Creating and maintaining a safe workplace is difficult in high-stress settings like hospitals. A recently released study by the New Jersey Hospital Association found that incidents of workplace violence in New Jersey hospitals rose dramatically between 2019 and 2021.
Patients, the most likely group to act violently, are under an enormous amount of stress. They’re often afraid and frequently in pain. They tend to feel they have little or no control over their situation or what will happen to them. It’s disturbing, but not surprising, that patients occasionally lash out against the very people who are there to help them. The sense of anonymity and emotional distance resulting from masking and other hospital-imposed constraints during the pandemic exacerbated patients’ feelings of stress, fear and pain. During the years examined in the study, things got worse. Incidents of violence in hospitals increased.
But not everywhere.
A single incident of workplace violence is one too many. The good news is that hospitals like Bergen New Bridge Medical Center in Paramus that are taking an aggressive approach to reduce violence are obtaining results that are contrary to the report’s aggregate numbers. Our experience has shown it is possible to implement strategies to turn those statistics around — even during the pandemic.
Hospital leaders who commit themselves and their organizations to reducing workplace violence can be successful.
The first step, of course, is to acknowledge the problem, study it holistically and get everyone on board with a plan to address it.
In 2018, after a comprehensive review and analysis of prior incidents of violence at Bergen New Bridge, our leadership team sought input from across the organization to develop and launch an equally comprehensive plan to reduce them. In fact, leadership was firm in its “zero tolerance” approach to violence throughout our facility.
Our study was a holistic one and our response mirrored that approach. First, we initiated policy changes that targeted areas of concern. Then, to raise and maintain awareness of the problem and our attempts at a solution, we posted signage throughout the facility in concert with our goals. The initiative was a standing agenda item and incidents were discussed and analyzed at meetings with behavioral health staff, emergency department staff, management, physicians on rounds and elsewhere throughout the hospital. We held monthly de-escalation training sessions for staff and providers. We committed to monitoring the data and sharing results with staff, physicians, leadership, and board members in real-time.
The result, almost from the start, was a high degree of buy-in throughout the organization because everyone recognized the initiative to be a real priority for leadership and its goal as one that served everyone’s best interests. Having the support of all nine Bergen New Bridge unions was essential.
Key to staff training was re-instilling a focus on patient experience and enhanced communication with patients and their families. Staff were continually reminded and urged to maintain vigilance. They were trained to recognize triggers that led patients to behave violently and were provided with coping skills and protective factors to keep themselves and their colleagues safe. We trained staff to take a hands-off approach in patient care when trigger signs were present and to only use restraints and seclusion (both of which are known to escalate emotions and violence) as a last resort.
At Bergen New Bridge, we believe in being over-prepared, if there is such a thing. Because uncontrolled bleeding is a major cause of preventative deaths, and approximately 40% of trauma-related deaths worldwide are due to bleeding or its consequences, our staff received STOP THE BLEED® training as well as training to be able to effectively prevent, protect and respond to an active shooter incident.
Our early analysis revealed that relatively minor changes in patient experience might significantly deter violence, particularly among behavioral health patients. We know that patients who are well-fed and enjoy their meals are likely to be more at ease in their surroundings. So, for example, we improved existing food and nutrition services and added new ones. For those patients, we also increased oversight of medication management, enhanced our focus on group therapy and pursued new and expanded group activities.
The data shows that all the hard work paid off.
In contrast with the aggregate research reported in the NJHA study, at Bergen New Bridge workplace violence by patients against staff declined across all three injury levels — minor, moderate and severe. The hospital experienced an overall 48% improvement in workplace violence between 2018 and 2021. Incidents involving the most severe injuries dropped even further, improving by 65%. Injuries resulting from workplace violence during the first half of 2022, from January to May, declined 43% compared with the same period in the prior year. While the researchers found that co-worker-related incidents elsewhere in New Jersey increased by 34% between 2019 and 2021, there were only two such incidents at Bergen New Bridge during that period.
The study confirmed that most incidents of violence occur in the emergency department, which is also the location of the most violent attacks on healthcare workers. In hospitals like Bergen New Bridge that receive mental health patients directly into their emergency departments, healthcare workers tend to be at even greater risk. In fact, we see our highest number of incidents in the emergency department and in our involuntary behavioral health units. In response, we have designated security personnel onsite at all times in the ED. Our Zero Tolerance initiative included improved communication with law enforcement as well as mental health cross-training for law enforcement.
Hospital leaders who commit themselves and their organizations to reducing workplace violence can be successful. Bergen New Bridge has demonstrated that a Zero Tolerance policy underpinned with action, shared responsibility, and commitment, can help transform hospitals into safer places for healthcare workers and for patients as well.
Deborah Visconi is president and CEO of Bergen New Bridge Medical Center.