Workplace Violence in Hospitals: 10 Steps to Preparedness

by | Nov 30, 2018

A Thanksgiving-week shooting at a Chicago hospital provided a sad reminder that an active shooter incident can happen anytime and anywhere. A staff member at Mercy Hospital told the New York Times about the struggle to evacuate patients during the event: “You had to put the blinders on and just keep moving forward, and that’s what I did.”

When hospitals create and train on an emergency management plan for workplace violence in healthcare, staff are better able to carry out their responsibilities even in the midst of fear and chaos. This emergency management checklist for workplace violence can help your hospital prepare and respond more effectively, so all personnel can keep moving forward in an effort to reduce the risk to patients and staff.

Emergency preparedness for workplace violence in hospitals or healthcare

1. Include workplace violence in your hospital emergency preparedness plan

An emergency preparedness plan should be based on an all-hazards risk assessment that includes the possibility of an active shooter and other forms of workplace violence, in both the communication plan and the policies and procedures elements of your plan. A communications plan should include maintaining an up-to-date contact database for hospital leadership and internal and external emergency responders; mass notification plans for staff, patients, and family; and processes for sharing information with the press. Include an incident command structure and criteria for both evacuation and sheltering in place.

2. Create a continuity of operations plan (COOP)

A continuity of operations plan, or COOP, can stand alone or act as an annex to an emergency operations plan (EOP). Develop a plan and procedures to identify and fill any staff shortages or operational gaps caused by the event or response. Consider how to send eligible evacuated patients home and reschedule postponed appointments and procedures, and be aware of requirements for tracking the location of patients and staff. Anticipate possible public responses to seeing your facility in the news as a crime scene.

3. Assemble crisis response kits

Place kits including radios, floor plans, staff rosters with contact information, first aid supplies, and flashlights on every floor. Make sure all staff knows where to find these kits and what they contain, and regularly renew their contents with updated information, fresh batteries, and other supplies that could expire.

4. Educate and train with the workplace violence response plan

Rehearsing and practicing procedures for a workplace violence incident will help staff respond more quickly and more consistently. A well-organized and effective training program will ensure that all staff know the location of the emergency plan, their roles in an emergency, and how to report an emergency and activate the emergency plan. When possible, make emergency procedures, notifications, and tools similar to those used every day, so staff are fluent and confident.

5. Collaborate with law enforcement and other first responders

Work with law enforcement and other emergency responders and agencies at each stage of emergency preparedness planning, from creating to testing the plan. In addition to establishing criteria for summoning law enforcement, have a communication plan for sharing information about casualties, resource needs, and any patients or staff missing after evacuation.

During a workplace violence event, such as an active shooter in a hospital

6. Recognize early behavioral warning signs

Aggressive behavior should be taken seriously. If patients or visitors attempt to intimidate staff or use uncooperative and verbally abusive language, that is a red flag. Stalking, harassing, or giving excessive attention to someone are also warning signs. Pay attention to body language such as arms folded over the chest, mouth held straight, or a reddening face.

7. Incorporate early defensive action to suppress the problem

Speak calmly, using “I” statements such as “I don’t like shouting. Please lower your voice” or “I want to have a good working relationship with you.” Use a slow, soft, clear voice. Ask the individual to sit down, which will show whether he or she will follow directions. Be aware of your nearest exit and don’t wait for a crisis to call for help. Specialized codes to call de-escalation or behavioral health teams in these situations may prevent a violent event.

8. Know when violence is imminent

There are several body signals that indicate an individual is likely to become violent. These include lowering of the head, tucking in the chin so the bottom whites of the eyes are showing, clenching and re-clenching fists, touching their head or pulling hair, and difficulty controlling fine motor skills.

9. Initiate defense actions if violence begins

Evacuate the area immediately, leaving belongings behind. Prevent others from entering the area and contact law enforcement. If you are unable to evacuate, find a safe place to hide that is out of the violent person’s view. Turn off sources of noise such as televisions, radios, and phones. Use silent modes of communication whenever possible. Only when in imminent danger, as a last resort, should an individual attempt to disrupt or incapacitate an active shooter.

10. Know how to react when law enforcement responds

Be aware that during an active shooter incident, law enforcement will focus on stopping the shooter as soon as possible. They may be in uniform or in plain clothes. They may push individuals to the ground for safety and may not stop to help the injured. Follow officers’ instructions right away. Keep hands empty and raised with fingers spread, avoid any quick movements, and do not stop to question directives or interrupt law enforcement activities.

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terry-zysk-100x100Terry Zysk, CEO of LiveProcess, has more than two decades of experience in leading organizations that provide innovative solutions to the healthcare industry.