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Addressing Rising Violence in Health Care: Insights on Collaborative Safety Strategies
Violence in health care settings has grown alarmingly in recent years, and health care leaders are urgently searching for ways to keep their teams safe. In this new "Safety Speaks" conversation, Barbara Griffith, M.D., president of Duke Raleigh Hospital, discusses the successful steps the organization has taken to address the sharp rise in workplace violence, and how reducing violent incidents requires collaboration among multiple support agencies.
Transcript
Tom Haederle
When Dr. Barbara Griffith assumed the presidency of Duke Raleigh Hospital three years ago, one of the first things she noticed was - in her words - "my staff don't feel as safe today as they did yesterday." The epidemic of violence directed against health care professionals has touched caregivers nationwide, distracting health care staff and affecting their ability to provide great patient care.
::Tom Haederle
Welcome to Advancing Health, the podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Violence in health care settings has grown alarmingly in recent years, leaving health care leaders searching for ways to address both the perception and reality of keeping their health care team safe and preserving the ability to give their best to patients. In this Safety Speaks podcast series hosted by Dr. Chris DeRienzo, AHA’s chief physician executive,
::Tom Haederle
e information and to join the: ::Chris DeRienzo, M.D.
Welcome to today's episode. I'm Chris DeRienzo and I am super excited to be onsite at Duke Raleigh Hospital to get to have a conversation with Dr. Barbara Griffith, Dr. Griffith, thanks for being on the podcast today.
::Barbara Griffith, M.D.
Thank you. I really appreciate your time today.
::Chris DeRienzo, M.D.
It's actually a funny story. We've intended to record this podcast when we were both going to be together at AHA’s Leadership Summit in San Diego, but as folks may remember, that was an interesting week for a whole lot of reasons, one of which was the whole CrowdStrike issue that sort of handicapped the entire U.S. air system for like a week on end.
::Chris DeRienzo, M.D.
And so you wound up getting stuck in Dallas, right?
::Barbara Griffith, M.D.
I sure did. I had every intention of making it all the way to San Diego, but I really only made it halfway across the country and realized it just wasn't going to happen to get the rest of the way. So I turned around and I came back to Raleigh.
::Chris DeRienzo, M.D.
I'm actually sort of grateful that that we wound up doing that because we got to spend some time walking around together at Duke Raleigh today and getting to see your teams and your people. It really is a fantastic culture that you built here. But let's rewind. So you came to Duke probably how long ago?
::Barbara Griffith, M.D.
It’s been about three years.
::Chris DeRienzo, M.D.
Three years ago. And you came from out of state. But Duke has been a home for you for some time.
::Barbara Griffith, M.D.
out of residency in the early: ::Chris DeRienzo, M.D.
Awesome.
::Barbara Griffith, M.D.
But spent a couple of years in, Louisiana, working with Women's Hospital in Baton Rouge. Fantastic facility and wonderful health care in that state, then was thrilled to get the opportunity to come back here at Duke and meet these wonderful people here at Duke Raleigh Hospital and be part of the fantastic things happening here.
::Chris DeRienzo, M.D.
And you mentioned residency, so you're an ER physician by background. Is that right?
::Barbara Griffith, M.D.
Yep.
::Chris DeRienzo, M.D.
That's right. Well, being an ER doc, you are no stranger to the epidemic of violence that we see in health care. And I imagine that when, when you got here three years ago, you know, that that was really just starting to sort of come to the forefront of our national attention. Talk us a little bit through sort of the story of what you saw when you got here and the steps that you've taken to build Duke Raleigh into what I got to see today.
::Barbara Griffith, M.D.
Thank you. Thank you for that question, because I really love to talk about this subject. I think as an ER physician, it's somewhat personal for me because it's really easy to understand how our staff feel an environment where today they don't feel as safe as they did yesterday. And I walked into Duke Raleigh right when that was heating up, sort of, you know, as the pandemic was starting to wind down and there was a lot of unrest everywhere across the country in every setting possible.
::Barbara Griffith, M.D.
And somehow that same unrest walked right into health care. And our staff, instead of being distracted by alarm bells and electronic changes and things that we talk about, distractions and health care being such an important part of the problems we need to solve today. Yeah, yeah. Now they were distracted by not feeling safe at work. Oh, being concerned that they could be punched by a patient or afraid of an angry family member.
::Barbara Griffith, M.D.
That dynamic. It was just so clear to me when I saw it, that we had to find solutions. We had to do something to help how our workforce feels about being in health care today.
::Chris DeRienzo, M.D.
That's such an important point because there's there are two parts to that story, right? There's the stuff that contributes to safety, much of which maybe you can't see. But then there are other aspects of what we do to improve the safety of an environment that I can see and feel. And it's at both ends. And we've got to be able to work on, on both of those sides in order for healthcare workers to not only be safer but also feel safer.
::Barbara Griffith, M.D.
Yeah, absolutely. Anything that distracts a team member from the needs of the patient isn't the best for a patient's outcome. Yeah. And so as leaders, our job is to support our staff and team having everything they need to be able to focus on the care that they're delivering.
::Chris DeRienzo, M.D.
Most definitely. I've been in Raleigh through the same period of time that you're describing, and it's been challenging. What are some of the unique challenges that you've walked through here on the Duke Raleigh campus, and perhaps some of the milestones? When you got to that point, you said, yeah, now we're really actually starting to make a difference and start to change both the perception of safety and the actual safety.
::Barbara Griffith, M.D.
The first thing that we did was we listened to our staff and we because we really needed to understand from their perspective, what did it mean to not feel safe? In what ways did they have concerns, or did they feel anxious about the work setting? And then we took a really multi-pronged approach to doing everything we can to decrease risk.
::Barbara Griffith, M.D.
And so it started with what they call hardening the facility, closing doors, locking doors. You need a badge to go through a door. It needs to be your badge. It needs to be visible, you know, really simple things that maybe over time we hadn't been as focused on compliance in that space. Those became top of mind.
::Barbara Griffith, M.D.
We want to have everyone identified on campus and understand, are you a visitor or are you a patient? Do you work here? And you need to come through an entrance that is observed and has staff who can ensure that, for example, you're not carrying a weapon. So that's the next step is we added weapons detection. And we did that actually across our system.
::Barbara Griffith, M.D.
And knowing that there's someone at the front door who's monitoring the traffic coming and going, it's very reassuring to a staff member. And just a little an interesting story. Maybe a year ago, we had an unusual situation when there where there was an imposter who was dressed as a health care worker who had entered multiple facilities in our area, came to this facility, appeared to be a staff member.
::Barbara Griffith, M.D.
Managed to find their way to the elevators at the floor of the building before you go up onto the patient unit. So their intention was to get to the patient units. Fortunately, a staff member noticed you're not wearing a badge. Who are you? You know, why are you here? And that led to alerting security and all activation of all the right resources, so that that individual never made it to a patient unit. Wow.
::Barbara Griffith, M.D.
And it was that sort of activation of awareness of who's in our facility. We want to welcome everyone who needs our care, but we want to keep them safe. And we're working together as a team to make sure that happens.
::Chris DeRienzo, M.D.
ld have expected to happen in: ::Chris DeRienzo, M.D.
And being ready means not only, as you describe hardening the target, the facility itself, but also changing our staff's perceptions because our team members are part of that that protective barrier around our obviously our core of patient care. And so that that took a series of things, you know, staff being educated that this is part of what we're supposed to do, but also the support from leadership that when I raise this flag or I ring this bell, I'm going to be supported.
::Chris DeRienzo, M.D.
So that that obviously is a culture that takes time to build, and one that I imagine also requires something of a unique relationship with local law enforcement as well.
::Barbara Griffith, M.D.
So that was probably the biggest change to the facility. And it may be somewhat unique to us, but our staff felt incredibly strongly that we should that are having local law enforcement presence on campus. And so, it took us about a year to work through: what does that relationship look like? Who would we partner with?
::Barbara Griffith, M.D.
And even the more complex pieces like developing contracts with our city, we had to work through that and fortunately, given the times we had wonderful support to get that done. But ultimately we ended up bringing the local police force on campus as, an off-duty option for them. There's one officer that's here at all times.
::Barbara Griffith, M.D.
Interestingly, those officers have lots of off-duty options. There are other places that they could work. Yeah. But they really want to support health care. And so once we opened the door to having them here on our presence, it's not been difficult at all to have officers who sign up to be part of our team.
::Barbara Griffith, M.D.
And they actually are part of our team, they are employees of this campus. When they are doing that Off-Duty work and they're patrolling and they are responding to help in situation where there could be a potential problem. Their mere presence is reassuring to our staff. And so that was something where we listened to staff that this was really important to us, particularly the folks who are working in the emergency department.
::Barbara Griffith, M.D.
Yes. We were able to achieve that change, and the result has been that the whole tone of the conversation around safety here has changed. Interestingly, we did a survey not too long ago to get a better sense of how they were feeling about safety on campus at this point. And we got back some really interesting comments. And the one that that I'm really proud to share is they recognize that the world we're in right now is not always safe,
::Barbara Griffith, M.D.
but we feel like our leadership is doing everything they can to keep us safe. So that recognition that we're not going to be able to do it all. You know, a lot of this is about awareness and risk mitigation and all the different complex components of safety in our world today. But that connection of the recognition that thanks for being done to support them was really fulfilling.
::Chris DeRienzo, M.D.
Wow. I love that point. Because you're right, there's a lot that we can't control in the external environment and broader societal challenges. And as hospitals, we're often pillars in our community so we can play a role in trying to change some of that direction. But we can't control what comes into our doors. We are the safety net.
::Chris DeRienzo, M.D.
And as you indicated, for your team to be able to say we get it and we feel safer here because our leadership team is doing what they can to protect us. I think that speaks volumes about how you've been able to build the kind of team and culture that you have.
::Barbara Griffith, M.D.
There's a couple other pieces to the local law enforcement connection that I think are important to share. Please. So it brought us that sense of reassurance and support here on the campus, but it also created this connection to the outside. Yeah. So instead of being on our own island, which a hospital typically is, we're now connected to what is going on in the community.
::Barbara Griffith, M.D.
There could be a risk developing in the community, and there could be awareness on the part of local law enforcement that the hospital could be affected and that connection is immediately there. There's a sense of an alert on campus to be looking out for something or being prepared for something. And that connection, I think, is an important part of how we move forward as hospitals
::Barbara Griffith, M.D.
in ensuring that safety is everything that it can be. The local threat assessment and management teams, that's a community activity that involves many different aspects of the community, not just law enforcement. But as a hospital now we can actually participate in that and be connected. I'll share another story that, that you may find interesting.
::Barbara Griffith, M.D.
We unfortunately had a situation with a patient who was very angry at a physician on our campus. Was seen here, discharged, and then not too long later, admitted to a local mental health facility. At that facility, continued to talk about their intentions and make threats toward what they were going to do to the physician when they were discharged, to the extent that the other facility shared that information with us out of concern. We engaged our support network here, which included local law enforcement, put some additional protective measures in place once that patient was discharged.
::Barbara Griffith, M.D.
You know, be it escorting the physician to and from her car and the things that, you know, both reassured the physician and would help to keep that individual safe. Ultimately, that individual left the state. And we knew that because of this connection with our community that was observing him and making sure that there wasn't something significant that was about to happen. We wouldn't have had that knowledge if we didn't have that connection.
::Barbara Griffith, M.D.
And the difference that made to this campus was immense.
::Chris DeRienzo, M.D.
I can only imagine. Those kinds of challenges I hear about all over the country. And you've built a unique model of integrating both within the walls and then through the walls with the parts of the community. I guess, just in in the couple of minutes that we have left, if I'm, you know, in a hospital in Louisiana or in North Dakota, and I'm just perhaps embarking on this journey, what are some of the key innovations in the approach that you've taken?
::Chris DeRienzo, M.D.
And lessons learned sort of going forward - not only that would apply to you here at Duke Raleigh because as you've indicated, the journey is never done. We can always continually improve our approach to safety, but also to others around the country who are perhaps even just starting to think about this.
::Barbara Griffith, M.D.
First and foremost, focus on communication. Because every element of the work that we've done and how we've connected across teams and how we've built a different culture here, has been based on having transparent and clear communication around what's going on. And it's bidirectional. How are the staff feeling that's informing what we're doing? We're continuing to give them feedback about what we're doing and make sure that they're aware of the changes in place.
::Barbara Griffith, M.D.
And I was going to mention the imposter scenario I mentioned before. A lot of communication went out across the entire team so that people understood what happened and knew what the mitigation efforts were. All of those pieces work together, because you're talking about it, you're connecting around it. And then ultimately our goal, which is to keep our workforce safe, but also make sure that our patients have the best outcomes are served through that intense focus on we need to talk
::Chris DeRienzo, M.D.
to each other. You hit the nail on the head. And ECRI (Emergency Care Research Institute) called it out last year in terms of the biggest patient safety issues facing health care in America. Number two, the second patient safety issue was the safety of our workforce. Dr. Griffin, that has been a true pleasure getting to spend some time with you today, meeting you and your team.
::Chris DeRienzo, M.D.
ourage you to join us. Nearly: ::Chris DeRienzo, M.D.
And the latest research aimed at fostering a culture of safety across health care settings. You can sign up and learn more by visiting AHA.org/patientsafety. Thank you all again for listening and be well.
::Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.
