“Workplace violence is a recognized hazard in the health care industry,” declares the U.S. Occupational Safety and Health Administration. It defines the problem as “any act or threat of physical violence, harassment, intimidation or other threatening disruptive behavior that occurs at the work site,” and can include threats, verbal abuse and even homicide.
The rising escalation of aggressive behavior in health care workplaces became evidently clear at Geisinger after two people were killed on the rural Pennsylvania health system’s properties in 2022.
“It hit us close to home—but it is hitting everybody in every home across the country,” said Narayana Murali, MD, system chief medical officer of medicine services at Geisinger, noting that the U.S. Bureau of Labor Statistics also has alarming numbers on violence against U.S. health care workers.
He added it also became clear that action was needed when a Press Ganey analysis found, in the second quarter of 2022 alone, that nurses in the U.S. were the subject of roughly 57 assaults a day—or about two every hour.
“It was not appropriate for health care organizations to turn around and tell their staff ... that you need to cope with this menace, as opposed to doing something that is absolutely important: to keep the workplace safe and secure,” Dr. Murali said.
Dr. Murali was joined by John Oast Jr., Geisinger’s director of security training and special programs, in an AMA Insight Network webinar (available for free with registration) to discuss violence against physicians and health care staff in their workplace—and what Geisinger is doing to prevent these incidents.
Geisinger is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Members of the AMA Health System Program have access to the AMA Insight Network’s Quality, Safety and Equity community. This virtual forum provides an opportunity for like-minded leaders from across the country to hear more examples of how leading systems are finding innovative ways to address health care inequities in their communities.
The system takes action
A local high school senior was fatally stabbed in the parking lot of a Geisinger clinic in Scranton, Pennsylvania, in June 2022. In December of that same year, a staff phlebotomist was fatally shot as she was walking to her car at the end of her shift at Geisinger’s main campus in Danville.
Along with those tragic events, Oast said there was a rising escalation of incidents where aggressive behavior was directed toward staff. This was coupled with growing stress among physicians and other health professionals as the COVID-19 public health emergency continued, and new masking and screening requirements were instituted for visitors.
Geisinger, however, was already in the process of upgrading its safety and security in anticipation of new standards being developed by The Joint Commission.
This included providing 6,000 Geisinger physicians and other staffers with a badge that could notify security and other nearby employees if they were under duress.
Staff also received training in active-shooter responses plus de-escalation and aggressive behavior-management techniques, which Oast described as “verbal judo.”
Other actions included installing metal detectors in the emergency departments of nine Geisinger hospitals and offering security escorts to staff and patients.
In addition, a patient-misconduct policy—with clear guidelines based on patient condition and decision-making abilities—was developed. It asks patients to “recognize and respect the rights of other patients, families and staff” and makes plain that “threats, violence, rude communication and harassment of other patients and hospital staff will not be tolerated.”
The AMA has spoken out consistently and forcefully in defense of physicians against violence and verbal mistreatment by patients, families and others. In a Leadership Viewpoints column, former AMA president Gerald E. Haron, MD, explained why threats and intimidation against doctors and health workers must end. In 2020, the AMA House of Delegates adopted a policy to help protect physicians and other health care workers.
The standard of care in physician well-being recognition
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Physicians and teams feel safer
The actions at Geisinger have had an impact. The metal detectors helped intercept 5,000 knives, 346 pepper-spray containers, 130 firearms, 20 Tasers and stun guns, and 1,800 other prohibited items in 2022.
This success has continued, and in September, Oast reported that some 66,000 visitors were screened across the system. Forty-seven firearms were confiscated, along with 417 pepper-spray containers, 1,896 knives and sharp-bladed weapons, 262 tools that could be used as a weapon and seven Tasers.
“Prior to this, anyone could walk in with a firearm,” Dr. Murali said. “We have deterred close to 24,000 weapons walking into our system.”
He added that it is not just physical harm that is prevented. If a physician or other health professional faces an episode of either egregious verbal treatment or physical assault from a patient or their family, post-traumatic stress will continue to be there and can manifest itself in multiple different ways.
Each Geisinger hospital has its own workplace-violence committee that includes physician and nurse leadership as well as security personnel and patient-safety representatives. These committees’ findings are given to a systemwide committee that provides Geisinger leaders with a bimonthly report to help them spot trends, concerns and where extra support may be needed.
“The big driver has been staff awareness,” Oast said. “When we first put these processes into place, we were directing our staff to be sure to report these types of encounters because if it’s not documented, it didn’t happen.”
Dr. Murali said that Geisinger has set a goal of reducing incidents of violence by 3% across the system, including cases of:
- Aggressive patient behavior toward staff, or “code grays,” from 1,814 in 2023 to a target of 1,026 for 2024. (There have been 947 through September.)
- Assault injuries to emergency department staff from 2.4 per 10,000 ED visitors to a 2.3 rate.
- Assault injuries to all staff from 183 in 2023 to 111.
But the key metrics, Dr. Murali said, are found in Geisinger staff-engagement surveys.
The studies asked staff about their perceptions of the system’s safety and security efforts, including their thoughts on the following statements:
- Supervisors address concerns about safety that have been brought to their attention.
- Workplace safety and security are considered to be important at Geisinger.
- I have the training to deal with issues related to safety and security.
- Geisinger addresses workplace safety issues quickly and effectively.
Among all topics addressed in the engagement survey, those regarding security and safety scored the highest across all domains, Dr. Murali said, adding that agreement to those statements ranged between 85% to 94% among the system’s various departments.
“Our staff felt much better,” Dr. Murali said, and the engagement survey provide “the proof of the pudding.”
