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De-escalating Security Situations in Healthcare

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De-escalating Security Situations in Healthcare

Hostile encounters with patients and other violence against healthcare workers. Aggressive, antagonistic behavior between coworkers. Active shooter incidents like the one in an Oklahoma medical building in 2022 left four dead. These are all examples of workplace violence in healthcare that as many as 62% of healthcare workers say they’ve experienced.  

Here’s another striking workplace violence in healthcare statistic. In 2020, healthcare workers were involved in about a quarter of cases (23%) involving non-fatal workplace intentional injuries by another person that required at least one day away from work. The actual number of cases involving violence against healthcare workers is likely higher because many incidents (e.g., bullying, verbal abuse, and harassment) go under-reported. This is true even within organizations that have a proper formal incident reporting system.  

These workplace violence in healthcare statistics are why new and revised workplace violence de-escalation strategies are now required for all Joint Commission-accredited hospitals and critical access hospitals. The goal is to provide a framework to guide hospitals in developing effective workplace violence prevention systems. It can also act as a guide for physical security professionals on how to prevent workplace violence in healthcare.

Preventing workplace violence in healthcare settings requires many elements including leadership oversight, policies, procedures, reporting systems, healthcare security software, and, crucially, de-escalation training for security officers. 

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In response to this growing problem of workplace violence in healthcare, hospitals are ramping up their security efforts. However, hospital security guards are not there to be referees, nor should they immediately use physical force to resolve a situation. Instead, they must keep healthcare workers, visitors, and patients safe using de-escalation techniques.

Common Types of Workplace Violence in Healthcare Settings 

De-escalation, the process of making a situation less dangerous, effectively addresses workplace violence that threatens the safety of healthcare workers and patients. De-escalating situations means organizations must take a proactive approach to mitigate risk. However, security guards and others must also know how to diffuse tension at a moment’s notice. It takes a team approach to address various types of workplace violence in healthcare.  

The healthcare workers at the highest risk of experiencing violence are those who work directly with people receiving inpatient and acute psychiatric services as well as those working with patients in geriatric long-term care settings. High-volume metropolitan emergency departments as well as residential and day social services also present high risk. However, any healthcare organization can be vulnerable to workplace violence.  

What are common risk factors for violence in healthcare settings?  

The absence of facility policies as well as a lack of de-escalation training in healthcare on recognizing and managing escalating hostile behavior. Workplace violence is also more likely to occur when there is high worker turnover, insufficient staff, and inadequate security and mental health personnel on site. Security officers skilled at de-escalating situations are important not only for staff but also for patients as well as their friends and families.  

Healthcare workplace violence prevention also requires a solid understanding of who commits most of the violence in the healthcare setting. The answer? Most violent cases are committed by patients’ families and friends. Patients themselves are the next most common perpetrator of workplace violence. The healthcare workers at the highest risk of experiencing violence are those who may not know these facts and are unprepared to identify de-escalating situations and mitigate risk.  

How to Prevent Workplace Violence in Healthcare 

The good news is that healthcare facilities can take various preventative measures to decrease the risk of workplace violence. The first step toward preventing workplace violence is to recognize that workplace violence is a health and safety concern. This begins with management’s commitment through proper resource allocation, policies, and procedures to monitor incidents and take care of workers who experience or witness assaults and other violent incidents. Another thing an increasing number of healthcare facilities are doing is hiring professional security officers or establishing their own security departments to help decrease the risk of workplace violence. 

Other preventive measures include comprehensive self-defense and de-escalation training in healthcare for all workers as well as specialized de-escalation training for security officers. This is so they understand the psychological components of handling aggressive and abusive individuals and can defuse hostile situations effectively.  

Security Officer Techniques for De-Escalating Situations in Healthcare

Security guards provide critical intervention during a time when people are most vulnerable. That’s because their actions (or inaction) greatly impact the outcome.  

How can security officers de-escalate violence in healthcare workplaces?

By following these guidelines for proper behavior during a crisis in a healthcare facility: 

1. Identify Early Warning Signs

Teach security officers to identify risk factors for violence in a healthcare setting as quickly as possible. For example, they should be looking for early warning signs of agitation (e.g., body language and tone of voice) and intervene before the situation spins out of control. Security officers can use various risk assessment tools to detect workplace violence. These include: 

  • STAMP (Staring, Tone and volume of voice, Anxiety, Mumbling, and Pacing) for use in the emergency department
  • OAS (Overt Aggression Scale) for use in the inpatient setting
  • BVC (Broset Violence Checklist) for use in the adult inpatient psychiatric unit
  • BRACHA (Brief Rating of Aggression by Children and Adolescents) for use in the emergency department when determining the best placement in an inpatient psychiatric unit. 

2. Take a Hands-Off Approach

Security officers are not permitted to lay their hands on anyone until a healthcare worker or other individual verbally asks for physical assistance. Physical intervention should always be a last resort and used with the least amount of force.

3. Respect Personal Space

Security officers should respect the personal space of others unless an aggressor initiates physical contact. Standing three feet away from someone who’s escalating can help reduce that person’s anxiety. If a security guard needs to move in more closely, they should explain why.  

4. Start with Verbal Communication

Security guards should speak clearly, calmly, and respectfully while being mindful of facial expressions, gestures, movements, and tone of voice. Language should remain non-confrontational throughout the interaction.

5. Express Empathy

Security officers should use de-escalation techniques in healthcare to calm confrontational people. When used properly, verbal intervention and empathy can be quite effective to settle agitated people. Security officers should focus on how the agitated person is feeling to gain that person’s trust and help diffuse the situation.

6. Avoid Overacting

It’s important for security guards to remain calm and rational. Sometimes even allowing silence for reflection or giving the person a few minutes helps them absorb and think through what they said.

7. Recognize Mental Confusion

In a hospital environment, it’s likely to encounter people with dementia. Recognize the difference between aggravation and confusion and be gentle with dementia patients.

8. Identify Group Leaders

In group situations, train security officers to identify a leader and speak to them one-on-one. Get agreement on proper behavior and ask them to explain the rationale to their group.

9. Redirect Challenges

Security guards must know how to handle someone who challenges their authority. The goal is to avoid power struggles by ignoring challenging questions. Instead, refocus the person’s attention on the issue at hand and work together to solve the problem, reaching a peaceful resolution.  

10. Set Limits

Clear, simple, and enforceable limits are paramount. Security guards must know how to offer concise and respectful choices as well as consequences.  

De-Escalating Security Situations in Healthcare is Possible – With the Right Resources

Many of these skills are taught through courses by the Crisis Prevention Institute (CPI). These courses equip guards with the decision-making skills needed to assess and address risk, successfully intervening in crises without harm.  

Are you looking for more information on how to prevent workplace violence in healthcare? Be sure to watch the Thinkcurity webinar, 'The Future of Healthcare Security.' You’ll learn about:  

  • The historical evolution of healthcare security  
  • How people, processes, and technology have evolved with current healthcare security trends
  • Evidence-based approaches to improve healthcare security
  • How to prepare for future trends in healthcare security  

Watch now for a deeper dive into the future of healthcare security!  

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Thinkcurity Articles
Thinkcurity is revolutionizing education in the physical security industry through engaging content and thought leadership in every aspect of running a successful security operation.

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