Early Identification of Aggressive Behavior is Key to Reducing Violent Events

Hospitals are designed to optimize patient care, but they may not always be designed for optimal security. It is an unfortunate statistic that healthcare workers tend to be more at risk for workplace violence than those in other industries. According to the recent American Hospital Association (AHA) study, hospitals and health systems expended approximately $2.7 billion in 2016 responding to violence.

Aggression, generally defined as hostile or violent behaviors or attitudes toward another person, readiness to attack or confront with forceful behavior, is often the precursor to a violent incident or outburst. The aggressors could be anyone--a staff member, patient, family member, visitor, or others in the environment. 

In the healthcare environment, aggression has two distinct variations:

Clinical Aggression: Occurs within the clinical area between clinician (person delivering medical care) and the patient (person receiving medical care) due to illness or health-related issues.

Criminal Aggression: Originates from excessive anger or aggression stress that has been caused by a situation.

It’s important for anyone working in the healthcare environment to be able to recognize the signs of aggression and differentiate between clinical and criminal aggression. However, it is even more critical for support personnel to understand that clinical aggression can quickly evolve into criminal aggression. Consider the following example:

Mike came into the Emergency Department agitated and seeking pain pills. After examination, he is offered alternative treatment options and is not prescribed the medication he requested. A brief disagreement ensues between Mike and the medical staff when suddenly, Mike pulls a knife out. He threatens to kill the doctor if he is not provided drugs.

Authorities are immediately called and dispatched. While waiting for authorities to arrive, the medical staff and support personnel are now tasked with managing a violent individual and preventing him from harming their staff, patients and guests.

This scenario demonstrates just how quickly clinical aggression can evolve to criminal aggression and in turn create a potentially violent situation that place others at serious risk for harm. To respectfully manage a violent individual, it is essential to utilize innovative and creative strategies to underpin a successful security program.

Early identification of aggressive behavior and potentially violent behavior is key to mitigating risks and creating safer healthcare environments. All caregivers, those in support roles and assigned security personnel should be properly trained and keenly aware of the circumstances surrounding a potentially aggressive patient. This training equips them to successfully facilitate the most appropriate response to the behavior. It also provides a greater likelihood that warning signs will be identified for early intervention and de-escalation of the situation.

Since even small changes in behavior or the environment can lead up to a bigger event, being attentive and observant is vital. To respond effectively, security personnel should do the following:

• Identify potential threats proactively
• Use de-escalation training techniques
• Identify who might be harmed and provide protection
• Identify hazards and remove them
• Evaluate risks
• Fully and thoroughly document events

Staying vigilant and working in collaboration with healthcare partners is one of the most valuable means for a security program to mitigate violence in healthcare.

About the Author:

Lisa Terry
Vice President, Vertical Markets-Healthcare

Lisa Terry, CHPA, CPP has significant experience in healthcare security and police management. Lisa currently serves as the Vice President, Vertical Markets for Allied Universal Security. Prior to her current role, she served as Director of Hospital Police and Transportation at the University of North Carolina in Chapel Hill. Lisa has served as the Chief of Campus Police and Public Safety with WakeMed Health and Hospitals in Raleigh, North Carolina, and Chief of Police and Public Safety with Eastern Virginia Medical School in Norfolk, Virginia. She shares her knowledge, strategies, and lessons learned for successfully preventing and mitigating violence in her books: “Preventing Violence in the Emergency Department” and “The Active Shooter Response Toolkit for Healthcare Workers.”