Taking a proactive approach to reducing violence in healthcare | Safer Hospitals

Kimberly Urbanek followed an unconventional path to a leadership role in healthcare violence prevention.

Urbanek is system manager of public safety training at Endeavor Health in the Chicago area, and she’s also the owner and CEO of K4 Consulting, which works with organizations to improve safety.

Before moving into healthcare security, she started clinically, earning a license as a critical care paramedic and working in open heart surgery, critical care and emergency medicine. She says that experience has imbued her with a valuable perspective in thinking about healthcare security and trying to reduce the threat of violence.

“The transition into public safety really allowed me the opportunity to connect with clinical teams and executives, I think, in a unique way,” she says.

“I think it's allowed me kind of a large overarching view of how healthcare works and where the pain points are and some of the challenges that our frontline teams are dealing with.”

Now, she leads the workplace violence training for a system of nine hospitals and 300 healthcare locations. In an interview with Chief Healthcare Executive®, she talks about ways to reduce violence, protect workers and empower staff. She says it’s important to take a more proactive approach to safety, rather than simply reacting to problems.

While workplace violence in healthcare is not new, hospital and healthcare executives say the problem has worsened in recent years.

“It's a huge problem. It's a growing problem,” Urbanek says. “It's been around forever, but it's reached new heights, and the reach is very expansive now. It's not just in our emergency departments or in our critical care or behavioral health mental health units. And so I'm really passionate about making sure that we find evidence-based practices and practical solutions that can be employed by our staff who are experiencing this every day.”

(See part of our conversation in this video. The story continues below.)

Listening to staff

When asked about making hospitals and health systems safer, Urbanek says healthcare leaders must start by listening to their staff.

“You have to assess where people are and what's going on. You have to get out from behind the desk. You have to really look at your organization, I think, with a lens that is the bedside lens,” Urbanek says.“See what people are experiencing, hear where their struggles are, where they're getting abused or pushed back on on lots of different situations, and how they're not feeling supported, and how they are stressed out, and how their own human reaction is contributing to some of the issues as well, in spite of great care and great intentions,” she says. 

Leaders need to be connected to their staff and get their feedback. Health systems can consider doing employee surveys, although Urbanek acknowledges they can be cumbersome and aren’t always popular with workers.

Urbanek suggests leaders consider going around their facilities and sitting down with employees. And she says staff will talk openly, if employees feel that leaders are truly listening and willing to take action.

“They want to tell you,” Urbanek says. “Nurses want to tell you what's going on, if they feel that you really care.”

Training the right way

Staff need to be trained about ways to spot potentially troublesome situations before they get out of hand, and healthcare workers also need training in de-escalating conflict.

“It’s about creating training and putting your money where your mouth is, right when we talk about providing skills to people,” Urbanek says.

Many health systems are struggling financially, so finding the time for training can be difficult, and it’s not easy to pull nurses off the floor for training, she says.

“We have to get creative,” Urbanek says. “We have to go to people in their units, talk about micro learning, or small huddles and takeaways that can be digested and used.”

“We can't just give people online lessons, check a box, say we've done the training and then expect them to be experts in de-escalation. It doesn't work,” she says.

Commitment from leadership

Health systems can gain a lot of insight about risks of violence and vulnerabilities from their staff.

But staff may not be candid if they sense that leaders aren’t serious about trying to make progress.

“You have to be committed,” Urbanek says. “Leadership cannot do this halfway. It will be evident that you're just trying to check the box.”

Urbanek likens it to the mistaken idea that a pizza party will solve all the problems of an overworked staff that doesn’t feel supported or appreciated.

“We really have to invest in staff and invest in the solution to the problem, to really see those huge, wide ripple effects of success,” she says.

While she says it requires work and creativity to make organizations safer, Urbanek says, "You have the minds and the people to do it, if we're really committed at that executive level."

• Read more: Understanding the scope of aggressive incidents in hospitals

Being proactive

Health systems are going to have to be more proactive when it comes to improving the safety of their organizations, Urbanek says.

“All too often, across the board, in workplace violence, we’re reactive,” Urbanek says. “Even in our emergency responses, we wait for something to get bad enough, and we call security, or we call the police or we get hit.

“And so it's really about changing this lifelong belief that workplace violence is a reactive approach,” she adds. “We have to change that to being proactive and preventative before it even gets that far, and that takes time.”

Urbanek says training in de-escalation takes time because “it's also about connection, relationship, building, clearing the air, reestablishing boundaries.” And she says organizations need to be inventive in devising training that works within demanding schedules.

Healthcare workers throughout the organization need training in violence prevention and de-escalation, and while that must include the clinical teams, Urbanek says some training should be provided to all employees.

“You're going to have some areas that are lower risk than others, and so the training should be different based on those risk levels,” she says. “But everybody deals with workplace violence in some regard.”

While most violent incidents involve patients or visitors, including family of patients, training should also cover bullying or intimidation from co-workers and dealing with those conflicts.

Health systems also should think about training staff who talk to patients on the phone, such as those verifying insurance. While some may say that those employees don’t even deal with patients face to face, those workers can encounter harassment, threats and hostile behavior, Urbanek says.

“They're often the face of the organization, in the sense they're the front line,” she says. “The first time somebody calls to make an appointment or to verify their insurance or because they have a concern or a question, how they respond kind of gives that initial first impression in a lot of cases. And so if they're not trained, it doesn't matter that they're not seeing people face to face. They're still dealing with the violence, and they have to be equipped to respond in a way that promotes the culture of the organization.”

• Read more: Healthcare workers don’t feel confident in safety plans