Violence in healthcare settings is underreported and growing, warns The Joint Commission (TJC).
With that in mind, TJC recently updated an alert first issued in 2010, highlighting top six “contributing causal factors,” or failures by healthcare facilities that contributed to violent incidents in recent years.  

Use the following factors as improvement opportunities you should strongly consider as you re-examine violence prevention and response practices in your organization:
  •  Leadership failure (62% of events) – particularly in policy & procedure development and implementation
  • Human-resources-related factors (60% of events) – greater need for staff screening, education
  • Assessment failures (58% of events) – e.g. flawed patient observation protocols, inadequate assessment tools, lack of psychiatric assessment
  • Communication failures (53% of events) – among staff, and with patients and families
  • Physical environment (36% of events) – safety/security deficiencies in the environment
  • Inadequate care planning, information management and patient education
TJC notes the hardest areas to secure are the Emergency Department, followed by general medical/surgical patient rooms, given the combination of high traffic and high stress levels in those areas. It also reminds us that “security is a people action,” requiring staff to take responsibility, ask questions, and report any and all threats or suspicious events.
TJC concludes its alert with 13 suggested actions to prevent assault, rape and homicide in your healthcare facilities:
  1. Conduct a comprehensive assessment, working with your security department to audit your facility’s risks for violence. Be sure to evaluate environmental and administrative controls, review crime stats and records in your surrounding area, and survey employees on their perceptions of risk.
  2. Identify strengths and weaknesses in your violence prevention program. Then make improvements.
  3. Take extra precautions in your Emergency Department. This may include posting uniformed security officers, and limiting or screening visitors.
  4. Work with your HR department to thoroughly pre-screen all job applicants.
  5. Confirm that the HR department regularly observes employee discipline and dismissal procedures to prevent violent reactions.
  6. Require appropriate staff to be trained to respond effectively to patients’ family members who are agitated and potentially violent.
  7. Ensure violent incident response procedures are in place, and employees know what to do.
  8. Encourage employees to report all perceived violence threats, risks and incidents.
  9. Educate supervisors to treat all such reports seriously and thoroughly investigate every one of them. Also train supervisors to recognize when an employee or patient may be experiencing behaviors related to domestic violence.
  10. Ensure counseling programs are available to employees who become victims of crime or violence.
The next three recommendations pertain to how you respond to an act of violence at your facility:
  1. Report the crime to law enforcement.
  2. Recommend counseling and other support to patients or visitors affected by the violent act.
  3. Review the event and make necessary adjustments to prevent future occurrences.
(Read the full TJC alert and resources list here.)
Which of the above items could use an upgrade or adjustment to prevent violent incidents at your facility? Wherever you may be in your violence prevention and response planning, ensure you’re not negligent of the six lapses identified above.