Violence in hospitals and against healthcare staff has been steadily increasing since 2004. A recent article in the Journal of the American Medical Association (JAMA), cited the National Institute for Occupational Safety and Health, NIOSH publication 2002-101, which indicated that healthcare workers face four times the violence potential as other occupations.
If you add in the many domestic violence cases that play out in our hospitals, you can double or triple that figure. For reporting purposes, OSHA does not count domestic incidents (like murders) that take place in hospitals as officially “workplace violence incidents”.
Anecdotal incidents such as the shooting of a physician at Johns Hopkins Hospital in Baltimore, Maryland in September, 2010, and the January 1st, 2011 stabbing murder of an engineer at Suburban Hospital in Maryland by an employee angry because he didn’t get a good performance evaluation, keep the issue on the front pages, and cause hospital staff to worry about their personal safety.
The Joint Commission issued a Sentinel Event Alert in June 2010, on violence in hospitals and how it can affect both staff and the patients themselves. Nurses are on the front lines, and they are the most likely to be attacked, a fact which has not been lost on the nurse’s associations who are actively lobbying for safer working conditions.
Workplace violence issues were traditionally something handled in the Department of Human Resources, but security departments are increasingly involved in violent incidents and are critical to safeguarding hospitals.
Why Violence in Hospitals is Increasing
Violence is not a concept that people usually associate with hospitals. For years, hospitals have been seen as almost a sanctuary of care for the sick and wounded in our society. However, the perception of hospitals has been changing over the last fifteen years due to a variety of factors.
1. Doctors are no longer thought of as “Gods”. This means they are
are more easily blamed when a patient’s condition deteriorates.
2. Hospitals are now regarded as businesses. This perception has been
been aggravated by television in shows like a recent “60 Minutes”, as well as
by the effects of the recession on jobs and the loss of health insurance.
3. Lack of respect and resources (funding) for hospital security departments
. Rather than being seen as a crucial protection for the hospital staff and
patients, many security departments are chronically underfunded and used
for a variety of non- security functions, such as making bank deposits for
the hospital gift shop.
4. Resistance to Visitor Management programs in many hospitals. Again,
because of the unsettling effect of the recession, violent solutions are
becoming more common in the United States in general, for example, the
recent Tucson tragedy.
The federal government issued a guidance document for dealing with violence issues in healthcare,
OSHA 3148.01R, 2004, Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers
The Evolution of the Hospital Security Program
Even as recently as five years ago, many hospitals didn’t have a Security Director, instead they used the Safety Officer to double up and handle security. However, the Joint Commission and many professional hospital organizations recommend the formation of the Security Director position.
Now every almost every hospital has a Security Director who oversees the various security functions at the hospital. These cover a wide range of duties including managing either a contract security force, or developing and managing a proprietary security force; managing violent patients in the Emergency Department; managing incidents regarding kidnapping, infant abduction, cash handling, helicopter coordination, handling admission of prisoners, monitoring visitors, managing hundreds of cars and garages, dealing with harassment, sexual assaults and domestic violence issues which end up at the hospital.
As the Security Director has assumed responsibility for an expanded list of duties, the security budget has not always kept pace with the expansion of the security function.
Assessing the Value of Security to the Functioning of the Hospital
When we start to assess the value of the security program to a hospital, we have to start with the total value of the hospital.
One of the greatest surprises we find in conducting risk assessments on hospitals, is that they possess tremendous value but because they are so large, and perform so many different functions, individuals can’t always see the hospital as a whole.
To make it easy to understand, we can breakdown the value of a hospital into its component parts:
1. The value of the Facility – this is the current replacement value of the building, usually over 50 million dollars.
2. The value of the hospital Staff, including both administrative and medical staff members (use the value of their salaries for a year).
3. The value of specialized medical equipment, including all
the IT systems, X-rays, Cat scans, MRIs, and medical lasers, photon knives, etc.
4. The value of the actual revenue from the patients.
5. The value of the patient’s safety and their health information.
You can see that when we add up these asset values, and add another 10-12 categories, the hospital usually ends up with a value of $100 million to $500 million, or often higher. That is the total of the assets that are potentially ‘at risk’.
That is the value that the security function protects. Each of these asset categories can potentially experience a loss that would interrupt their operations, either for a limited time (like a gang fight in the lobby; or a theft of pharmaceuticals), or permanently (for example, a catastrophic fire).
The next step in the analysis is the see what kinds of controls are already in place to protect all these assets. Controls are mandated by a variety of federal, state and local laws, as well as best practices from insurance companies, and standards created by industry associations such as the Joint Commission, the Center for Missing and Endangered Children, the International Association of Hospital Security and Safety.