff are concerned that someone may become violent.

“You also should get your local law enforcement involved with this team because if an incident escalates to violence and they respond, you want them to be familiar with your process,” Cormier says.