The Occupational Safety and Health Administration (OSHA) estimates that three-quarters of the 25,000 reported incidents of workplace violence — ranging from threats and other verbal abuse to physical assaults and worse — occur in health care and other social service settings. It’s a nationwide problem. No hospital is immune.
HUP Security Director Joe Forte has seen these numbers increase over the past several years and enlarged his staff to keep pace. But, a recent Penn Medicine employee engagement survey showed that more strategies were needed. HUP senior leaders led several focus groups to make sure they understood exactly what people were saying and what they heard surprised them. Employees said they did not always feel safe in the work environment because patients, visitors and, sometimes even colleagues, were not respectful and, at times, abusive.
Forte stressed that security is just a phone call away. Indeed, 100 security officers patrol HUP and the Perelman Center and respond to patient assist calls (when a patient or visitor is out of control), around the clock. “The first line of defense when any kind of violence occurs is to call security,” agreed Denise Mariotti, chief HR officer. “This gets someone to the unit immediately and, if need be, Penn police will respond for further reinforcement.”
Wanting to take safety efforts to the next level, a multidisciplinary Visitation Task Force, led by Jessica Lazzeri, clinical director, and comprising staff from throughout the hospital was formed, and after months of studying the issues, created a multi-prong approach to address the issues.
Giving Staff the Tools, Education and Support They Need
Changing the visitation policy was high on the list. For several years, HUP has had open access visitation, meaning visitors are allowed to see patients around the clock. While this has helped support patient-centered care, it has also allowed large numbers of visitors in patient care rooms at unusual hours, bringing with them family dynamics that, spurred by the stresses of hospitalizations, sometimes erupt into fights and spill over onto abusive behavior towards the nursing staff.
Because many of these incidents occur in the evening, HUP’s new visitation policy, which will go into effect in October, ends regular visiting hours at 10 p.m. After that, only one support person is allowed to stay with a patient. The policy does allow exceptions, though, for example, allowing more visitors up for a patient who is approaching the end of life. “Each unit will have that flexibility,” Mariotti said. After 10 p.m., the Ravdin doors will be locked and all visitors must come through the ED.
In addition, visitors staying between 10 p.m. and 6 a.m. must wear a visible, special visitation pass. It will have the visitor’s name and a patient’s room number written on an attached label. After 12 hours, red stripes on the pass will bleed through, clearly showing that the pass has expired.
HUP will also be rolling out violence prevention training from the Crisis Prevention Institute (CPI). “We needed to arm people with the skills to identify when something is going south… and prevent it from happening,” Mariotti said.
CPI offers different levels of training — from online (which will be available on Knowledge Link) to advanced physical skills training. “Clinical staff will be trained on different levels, based on the experiences in their departments,” Forte said. For example, ED staff might need a higher level. “Members of Security will receive all levels.”
Putting a Respectful Culture in Place
Penn Medicine’s BE standards have set the stage for a culture of civility and mutual respect. With pledges to “Be Compassionate, Be Present, Be Empowered, Be Collaborative, and Be Accountable,” employees are helping to make every experience for patients and families — and coworkers — exceptional. But this type of behavior is not a one-way street. It needs to be followed by everyone in the hospital.
This crucial message will be spread throughout HUP and the Perelman Center. Signs stating that “Verbal abuse and/or physical abuse will not be tolerated” will be posted on every unit and in public areas throughout HUP and PCAM. “We’re recreating policies and expectations for patients and putting them in every admission packet,” Mariotti said.
“People have become tolerant of being verbally abused, but no one deserves to be treated that way,” she continued. “If we create a culture of respect, there’s a better chance of people behaving in a certain way and understanding that our tolerance for those who don’t is low.”
“Will it stop everything? No. But it tells staff that we’ve heard you and are putting things in place to support you,” Forte said. “Abuse won’t be tolerated.”