Resetting Expectations to Reduce Patient Violence

October 29, 2018 | Strategic Insights for Ambulatory Care


​At the 2018 annual conference of the American Society for Health Care Risk Management (ASHRM) in Nashville, "Would You Expect Aggression at an Airport? Re-Shaping Organizational Culture" was presented by Monica Cooke, MA, RNC, CPHQ, CPHRM, DFASHRM. Cooke highlighted the difference between violence in healthcare settings and violence in other settings. Why don't people act out at the airport? Cooke suggested that it's the result of a cultural expectation. Cooke highlighted four types of violence: criminal intent; customer/client/patient; lateral (coworkers); and personal. More than half of all workplace violence incidents occur in healthcare, and a common root cause in events involving patient violence in healthcare is the lack of adequate aggression assessment. In other industries, the culture tolerates much less aggression, and barriers to aggression are also built in, such as access to distractions, unwillingness to go there when sick, immediate response to violence, and risk of legal consequences. What's different in healthcare? "We make excuses because we're compassionate—we're caring to the point where staff are getting beat up," said Cooke. Aggressive events feature three variables, typically: a stressful inciting event, an emotionally charged patient, and an insensitive or uncaring response.

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