Law Enforcement and Clinical Caregiver Partnerships Help Prevent Workplace Violence

Cleveland Clinic’s second SHIELD healthcare safety conference brought to light important topics around the issue of workplace violence in healthcare.

Leaders from Cleveland Clinic’s Nursing, Protective Services, Ombudsman and Caregiver offices hosted the conference as part of the Cleveland Clinic/HIMSS Patient Experience Digital Series. The event included three 30-minute sessions. The first, recapped here, focused on defining workplace violence in healthcare and shared insight on Cleveland Clinic’s approach to violence prevention and response.

In part two of this three-part series, we highlight the second conference session: “The Power of Collaboration: Addressing the connection between legislation and law enforcement, the unique challenges facing healthcare and creative safety strategies.”

Session speakers included:

• Gordon Snow, Chief Security Officer, Cleveland Clinic Health System
• Barbara Morgan, MSN, RN, NE-BC, Associate Chief Nursing Officer, Cleveland Clinic Emergency Services
• Anthony Roetzel, Regional Operations Commander, Cleveland Clinic Police Department

Strong relationships aid safety

“Healthcare workers are four times more likely to suffer from workplace violence than those in other industries – and no facility or unit is immune,” said Snow as he began the session.

To help prevent workplace violence in healthcare, he said much progress can be made by having strong relationships between law enforcement and clinical caregivers. At Cleveland Clinic, those relationships include Cleveland Clinic’s Protective Services, including the state-certified Cleveland Clinic Police Department, traffic control, analysts and communication officers working with building and property personnel, fleet and emergency management personnel, nursing caregivers, victim advocates and others.

“Cleveland Clinic’s Police Department includes 150 sworn police officers in Ohio and 350 unarmed security officers – all of whom are a major part of workplace violence initiatives,” added Roetzel.

Cleveland Clinic’s Protective Services is also a leading participant in the health system’s Workplace Violence Prevention Committee, which is chaired by Stephen Meldon, MD, Senior Vice Chair, Emergency Services, and Janet Schuster, DNP, MBA, RN, NE-BC, Chief Nursing Officer, Lutheran Hospital.

The committee helps prepare caregivers to recognize, prevent and react to workplace violence. Other committee members include employees from human resources, legal and ombudsman services, employee assistance and workers compensation, professional staff affairs, operations communications, clinical risk management, environmental health and safety, patient safety, diversity and inclusion and emergency services.

“Bringing all stakeholders to the table for discussion and collaboration is key,” said Snow.

Morgan added: “We have strong and intentional partnerships with the hospital-based law enforcement team, which is in alignment with our enterprise core values of safety and teamwork.”

Collaboration drives new safety strategies

Working together in this way has led to the development and implementation of new workplace violence prevention and response strategies in recent years. One of the most notable has been in Cleveland Clinic’s emergency departments (EDs), which tend to have higher rates of violent incidents.

Together, Protective Services and ED nurse and physician leaders created and implemented a unified, standardized approach to caregiver safety in all EDs that was based on prevention and de-escalation. According to Morgan, the result was a safety plan that includes:

Expanded police officer presence and visibility. Cleveland Clinic now has police officer presence in every ED location.

Improved weapons screening with walk-through and hand-held (wand) metal detectors/magnetometers. Walk-through metal detectors were installed at the entrance of every ED and patients or visitors who arrive at an ED via ambulance are now screened for weapons with hand-held magnetometers.

Updated panic alarms. Four types of panic alarms across EDs were consolidated into one gold standard alarm/panic button. The update also included a standardized alarm location labeling system.

Required training for all caregivers. All ED caregivers were required to complete annual Welle (previously NAPPI) violence protection training.

Enhanced basic crime prevention. Expanded caregiver communication with ongoing tips and recommendations for basic crime prevention, such as removing purses, clothing (jackets/coats) and other personal belongings from desks or other areas accessible by patients or visitors.

Implemented caregiver escort program. Ensures caregivers have access to an escort (24/7) when coming to and from work.

Working together delivers results

Morgan says Cleveland Clinic’s law enforcement/caregiver partnerships have strongly affected the occurrences and seriousness of violent incidents and inappropriate behaviors at Cleveland Clinic.

“For example, the visibility of police and security officers discourages incidents,” she said. “It’s a proactive measure in which team and environment can benefit.”

In fact, she says the safety plan specifically has been so successful in helping ensure a safer environment for ED caregivers that components of the plan have been extended to other caregivers and care areas. She cited standardizing panic buttons in outpatient areas, weapons screening in inpatient and outpatient areas and instituting Welle training as part of the onboarding process for all new nursing caregivers as well as caregivers who register or transport patients.

“Our goal is always to standardize practices and processes,” Morgan said. “We quickly realized our inpatient and outpatient partners could benefit from the processes we put in place in the EDs, so the ability to replicate these processes was very important.”

In a similar example, Roetzel explained that several years ago, as the Police Department was increasing its presence in the health system’s regional hospitals, it became clear that an intermediary officer position was needed for hospitals with behavioral health units.

Roetzel said his team worked hand-in-hand with nursing to create the position, which became known as the hospital safety officer. They identified that the hospital safety officer should fall between a security officer and a police officer – requiring a higher level of training than a security officer, but not at the level of a police officer and without the general appearance of a police officer.

“Hospital safety officers expand security forces and are taught de-escalation skills, behavioral health diagnoses and more,” Roetzel said.

He noted that the collaboration with nursing included everything from the initial interview process to a two-week training and onboarding period during which officers shadow nurses to learn about behavioral health diagnosis, trauma informed care and use of patient restraints, and participate in hospital safety rounds and huddles.

According to Morgan, workplace violence safety and education are happening more and more during hospital rounding and huddle processes. Replicating this in all hospitals is next on the agenda.