Medical centers are intended as places for care and healing, but they are increasingly sites of violent incidents, some resulting in serious harm or even death. Health care violence can take a number of forms, depending on the perpetrator’s motive, actions and whether the person is a patient, visitor, employee or bystander. In all cases, it’s a threat that should be minimized in every way possible, experts say.
The American Hospital Association recently hosted a webinar about what hospitals and practices need to know to protect themselves, staff members and patients. “Understanding Origins of Violence in Health Care Facilities” featured Jason Grellner of Evolv Technology and Drew Neckar of Cosecure. Both panelists spoke candidly about technology, terminology and steps that can be taken to dial down the danger at health care facilities.
Defining the threat
Neckar said acts of violence can affect any type of health care facility, and they can range from verbal harassment and minor assaults to extreme acts like stabbings and shootings. The main types of violence are motive- and relationship-driven, Neckar noted, and factors like intoxication, confusion, high stress levels and mental health issues often compound the risk.
When assessing a facility’s vulnerabilities and needs, it’s helpful to start by reviewing official definitions of health care violence from the Joint Commission and the Occupational Safety and Health Administration, Neckar said. The OSHA definition is likely to be updated soon, Neckar noted, so health leaders should watch for it, as it likely will necessitate hospital protocol changes.
Grellner discussed techniques that can help with early threat identification, including artificial intelligence-based facial and sound detection capabilities. Facial ID technology can help facilities identify a person who has a history of violence or crime, and non-recording sound detection platforms can analyze voices for volume, agitation and other factors that suggest violent behavior is imminent.
Deploying the tactics
According to Neckar, some of the most effective ways to mitigate violence include de-escalation training for staff, risk identification activities and proactive facility design. Simple environmental design steps can be helpful, such as seating the clinician close to the door in an exam room, designing emergency department registration desks so patients can’t walk around them and assault staff, and using window coverings that can’t be penetrated by gunfire.
Neckar also demonstrated a “heat map” analysis that can show where crime and violence have occurred outside a facility, on the street and in parking lots. Grellner described the usefulness of a scoring system called the CAP Index, which provides data on crime risk in the area where a facility is located. It can show which hours of the day tend to have the most illicit or dangerous activity.
Grellner also highlighted health care professionals’ role in identifying how domestic conflict plays into workplace violence, so its effects can be addressed. “We have to understand the prevalence and consequences of domestic violence. They surround us,” Grellner said. “How many of our coworkers could be impacted? That interpersonal violence doesn’t stay at home.”
Diverting the danger
Sometimes violent intent lies well below the surface, so facilities need to be aware of subtle signs of trouble in an individual, the presenters said. Neckar described a scenario in which a female nurse practitioner felt ostracized by male coworkers, complained frequently and then devised a plan to poison the coworkers with tainted baked goods. Fortunately, security personnel had the tools to identify the nurse practitioner’s suspicious behavior. They analyzed her workplace activity and internet use and were able to intervene before anyone was harmed.
“In every incident of targeted violence we have seen across the country, there is a definite pathway to violence that the attacker takes,” Neckar said of the behavioral information that can be analyzed to prevent threats. “In every incident, there’s also a precipitating event – or multiple events – that put that person on the pathway.”
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