Centers for Medicare & Medicaid Services (CMS) recently issued a notice from the Center for Clinical Standards and Quality (QSO-23-04-Hospitals) regarding Workplace Violence in Hospitals.
Too Little Too Late
In this notice they cite that in “April 2020 Bureau of Labor Statistics Fact Sheet found that healthcare workers accounted for 73 percent of all nonfatal workplace injuries and illnesses due to violence in 2018. This number has been steadily growing since tracking of these specific events began in 2011.” Although anyone that has worked, or is working, in healthcare knows this all to well.
Security Statistics for Hospital Workplace Violence
What was interesting, is that this information was compiled by the Bureau of Labor in 2020, but not released and/or apparently acknowledged until now, and that the statistics cited were from 2018? What they did not acknowledge is the fact that there are likely hundreds of thousands of cases that were never reported, thus the extent of the real problem is under-reported.
A well-known fact known by healthcare security experts is that in many cases nurses do not report all incidents of violence that they have endeared. In fact, in every hospital that I have surveyed in the last 20+ years, I have heard the same thing, and that is “its just part of the job” that they are assaulted. Why such a belief exists is the problem that hospital administrators, staff, and experts have been pondering for years.
While it may not be true that hospital administrators condone such a mindset, it is likely that they have either not asked staff about the notorious workplace violence risks, or they do not understand just how prevalent it is.
When talking to staff, mostly nurses in this case, they will admit that they do not tell management about most incidents. When asked why they do not tell their managers, they will often say we have been telling them for years and they do not do anything about it. That may have been the case 20 years ago, but it is my opinion that the staff needs to be that squeaky wheel and report everything.
Under-reporting of Healthcare Workplace Violence
Back in about 2010, as the result of relentless pressures brought about by nursing unions and associations, California got their act together and started requiring that all healthcare facilities report all cases of workplace violence, and reporting had to be made to the local law enforcement jurisdiction within a set time frame. What they did not take into consideration was that law enforcement was either not aware of the new reporting requirement, or they did not know what if anything that they needed to do with the information. So, in essence, things did not go as planned by the politicians in Sacramento, because in some cases the police refused to accept the information unless someone was going to be arrested.
To get back on track here, while the latest notice from CMS is welcomed, it is my opinion that most healthcare security experts know that it does not go far enough. Where is the definitions for “an environment that prioritizes their safety to ensure effective delivery of healthcare”. I say this because healthcare administrators across the country question what they can and cannot do. Hospital security directors and managers claim that they do not have the staffing, tools, training, and support to properly deal with the problem, and security officers do not have the training needed to intervene before punches fly. While it is not always the case, many times it comes down to hospital security not being properly funded, trained, and managed.
Has Your Hospital Security Been Properly Trained
Although we would like to believe that our hospital security officers have the proper training, both in quality and the amount of training, the facts may disappoint everyone. There are numerous deescalation training courses out there, and yet a large number of hospital security officers either do not get it, do not follow it, or were taught years ago and never got a refresher course. In some cases, hospitals will develop their own training, so as to keep their costs down, and yet when something happens and there is litigation as a result, they find out the hard way that their program is not aligned with the industry standards.
Hospital Security Management
I have visited numerous hospitals as part of a security risk assessment or a security program review over the years. In many cases I found that the hospital security manager did not have the proper training or certifications do perform the job. The disturbing fact is that when a hospital contracts out their security services, the manager that the hospital security contractor puts in place to manage the program normally gets no healthcare specific training.
I will leave you with these questions to ponder;
- Do you how your hospital security program compares to the industry standards, best practices, and/or guidelines?
- Are your security officers properly trained?
- Does your security leadership have the qualifications to properly manage your hospital security?
- Are your security officers and/or management increasing your security risks or liability exposure?
- Does your security contractor have the proper knowledge, training, and risk mitigation strategies to protect your organization?
There are many other questions that I could insert here, but suffice it to say if you are not 100% confident in how well your security program is managed, or if your security officers are competent based on industry standards, it is time to get an independent and unbiased security expert in for a complete security risk assessment and program review. As I have already stated, outside organizations such as CMS, The Joint Commission, OSHA, and others will react to vulnerabilities and serious incidents after the fact, and in the case stated about that can be years after the fact. It is past time to get in a proactive posture on the serious issue of workplace violence so as to prevent an incident from happening in the first place.