To protect staff, health systems should look at training before tech: Safer Hospitals

Even as a security consultant with experience in the field, David Corbin says the level of violence reported in hospitals is disturbing.

Several fatal shootings have occurred in hospitals over the past two years, including the killing of a New Hampshire hospital security guard last month. In addition to those horrific incidents that have ended in the loss of life, doctors and nurses say attacks in hospitals have become all too common.

Health systems and hospitals are increasingly looking at ways to reduce violence and improve security, says Corbin, the owner of Dynamic Security Strategies. But too often, hospitals aren’t asking the right questions, he says.

“Oftentimes, what you'll see is that hospitals say, ‘What are the best practices?’ And I'm not a huge fan of that question. Because to me, they're asking: what is everybody else doing? And that does not mean that that's the right thing to do. It just means that everybody else is doing it,” he says.

Rather, hospitals should be looking for solutions that have a track record of success, he says. If hospitals are going to look at other systems and what they’re doing, he says they need to drill down to be sure the efforts are effective. Some solutions that work in certain hospitals may not succeed elsewhere.

“Something that's implemented by a very large healthcare system with lots of resources isn't necessarily going to work in a community hospital that doesn't have the same level of resources or staffing,” he says.

In an interview with Chief Healthcare Executive®, Corbin talks about ways hospitals can make a safer environment for staff. While weapons and other technology can be effective, Corbin says health systems should focus more on training.

“I love security technology. I think there's some really great stuff out there,” Corbin says. “But I'm also of the mindset that when it comes to workplace violence, I'd rather see people spend their money on training, and getting the right resources, human resources, people on the ground, doing the things that they need to do.”

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

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Developing successful programs

Hospitals executives need to be heavily engaged in violence prevention programs, he says. Those programs must be “supported at the highest level of the organization,” Corbin says.

Regularly, staff complain they've addressed concerns to healthcare leaders, and workers don't feel like they're being heard. Leaders also need to tell workers about new security measures they are adding, and sometimes they don't do that, he adds.

"It's important to have that engagement at the top, but to also have like that consistency of communication from that leadership to the staff," he says.

Corbin also says violence prevention programs must involve the entire organization.

“It really has to involve a whole hospital response,” Corbin says. “It can't just be placed on the shoulders of security. You can't ‘security’ your way out of this problem. Security only has so many resources. They can't be everywhere all the time.”

Hospitals should have a designated individual leading workplace violence prevention programs, a recommendation of The Joint Commission. Corbin says that’s where some organizations fall short.

As Corbin says, “Without an accountable leader, who's running the whole program? How are you going to make any progress? There's nobody keeping their finger on the pulse of the program all the time. And that's where I see a lot of folks slipping, despite their best intentions.”

While the program needs a leader, a multi-disciplinary team should be involved in violence prevention, Corbin says.

Violence prevention programs should be led by a clinician or someone who deals regularly with clinicians, because those programs will need the input and feedback of doctors and nurses to be successful, Corbin says. Too often, hospitals don’t have enough clinical integration in their violence prevention programs.

“That's really where I think the future is in workplace violence prevention and mitigation, is having that clinical and security integration, and going at the problem together, not with separate approaches,” Corbin says.

Corbin pointed to a healthcare organization that chose someone with a background in treating those with substance use to lead the violence prevention effort, and he says that effort has been very successful.

But he says, “getting the clinical and security folks together is key. And then you get the support of your top leadership.”

Larger systems may need to commit resources, but Corbin says it doesn’t need to be a high-cost proposition.

Corbin also stressed the importance of training staff in de-escalation strategies. And he says that should go beyond the clinicians and cover everyone in the organization.

“Oftentimes, what I'll see is security gets the highest level of training and maybe clinicians, the second highest, but then you miss people,” Corbin says. “What about the person from environmental services, who goes in to clean that violent patient's room? They should know the signs of when they should not go in that room, and when to leave and how to get help.”

• Read more: If hospitals want to improve safety, start by talking to employees

Using metal detectors

More hospitals are using metal detectors to catch individuals bringing weapons into health systems. Corbin says the technology can be effective, but hospitals need to use it thoughtfully.

Metal detectors “can certainly enhance the security program, but you have to understand what you're trying to accomplish, and not just throw them in and then figure it out,” Corbin says. “And believe me, people do that.”

Hospitals need to consider the staffing requirements. The detectors need to be staffed around the clock, and Corbin says it’s best to have two employees at a time.

“You need at least two people. One needs to watch the people coming through and the second person needs to be there for secondary search. So when somebody sets the alarm off, that person has to find the weapon, or determine that there isn't a weapon through a secondary screening, whether it's a bag search, or they use a wand,” Corbin says.

Hospitals and health systems need to decide how aggressively they want to use the detectors.

Corbin says, “You have to decide, what are you trying to detect? Do you want to detect down to a little pen knife that somebody has in their pocket? Or are you okay, missing a 3-inch knife? Do you only want to detect handguns, or big stuff that you're worried about, like a 6-inch knife and 8-inch knife?”

Often, hospitals using detectors are typically finding weapons on people who are licensed to carry them and aren’t planning any harm. But if detectors are used to find any potential threat, it will likely mean longer waits for those entering the hospital, he says.

However hospitals use the metal detectors, they should be consistent. He worked with one system that had a detector set to identify any knife or weapon, but another hospital’s detectors allowed his entire test kit, which included an inert firearm, to go through without sounding an alarm.

Hospitals should also consider placing detectors outside the emergency department.

“Please don't just put them in your emergency department, because there's people bringing in weapons at other entrances as well,” Corbin says. “And if you just put it in the emergency department, if somebody's a determined attacker, they're just going to use the entrance without the metal detector.”

Hospitals should look to limit the number of public entrances to their facilities, and Corbin says many have since the COVID-19 pandemic. If health systems are going to use the detectors, Corbin says they should be placed at all public entrances. He also says detectors should be placed at employee entrances, as well.

Again, Corbin says metal detectors should be utilized as one component of a broader plan to keep people safe. Hospitals are making a mistake if they install the detectors and “there’s no program behind it.”

“You put in metal detectors, and you have no de-escalation program in place for clinical staff,” he says. “And, you know, you have no threat assessment team. All the pieces behind it are missing.”

That’s why Corbin says health systems should look at training staff and developing robust violence prevention plans.

“I'd rather see them spend money on people and programs, then technology,” Corbin says. “Technology has a role, of course, as a layered approach. But what I do find is, especially in the wake of a serious incident at a neighboring hospital, people are looking for something that they can point to and say, ‘Look, we're doing something.’”

“That's fine and good, but there's no program behind it.”

(This is an ongoing series of stories looking at what hospitals can do to reduce violence. To share ideas or suggestions, please contact Ron Southwick, senior editor of Chief Healthcare Executive: [email protected])

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