Protecting Healthcare Workers: Evolving Strategies

The alarming rate of violence against healthcare workers underscores the urgent need for comprehensive security measures within medical facilities. As incidents continue to rise, it's imperative that proactive strategies are employed to safeguard the well-being of patients, visitors and staff. 

In this episode, Paulina Rios Maya from EM360 speaks to Sheila Cook, Chief Experience Officer at the University of Illinois Hospital & Health Science System, and Clete Bourdeaux, Healthcare Business Development Director for HID’s workforce identity management unit, to discuss: 

• Workplace violence
• Evolution of security protocols within medical facilities
• Healthcare security 

Transcript

Speaker 1: 0:06

Powering trusted identities of the world's people, places and things. Every day, millions of people in more than 100 countries use our products and services to securely access physical and digital places. Over 2 billion things that need to be identified, verified and tracked are connected through HID Global's technology.

Speaker 2: 0:28

Enterprise Management 360, your main source for tech news, analysis, podcasts and videos for the enterprise. Hello everyone, I'm Paulina Riosmaya, head of Industry Relations here at EM360. In addition to overseeing the production of our podcasts, I'm passionate about security, intelligence and the latest trends in technological innovation. Today, I'm joined by Sheila Cook, chief experience officer at the University of Illinois' Hospital and Health Science System, and Cliff Bordeaux, healthcare business development director for HID's Workforce Identity Management Unit, to discuss hospital worker violence. Thank you so much for being with us today.

Speaker 3: 1:09

Thank you, thank you.

Speaker 2: 1:10

Thank you. Let's begin with you, Clete. I read this great article where they presented survey results which stated that healthcare workers are four times more likely to experience workplace violence compared to workers in private industry. What are your thoughts on the findings from such surveys, which reveal that most nurses have encountered workplace violence and nearly half have witnessed an increase in incidents over the past year?

Speaker 3: 1:38

So if we're talking about the same one, I think there's a recent one. If we're talking about the one done by nurses, that was like a survey of like a thousand. Because I work in this space, I can say I was not surprised. Obviously it's unfortunate. I am saddened. I guess what stood out to me about that one is that was not an external force like consultants et cetera. That was some nurses organization with 1,000 nurses surveyed. So that was clearly from the horse's mouth. And so to hear that there is not a decline we're two years out of COVID and if it's still on an uptick, it was absolutely disheartening. But again, I gave that a lot of weight because that national nurse survey was that was for nurses, by nurses, and I think it was like a thousand people were surveyed. So it was not encouraging at all. I think there's a lot more work to be done.

Speaker 2: 2:32

Yeah, definitely Sheila. With more than 30 years of combined experience in critical care, nursing, human resources and hospital administration, I wanted to ask you could you provide some insight into the evolution of security measures within medical facilities? I'm particularly interested in understanding the notable changes you've observed over the years.

Speaker 4: 2:56

Oh, yes, definitely. My nursing career goes back to the mid to late 80s in terms of being at the bedside, and during that time frame there wasn't an issue around healthcare violence or violence against healthcare workers. The prominent issue had to do with how we manage patients who came in with mental illnesses. That may have led to some violence against healthcare workers, and so having that awareness and seeing it over time increasing year over year, has led us to actually take a look at what are the barriers to providing that safe environment and then what are the opportunities in terms of the workflow. So, as I compare my time at the bedside and when I look at our nurses now, the opportunity for prevention is most important, because it's not only that mental, that patient who comes in with mental health conditions or behavioral conditions. It is sometimes the escalation of communication and behaviors that lead to a violent situation or a traumatizing situation, and that violence could be physical, it could be verbal. So now, as I look at the responsibility in ensuring that we can provide and supporting efforts to provide that safe environment is really about my role in supporting those initiatives, because it has increased year over year as we look back in history, History, my history in nursing.

Speaker 4: 4:32

I call it history, but a day to day, a usual day, as I think, as I reflect back in my role as a bedside nurse, didn't really involve thoughts around potential violent or potential situation where threats were intimate to both, either the staff or to patients. And now it's top of mind as we enter into the work setting to be aware of what are the opportunities for individuals to be threatened by a patient. If we think about violence and comparing the 80s, 90s or now the latter part of the late 90s and early 2000s in my days it was about per se, the patient and are we presenting a situation where the patient could become violent or threatening? And most times it's around controlling or having the opportunity to control based on what their needs are.

Speaker 2: 5:34

Yeah, definitely, and I think, with your impressive experience I mean this is very sad to hear and to see that you know that there has been this evolution. You also have 20 years of experience as a subject matter expert in healthcare and security industry. So, as Sheila said, there has been a remarkable evolution in security protocols. My question to you would be have you observed this evolution of security protocols within medical facilities, let's say, for protecting patients, staff, visitors, and how do you believe have these changes influenced the overall safety landscape in healthcare settings?

Speaker 3: 6:12

Have I observed them? These changes Absolutely. So some of the clients that I can think of going back to 2011,. They were special facilities, they were especially secure facilities, so they required different measures, different checks. But now it's open for everyone. Everyone should receive things that used to be reserved for very special places, very special patient populations, high secure facilities.

Speaker 3: 6:39

Now we see that healthcare is, and sometimes, an intentional, soft target. When you think about ransomware, things like that is sometimes an intentional soft target. When you think about ransomware, things like that, they're an intentional soft target, but then, most often, they're unintentional. They are just a consequence of what's happening. Obviously, we go to COVID and they're the consequence of what we're doing as we move along the timeline of humanity. So, like Sheila said, like you know, 80s, 90s, her concerns they're very different now. Her staff's concerns are very different now. So I have seen the protocols shift with it. Case in point is Sheila's facility. There was a time when you probably could just go in the ED with a car accident and sit there. But now, sheila's facility, if I go in her ED, there's a weapons detection system there and it's absolutely needed and obviously her facility is far from alone. But that's just one quick example of how things have moved along.

Speaker 3: 7:36

Security protocols change and Sheila spoke a little bit about it. But there was decades ago. The research said it's better for patient care to be you know, to have loved ones there at the bedside, visits et cetera. That was better for patient care. Those things are all decades old and just another evolution is policies and protocols say we don't just let anybody come around. We know, because of COVID and other things, reducing the number of people can help manage infections, infectious disease. Reducing the number of people can help manage infections, infectious disease. Reducing the number of people helps manage the stress of nurses. And this is all backed up by data, all backed up by data. So the security protocols have definitely changed and it's no longer very special situations that require higher level of security in healthcare. I am one that votes for some level of workplace violence prevention at every healthcare facility.

Speaker 2: 8:37

Yeah, I mean you started talking a little bit about, you know, these intentional attacks that are happening now, such as ransomware. So I want to jump away from the past and explore, you know, the contemporary solutions from healthcare leaders, and here we have one, sheila. I want to ask you, in light of current challenges surrounding violence and kind of what Clete was saying before, how does your experience as a nurse inform those decisions you make as a management leader? And I'm interested hearing your recommendations for proactive strategies to enhance security and safety standards in today's healthcare environment.

Speaker 4: 9:15

Oh, yes, Well, if I talk about my experience as a nurse first and how that has impacted my decisions or my support of initiatives to increase safety, there is the understanding of the workflow for the patient or the visitation flow as we talk about patient care, and then knowing the opportunity for an appropriate assessment. In my time, reflecting back decades ago, that assessment was really around the physical reason they brought the patient into the hospital. It evolved to social determinants of health. It evolved to is there violence in the home? Because that could potentially lead to violence in the healthcare setting. So, looking at nursing and in that whole trajectory, the initial assessment of patients even coming in the hospital, violence, the potential for violence or the potential for harm to the patient themselves is now a part of that focus. So, where we once looked at you came into the hospital for pneumonia, for example, and the assessments were around there the concern is now more broader, more comprehensive to look at are there opportunities for this patient to be in a violent or harmful situation or that patient that caused harm? So knowing the assessment process and what nurses have to review and determine helps us in making decisions about what's needed, and I can share some of the things that we're doing as we talk about the assessment.

Speaker 4: 10:44

Most recently we implemented what's called DASA.

Speaker 4: 10:50

Most recently we implemented was called DASA and that is a dynamic appraisal situational assessment tool that occurs every morning at 8 o'clock and it occurs throughout the shift and out of native report goes to those specific units and nurses making them aware of this patient potentially being an intimate threat, and so those patients then, depending on the nature or the concern, are flagged within the EPIC system so that, should they return, we are aware and in a more of a proactive state to be prepared to work with that patient and bringing in experts to prevent any escalation.

Speaker 4: 11:25

That's something that you know just didn't occur as we reflect upon my bedside experience. But knowing that now, as an administrator, it is supporting and providing education around these particular initiatives and the why's behind that makes a big difference and it impacts how our staff looks at our focus around keeping them safe as we go, and that's important because staff have to have trust not only in the fact that we are providing resources, but what are their concerns as they come in and out of the work setting and what are we doing differently to address those concerns?

Speaker 2: 12:04

Do you have any? Yeah, do you have any thoughts on that?

Speaker 3: 12:06

Maybe I did. I had a question for Sheila. As she was saying it, I think she got around to it. But, sheila, this is software you guys are using for the assessment, right? Yes, we discussed that. So this is software that assesses the patient and they're already there or they haven't come yet.

Speaker 4: 12:21

Both they're already there not come yet and we know that they will be admitted. When you open up that medical record you can see where that person could be potentially a threat to staff. But on admission and throughout the day there's an ongoing assessment. There are certain parameters that are reviewed by our behavioral staff specialists and shared with nursing.

Speaker 3: 12:45

As I listen to that and Sheila describes what they're doing. I don't have experience with that, but I hear an opportunity for us to recognize the synergies of technology. It's not Sheila's facility but there's another Chicago facility. So when Sheila says, oh, we can identify patient behavior that's potentially unwarranted. There's a downtown facility where Sheila, there's a guy that he's known to be a patient and I think they've got him like he's double digits of like trespassing and incidents and stuff like that.

Speaker 3: 13:20

So with an assessment tool and I'm sure you guys have that, but I see the potential where if you have a name that's kicked out from the assessment tool, we marry that with in your case, we marry that with a list of people that could come in the door, potentially after hours over in your ED, and right away we know, hey, be on the lookout for this guy or gal.

Speaker 3: 13:40

Yes, and I'm just thinking about that other facility. So you know these are two disparate pieces of software, but someone with overarching vision like Sheila can say, hey, you know what? Let me take the output of this assessment tool, let me input that into watch lists of my visitor management. Like these are all things that someone in Sheila's position could do to help protect our facility and the good thing is it's just making the use of use of technology that's already there. She already has both of these tools. We linked them up and I think that could help and we get away from a guy or gal having I think he had something like 15 trespassing incidents and attacks and stuff like that. Again, that wasn't Sheila's facility, but that was another large downtown Chicago facility.

Speaker 4: 14:25

Yes, town, chicago facility. Yes, we haven't had one of this at that particular scale or magnitude, but we have had incidents, prior to the implementation of our visitation management system, where known and banned visitors get into the hospital or where there were delays in communicating the fact that we have a patient who wants to restrict visitors. It was manual and so with the implementation as you talk about technology of our visitation management system, all of that is streamlined now. So our nurses and staff feel safer because there's a minute instance of communicating and we know to your point that those individuals among that watch list and that there's direct communication with inpatient, with our front desk staff, concierge, hospitality services and with our security services.

Speaker 2: 15:16

Right, I mean we know that. You know the use of technology is just one measure of the infinite ones that we have on this. But as Sheila was talking, you know about the potential of harm and all these assessment processes, it kind of got me wondering. You know what are some and, cleve, you can answer this question. You know what are some of the immediate actions that hospitals should be taking to safeguard the safety and welfare of their employees and, specifically, I'm looking for you know what are the ongoing measures that you suggest hospitals should prioritize to address this issue effectively?

Speaker 4: 15:52

Yes, that's a really good question, because as we talk about violence, I always like to share of course, in my shoes it is violence within the healthcare. But we really have to be mindful of the fact that violence is increasing around the world and for various reasons, and so I'm a true believer that our patients and our visitors I used to teach my staff our patients come into the hospital not just with their physical condition but they bring themselves, they bring their personality issues or their behavior issues, so we have to be mindful of that and then have a proactive resolution to all of those situations. So in our multifaceted approach here at UI Health, we provide education and training, what we call workplace violence prevention education to our charge nurses who are leading, say, shift by shift, cpi training and an annual requirement that everyone has to take in terms of prevention. And as we look at operations day to day, what are those immediate responses when we have a particular situation? So we have security at all critical entry points and Clete shared earlier, we have the metal detectors that are now at our entry areas as well to detect weapons that may be coming in.

Speaker 4: 17:10

You know, with employees, pettit buttons were installed in certain units depending on the population, key card, access to various work settings and the codes the codes that announce someone or an area is in a potential dangerous situation. One is called a cold bird. It's not new. Various places have implemented that. But that's where we mobilize needed individuals to address a threatening situation Security someone from the patient experience team, someone from behavioral health, someone from the chaplain to provide support to that area and to help to deescalate.

Speaker 3: 17:48

Curious, sheila. I have a loved one in your facility. She doesn't have the duress, but I don't know. Maybe nurses, maybe clinicians because she's not on that side of things Are personal duress buttons. Are they there yet? If they aren't, is it something that you support or trying to get?

Speaker 4: 18:06

No, we are having. You know, we've had some communication around that and so, looking at where we look at the, we want to consider the recommendations of staff as well, and so that has not been implemented throughout the house.

Speaker 3: 18:19

But but I'm sure it's something you support.

Speaker 4: 18:22

Yeah, exactly.

Speaker 3: 18:23

I was going to say like just data to back up. I had this data and maybe even just a tidbit for Sheila because I know that these data is important. Scores are important. So there was another facility that had the responsiveness when you're not having to deal with and also maybe Sheila can relate to this from her bedside experience but HCAP scores from another facility that was really doing a great job of keeping before and after data. Their HCAP scores increased from 48 to 67 percent specifically for responsiveness, after they put in something like visitor management, which helped not just workplace violence but actually helped with patient care. It helped with responsiveness because you're not managing who does what, who goes where. And then also, of course, we believe Sheila, but just data from another facility backing up exactly what Sheila said about feeling safer. They did a staff survey after visitor limitations and it says it decreased. 81% agreed that it decreased their stress during after hours. So that's kind of like tying into something else that Sheila said about feeling safe when you're at the bedside.

Speaker 2: 19:38

Yeah, I think that's very important when it comes to people coming to the hospital and kind of, not only the patient but also the people who are coming to visit the people who are working there. I think it's an overarching issue that's coming on there. So it's clear that the capacity building that Sheila was talking about and the operational security a little bit more of what you were talking about shows how multifaceted is healthcare security. But I kind of want to give some examples for our audience. How do you prioritize and coordinate these different components? We talk about different components here, so how do we ensure a comprehensive protection for patients, staff, visitors, facilities? Do you have any idea on how to bring all this about and make them work?

Speaker 3: 20:25

I would. I'll start and then Sheila can jump in, but I would. It's a tough one. Patients are the reason that we're there. Patients are what Sheila and her team signed up for.

Speaker 3: 20:37

So on one hand, I would say measures that are going to directly affect patient care, but to me it's equally as important because if we are not protecting our staff, they're leaving at record rates it's well-documented clinician burnout, et cetera. So that's still patient care. So, when it comes to a priority, if I had a checkbook, would it go directly towards patient care? Would it go directly towards a reduction of violence specifically directed to our staff? I don't think that I would prioritize one over another. Now, in reality, what I will add, there's a dollar sign assigned to everything in life and so in how it plays out in reality, is that a lot of times the priority is given after an incident, which is super unfortunate. But again, that's life.

Speaker 3: 21:30

You know our security protocols changed after 9-11. You know there was an incident and we changed. That happens in health care. There's an incident down the road at a hospital. I get a phone call hey, Clete, we don't want to be that, let's change. So incidents can help with priority Renovations when there's existing budgeting in place or renovations help with budgeting, to now get some of those protocols in so it can become a priority when we are already doing things like building a hospital, which hospitals are always building. When we're building a hospital, when we're doing extensive renovations, that's the time. Security is always a priority, but that's a time to try to bring it to the forefront again. So I don't know if I'd choose one over the other, but just speaking to timing and to things to consider, you want things that are going to really really help with patient care, and I think that kind of comes back to protecting our clinicians. That's how they provide the best care. They need to be there, they need to be in a proper state of mind less stress managing less people.

Speaker 4: 22:36

I agree totally with Cleve. I wouldn't put one over the other. You have to consider all avenues, all possibilities, and it's most important, I think, to get and keep a pulse of your workforce, to ensure that we're hearing their voice and to ensure that our strategies and tactics and what we have in place will address and it is aligning to meet their needs. If there's an incidence at another facility nearby, you can bet that we have a certain type of concern coming into either a different setting. So awareness and transparency around those other related incidents Clete mentioned earlier.

Speaker 4: 23:21

You know the cyber threats. We know what happened most recently in the Chicagoland area. So what changes or measures do we take to prevent it from occurring here? So that awareness is key and sharing that awareness with staff and being more proactive when we can with staff. And being more proactive when we can because we're always going to respond to the incident, but also taking that opportunity to be proactive, Sharing and educating and the collaborative work around meeting these needs for our staff. Because if the staff can't come in to take care of the patients or they are feeling less than okay because of what is happening, it has an impact on patient care and how I deliver care and how I communicate with patients and visitors and everyone.

Speaker 2: 24:06

Yeah, I think the main emphasis here is how important security is. Sheila, I want to finish with you. I mean, your innovative strategies have led to an overall improvement in patient experience across the University of Illinois Hospital. So I'm wondering what innovative measures do you envision for enhancing health care security in the future? You know, now we're looking at the future. How do you envision it In my particular?

Speaker 4: 24:32

role when we look at our security and our security measures and we look at the overall needs.

Speaker 4: 24:38

I shared earlier some of our multifaceted approach that we have. Those efforts are going to continue and we're going to consistently look at how do we grow and what's the need to evolve. You made a very good point earlier around the build of a new hospital or the build of a new facility within a hospital, considering what measures need to be in place as we talk about construction as opposed to just the building itself. So in my role, it is to support and to bring evidence to the table around patient experience and the impact of the overall human experience when we talk about, for example, the build of these new facilities. So we will continue to increase and enhance every opportunity to provide awareness, education and, where there is a need to implement a different tactic or a different technology around safety or awareness and that key assessment to be more proactive in managing those patients in those situations. That's in the forefront and it's in the forefront, but it remains a day-to-day concept in terms of how we are approaching providing a safe environment and a safe environment for everyone.

Speaker 2: 25:58

Perfect. Well, thank you so much, Clete and Sheila, for this wonderful conversation. We really appreciate your insights on this topic and I'm sure our listeners took a lot away from today's podcast. That wraps up another EM360 podcast episode. Whether you're sipping your morning coffee or winding down after a long day, we hope this episode sparked thoughts and provoked some questions. For further information on what we've talked about, please head on over to hidglobalcom. If you enjoyed today's episode, don't forget to subscribe on all major platforms. Follow the conversation on our socials at EM360 Tech on X and LinkedIn, and for more great content, head on over to em360techcom.