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www. SecurityInfoWatch.com • Februar y/March 2018 • SECURIT Y TECHNOLOGY E XECUTIVE 25 Healthcare facilities can no longer be considered safe havens, and have far surpassed other places of business in the US as the leader in incidents of workplace violence against workers. especially in areas such as emergency departments and behavioral health units where unpredictability is commonplace. Add to this volatile mix the pres- ence of opioids and other drugs, the presence of forensic patients (those subjects in protective legal custody requiring a law enforcement presence) and treatment of the victims of crime related activity (gang shootings, domestic violence cases, etc.) and the stage is set for dangerous situations to erupt. Healthcare leaders continue to struggle with this issue, and many professional healthcare advocacy groups have made concerted efforts to better con- trol this epidemic as it not only threatens health- care workers but also negatively impacts the ability of healthcare facilities to provide quality patient care. The American Hospital Association (AHA) as well as the Emergency Nurses Association (ENA) are just two of the many professional healthcare associations that are working diligently to address this growing issue in our country through the "Hos- pital Against Violence" campaign and a national day of awareness regarding workplace violence in healthcare which was inaugurated on June 9, 2017 2 . While these efforts are certainly important for the safety of staff and clients, there is also a significant financial incentive involved. In July of 2017, the AHA issued a groundbreaking report 3 that compiled the actual costs of workplace violence to healthcare providers as well as to communities. Some of their findings included: • It estimated that proactive and reactive violence response efforts cost U.S. hospitals and health systems approx. $2.7 billion in 2016. • It also estimated national in-facility violence costs of $428.5 million, including $234.2 million for staff turnover, $42.3 million in medical care and indemnity (compensation for lost wages made to employees who were injured on the job) for employee victims of violence, and $90.7 million in disability and absenteeism costs. • The report also indicated an annual cost of $17,500 per hospital on workplace violence prevention plan development. Preparing Your Organization for Workplace Violence Two critical components of any workplace violence prevention plan are staff training and physical envi- ronment design. In designing a workplace training program for employees, regardless of industry, one should consider a multi-tiered approach, in which the basics of workplace violence are discussed in a Tier 1 program (defining workplace violence, its sources, and current trends). For example, such a program in healthcare should be tailored to speak to the unique challenges posed when it comes to workplace violence prevention, such as: • The receipt of a poor prognosis, imposing of physical limitations or providing other "bad news" to emotionally unstable patients or those without sufficient coping mechanisms when such information is shared. • Dealing with patients and clients that suffer from behavioral disorders or are under the influence of alcohol, medications or controlled substances. • The denial of narcotics or other controlled substance prescription demands or refusal to categorize a client's diagnosis based upon their request due to disability claims, insurance reimbursement or other illegitimate purposes. • Misplaced blame for financial situation result- ing from charges incurred from medical treat- ment and/or related services (labs, X-ray, etc.). • Refusal to follow medical advice which results in exacerbation of initial injury or condition resulting in additional issues mentioned above (physical limitations, medica- tion needs, financial impacts, etc.). In the second phase of a three-tiered training pro- gram, the lessons from the previous Tier 1 presenta- tion should be reinforced and specific techniques on how to de-escalate p o t e n t i a l l y v i o l e n t behavior and how work- ers can recognize verbal and physical queues that people tend to display prior to initiating physical aggression. When faced with escalating behavior, there will typically be additional physical warning signs manifested by the subject as part of their "fight or flight" response to the encounter. In these situations, staff should be trained to not only recognize these behaviors but also how to appropriately react to them once such behaviors manifest themselves.