Article originally published in Hospital + Healthcare, original article available here.
On 12 January 2016, a 39-year-old patient in a psychotic mental state brought on by methamphetamine use held a pair of scissors to a doctor’s throat at a Sydney hospital, threatening, “I’m going to kill you”. A constable managed to make it to the scene but, following a struggle, the patient gained control of the constable’s service weapon, shooting the police officer and a hospital security guard.
Far from an isolated occurrence, the violent incident is part of a disturbing pattern for the at-risk healthcare sector. Across the country, workers in care settings face a significant risk of patient-initiated, occupational violence, whether they’re operating in emergency rooms, psychiatric hospitals, community health clinics, social service offices or people’s homes.
The security issue has been at crisis levels for some time now. Since 2009–2010, the sector has consistently logged the highest number of serious workers compensation claims, with disproportionately high rates of homicide and other violent incidents.1 In fact, the Australian Institute of Criminology identified nurses as the occupational group most at risk of workplace violence.2
What makes occupational violence so frighteningly commonplace in health care? According to researchers, the following conditions pertain to work in care settings:
- Work undertaken alone, in isolation, or in a remote area with the inability to call for assistance.
- Work done offsite or in the community.
- Work done in unpredictable environments.
- Face-to-face communication with customers.
- Care provided to people who are in distress, afraid, ill and/or incarcerated.
- Service methods used that cause frustration, resentment or misunderstanding.
- Care provided or services rendered for people who have unreasonable expectations of what an organisation and or employee can provide to them.
Despite those factors, the industry hasn’t done nearly enough to keep its frontline workers safe, as forcefully argued in the NSW Health investigation into the security of the state’s hospitals. The subsequent report, compiled by former state minister Peter Anderson, addressed many of the industry’s failings, before offering non-clinical physical and operational security practices to better help hospitals prepare and respond to major and minor events in their facilities.
The safety and security culture in hospitals
One stark report finding is the absence of a proactive culture of safety and security throughout the NSW hospital system. Although the sector prioritises patient safety, it has generally done a poor job of articulating and mandating strong worker safety prerogatives.
Promoting such a culture would be the responsibility of those at the very top of the hospital hierarchy: chief executive and board. To date, prioritising frontline worker safety as a matter of governance has been neglected. Zero-tolerance policies and mitigation procedures against criminal offences committed towards employees, patients and members of the public are crucial and should be enforced.
What’s more, hospital staff routinely fail to report incidents relating to violence and aggression against staff. Those under-reported safety incidents don’t get tracked in hospital systems, which limits understanding of safety and security risk.
Another key issue is clinical and security staff don’t operate as an integrated team. Clinical staff often misunderstand the security officer’s role, with medical workers routinely asking or directing security officers to do things outside their roles, responsibilities and powers. Compounding this, clinical team members don’t fully understand their own role in physical security operations, which should consist of alerting security officers of potentially difficult situations and involving security personnel in post-incident debriefings.
Many of the legacy incident information management systems hospitals are using fail to enable robust physical security operations as well, even when there is a desire to promote a proactive safety culture.
Time for an evolution in hospital security and safety
The necessary set of technology features to efficiently track and report on security incidents is often lacking. Across the system, many incident management solutions don’t allow workers to input enough details about an incident, such as when the incident happened (day of the week), what kind of incident it was (type of event), even who is inputting the data. This level of event data is needed to make informed policy recommendations based on a clear understanding of risk at a hospital.
The lack of basic functionality in non-clinical physical and operational security stands in sharp contrast to clinical care, many aspects of which have digitised apace. What is needed to ensure safety and security for practitioners, visitors and patients is commitment to advanced digital systems that support proven safety and security-promoting behaviours.
Noggin, a leader in crisis, safety and security management technology, has identified that smart safety and security decisions depend on a steady stream of high-quality information about what’s happening in hospitals and other facilities. That won’t happen if staff can’t supply the information easily. Noggin’s total incident management solution digitises and supports functionality that:
- Enables the speedy inputting of an incident, including relevant details like date/time as well as type of incident and decreases the friction of submitting reports.
- Easily identifies the person who made the system entry.
- Ensures easy, in-system follow-up of an event, as well as meeting collaboration and escalation.
- Centralises all non-clinical incident reporting, including persons of interest.
The store of data yielded through consistent, non-clinical incident reporting enables stakeholders to gain a detailed understanding of risk, which in turn helps shape policy recommendations for improvement, such as demand-driven security rostering.
Once standards are prescribed, incident information management systems should be in place to enforce them, to ensure constant improvement or coordinating audits for compliance.
Workplace violence in hospitals represents a stark, but not insoluble, problem. Not only does it put the lives of staff, patients and visitors at risk, it can also lower the quality of patient care, due to clinicians operating in an unsafe environment.
The precedent set by the digitisation of clinical care provides a way forward for non-clinical physical and operational security processes. For strong gains in visibility, coordination and efficiency, those processes can be likewise digitised in all-encompassing platforms, purpose-built for managing safety and security operations and communications. These systems give districts hospitals and other facilities the ability to pick up on trends in risk, so as to prescribe improvement actions as security events are documented. Their cumulative effect will go a long way towards reducing risk, promoting and reinforcing proactive safety and security cultures and, most importantly, ensuring a safe clinical environment for practitioners, staff, visitors and patients alike.
- Safe Work Australia. Health care and social assistance. Available at https://www.safeworkaustralia.gov.au/industry_business/health-care-and-social-assistance.
- Health Times: Zero tolerance for violence against health care professionals. Available here.
James Boddam-Whetham is the CEO of Noggin, a software company that provides innovative incident management solutions for managing emergencies, risk, crisis, compliance, operational security, business continuity, work safety and more. Noggin offers a dedicated healthcare software solution to help hospitals and healthcare agencies effectively respond to non-clinical safety, security and critical incidents affecting their staff and operations.
Image credit: ©stock.adobe.com/au/mikumistock