People who choose to work in healthcare often do so out of empathy and compassion for others. It’s a challenging irony that these caregivers, who are only trying to ease people’s pain and cure their ailments, are five times more likely to experience violence in the workplace than any other profession.
This is unacceptable, and SSM Health — along with many of our health system peers — is taking action to change this reality.
Related: Can AI reduce patient violence against clinicians?
Violence is not just happening in healthcare, of course. Public spaces that used to be deemed immune — schools, places of worship, theaters — have had to change operations to keep people safe. But no other industry deals with the frequent physical and verbal assaults that affect healthcare workers, according to data compiled by the U.S. Bureau of Labor Statistics. And those rates may actually be higher than previously thought. The American Medical Association notes that “available data indicate that healthcare workers experience high rates of workplace violence [but] such events are widely underreported.”
The early returns on our efforts show promise — although no program can make all violence disappear — and we share them in hopes other organizations want to borrow from our lessons learned.
From 2021 to 2023, we achieved decreases of more than 20% in both annual “struck by patient” incidents and employee days away from their jobs due to workplace violence. During that same period, worker compensation cases involving violence also dropped, from 105 to 64, leading to significant cost savings.
Some of our anti-violence measures are not obvious to a visitor or patient, which is by design. Our hospitals must continue to be welcoming places. Here are some key components of our approach:
Training in trauma-informed care and de-escalation. When people come to a hospital for treatment, they are at one of the most vulnerable points in their lives, and in an unfamiliar setting. It’s stressful. Some patients or visitors may have previously experienced trauma that affects their response to a specific situation. Our teams are taught to keep this in mind when working with an individual in crisis or their family members.
In one case, a security officer who had just completed trauma-informed care training responded to an emergency room incident: A man was threatening violence and demanding that no men come near him. With his training in mind, rather than moving forward with physical restraint, the male officer stopped, had all male staff present pull back, and had female nurses intervene to calm the man. It worked, averting violence.
We later discovered the man had suffered childhood trauma at the hands of a male relative, leading to current behavioral issues. Through de-escalation, everyone, including the potentially violent man, remained safe and the patient received the care he needed.
Security academies. We will soon open our third security academy in our third region, making the program that launched two years ago in St. Louis — where SSM operates eight hospitals — a systemwide endeavor. Each academy leverages the trauma-informed, de-escalation approaches in simulation training; a classroom; an area for Taser training; and a large practical skills area where employees learn physical intervention and self-defense techniques.
There’s also a mock hospital room where security officers conduct scenario-based training with actors. One scenario, for instance, involves an officer who must use critical-thinking skills to deal with a potentially violent patient who is refusing to be discharged.
While the space is used extensively to train security officers, it’s also there to train nurses and other caregivers. Clinicians and security officers often work together in crisis situations, so it’s important for them to train together. We also know that some situations require immediate action, when caregivers can’t wait even the minute or two it takes for officers to arrive and start de-escalation techniques.
Public education. We’ve instituted a code of conduct for patients and visitors, including signs and handouts that make it clear what types of behaviors are expected and acceptable. Those who willfully violate these rules are given a chance to explain their point of view. Depending on the violation, they may be asked to receive future non-emergency care at a non-SSM location.
Diligence and redesign. Public entrances have traditional screening and state-of-the-art weapons detection systems. Anyone found with a weapon is instructed to put it in their vehicle. Patients arriving by ambulance are screened as well. We also provide free gun locks to visitors and community members, reminding them of the dangers that an unlocked weapon can pose, especially to a child.
We also have completed site-by-site surveys of our physical spaces and redesigned them as necessary using Crime Prevention Through Environmental Design principles to increase safety for patients and staff. In all, we have spent more than $20 million to provide security and prevent violence for our workers, patients and communities. We’ve found this helps us retain and recruit frontline staff, without whom we could not exist.
These measures have gone a long way to help us in our goal of making healthcare safe, but we know more work needs to be done. As an industry, it’s our responsibility to provide security for our caregivers so they, in turn, are able to care for others. When we collaborate and freely share best practices, we will meet the challenge.
Steve Smoot is chief operating officer at SSM Health, a 23-hospital health system based in St. Louis.
