Key Points

• Violence in healthcare is growing globally and risks becoming "normalized," fueled by factors such as long wait times, poor communication, and especially inadequate investment in security.
• The rise in violence is causing significant psychological harm contributing to demotivation and workforce attrition.
• A case study from a U.S. Level 1 Trauma Center demonstrates that employing specifically trained security personnel, supported by targeted technology, effectively mitigates violent incidents while allowing healthcare facilities to maintain a patient-centric approach.

Violence in healthcare settings has been on the rise globally for years and is reaching a point where it risks becoming “normalized” as part of a hospital working environment, according to international groups representing healthcare workers, including the World Medical Association. There are a multitude of reasons why, but the top preventable cause of violence, according to a 79-country survey, is a lack of investment in security.

The Violence Study of Healthcare Workers and Systems, the largest-ever global study of its kind, was conducted to gain insight into risk factors and prevention. It concludes that the frequency of violence has increased over the years and is both demotivating healthcare workers and causing them to contemplate leaving their jobs (“ViSHWaS: Violence Study of Healthcare Workers and Systems—a global survey,” BMJ Global Health, Sept. 2023).

“Violence against healthcare workers is an unfortunate reality in medical practices across the globe,” it concludes, noting that significant psychological impacts could harm health outcomes by impacting labor markets. “It is crucial to address the psychological impact of workplace violence on healthcare workers, leading to burnout syndrome, impaired work ability, PTSD, and even retirement.”

What is the top preventable cause of violence?

Violence in hospitals and other healthcare settings is a global problem with a complex etiology. Contributing factors include everything from long wait times to poor communication with aggressive patients.  The top cause of violence is something that facilities have little ability to control; namely, patients with an altered mental state. However, the second leading cause of violence is something that is very much in the control of healthcare providers: lack of security.  

“Survey respondents were asked to rank the 10 causes of violence based on their perceived importance. A patient’s altered mental status is considered as the most important cause by 27% of respondents, followed by a scarcity of security for healthcare workers (13.8%).

The most common suggestions include increased security, staffing levels, training and worker support, and improved infrastructure. — "Recommendations from the victims' perspective" section of a June 2024 literature review of research examining workplace violence against healthcare workers

What do healthcare workers want to see?

It seems that healthcare workers themselves understand that greater investment in security is key to a safer work environment, according to a June 2024 research study (“The growing burden of workplace violence against healthcare workers: trends in prevalence, risk factors, consequences, and prevention – a narrative review, eClinicalMedicine).

In the study’s section on “recommendations from the victims’ perspective,” the authors say that healthcare workers recommend a range of actions to curb violence. “The most common suggestions include increased security, staffing levels, training and worker support, and improved infrastructure.”

Case Study in Success: Addressing Volatile Situations by Integrating Security & Care  

Problem

Like every large healthcare facility, a Level 1 Trauma Center in Virginia in the USA was facing potentially explosive situations—and not once in a while, but just about every day.

Individuals referred for mental health treatment arrive daily through the doors of the hospital’s emergency department, putting patients, families, and staff into close contact with individuals who pose an established threat to themselves or others. The hospital was struggling with these patients, who were sometimes aggressive and often had items on their persons that could cause harm.

The hospital needed to find an effective way to remove contraband from patients identified as at-risk to ensure the safety of all involved in the treatment process and to promote successful patient care outcomes. Contraband came in many forms, from syringes of drugs like fentanyl and other illegal substances to guns, knives, razors, scissors, and other items that could be used as weapons.

The challenge—and the stakes—couldn’t have been higher. The hospital needed a way to enhance safety by identifying and removing dangerous items from potentially dangerous and unstable individuals—and do it in a manner that didn’t spark the exact violence that the hospital was trying to prevent. It needed to apply security policy but seamlessly fit enforcement with the hospital’s patient-centric focus and mission of care.

Solution

Ultimately, it was decided that only the right people, with the right training, could solve the problem.  It was a job for security, certainly, but more important was the need to integrate qualified, trained security personnel into the hospital’s care team.  

The hospital’s security services provider put together a plan to meet the hospital’s needs. It included technology—handheld wands to scan at-risk patients for weapons and prohibited items—but it was built around people. The officers, hand-picked for the intricacies of the assignment, were extensively trained to deftly manage even the most unstable patients and most dangerous situations.

Results

From the outset, officers began removing a staggering number of potentially deadly items from at-risk patients—threats that had previously gone undetected. In a single month, for example, the firm’s security officers received 182 behavioral health calls and conducted 79 positive searches for contraband items. In all, they removed 579 contraband items from behavioral health patients in a single year.

More important, however, was the ability of officers to conduct the vital security searches, and usher at-risk patients through the care environment, while mitigating the risk of violence. One note from an emergency medical technician describes how importantly the hospital views officers’ ability to de-escalate potentially deadly situations.

“I just wanted to call your attention to a great security response from our officers during a VERY intense patient assist,” he wrote. “Our patient became suddenly violent against staff and the response by the security officers was proactive and kept staff and the patient safe.  Even after an officer got spat on by the patient, everyone kept their cool while going hands-on and getting the patient restrained.”

Effective program management has also been important to the program’s success, including close monitoring of the volume of assistance calls in order to calibrate officer staffing. And the security firm’s on-going refresher training recognizes that, just like technology, the human element of security—which relates to decision-making, common sense, and awareness—must be continually upgraded.

Our patient became suddenly violent against staff and the response by the security officers was proactive, and kept staff and the patient safe. You all deserve to be recognized for the wonderful help that you guys gave us in controlling this patient. — Note to Security Firm by Emergency Medical Technician, Level 1 Trauma Center, Virginia, USA

A Unique Assignment Requires Special Training

Managing security in a hospital environment is a uniquely difficult challenge fraught with pitfalls—a point evidenced by even the most casual review of healthcare news and driven home by citations issued against hospitals for violations. “It’s 180 degrees different than protecting a mall or a warehouse, it requires highly educated and technical personnel,” explained a senior healthcare consultant for a leading global security services firm.  

It also requires an ability to interact and communicate effectively with a wide range of individuals, from healthcare clinicians on the care team to an individual in the midst of a mental health crisis, as hospitals are often on the front lines of managing these individuals.

As such, officer training is a vital consideration for healthcare facilities when selecting a security partner. This is necessary to ensure deployment of security officers who possess the confidence and skill to manage highly charged events in accordance with a care-centric mission.

Screened and certified officers should undergo multiple training modules, as well as exercises to practice for their particular assignments and help understand events from the point of view of others. During exercises, officers might assume the roles of clinicians, patients, and other staff to gain a deep understanding of how situations can appear to different stakeholders. In doing so, they can learn the difference between clinical aggression and criminal aggression, be taught what it is like to be a victim of various mental health diagnosis, and—using a variety of training techniques—discover how requests by security officers may appear to a patient who is high on drugs or hearing voices.

Finally, the training of security staff should not be limited to security issues. A firm’s training must recognize that to be an effective part of a care team, officers should be well versed in a healthcare facility’s culture, history, mission, and norms—and not just job tasks.