Addressing Healthcare's Evolving Crisis: Workplace Violence

Over the past year, we became one of the first hospitals in Massachusetts to implement a Patient and Visitor Code of Conduct (PVCoC), with a goal of lowering the level of abuse and disrespect that our caregivers experience from visitors and patients.

The need for this type of policy is both sad and alarming. The Bureau of Labor Statistics reports that health care workers are five times more likely to get injured at work than other professionals. In fact, the Massachusetts Health and Hospital Association (MHA) just released a report showing an alarming trend in increased incidents over the last 3 years. They estimate based on reporting by 88% of MHA member hospitals that someone – most likely a clinician or employee – was either physically assaulted, endured verbal abuse or was threatened every 38 minutes in 2022. 

This is clearly not just a UMass Memorial or Massachusetts issue, but rather a rapidly evolving national concern. As well documented in the new MHA report, a poll conducted by the American College of Emergency Physicians showed that more than 80% of ER physicians reported that the rate of violence in the workplaces has increased, with 45% noting a spike in incidents in the past five years. The International Association for Healthcare Security & Safety has reported a near doubling of assaults per 100 hospital beds between 2016-2021, across the United States. While this increase in reported incidents is disturbing, the reality is that it is likely even worse since many assaults are still under-reported, and because verbal assaults and threats have often not been captured. At UMass Memorial, we've worked for several years to accurately document the frequency of incidents so that we can measure our success in addressing the issue over the next several years.

The safety of our caregivers, along with that of our patients, is what I worry about more than anything else. While national labor shortages and staffing concerns have dramatically impacted us the past few years, we continue to devote resources to making our hospital as safe as possible. Our Patient and Visitor Code of Conduct (PVCoC) is a major step in the right direction. Based on our UMass Memorial experience with internal development and rollout of this Code, we have been able to work with the MHA and many other Massachusetts hospitals in drafting and adopting a “universal” set of Code of Conduct Principles to be implemented across all hospitals in the state. We strongly believe this will help elevate patient and family behavior expectations and norms across Massachusetts hospitals. 

Our Patient and Visitor Code of Conduct (PVCoC) provides a set of boundaries and guidelines around the most challenging circumstances that occur in the hospital setting. But to be most effective, we must take time to ensure all of our caregivers receive the proper training and support so that they feel comfortable utilizing it. It is important to remember that many patients turn to UMass Memorial seeking compassionate care for psychiatric illness, and that other patients may act inappropriately due to medications and other medical issues. The PCVoC should never be used maliciously against these types of patients. Rather, it is designed to be a tool that is reserved for situations where patients and visitors are aware of their inappropriate behavior, able to control it and choose not to.

That’s why each of our managers is leading one or more 30-minute PVCoC training sessions with all patient-facing caregivers on their team. This training will include details on when the PVCoC should be utilized to de-escalate incidents and how it can aid in creating respectful resolutions for everyone involved. At the core of the PVCoC training is the NOPE model, which can be seen below. It will help caregivers identify concerning situations, draw a line against caregiver abuse, inform the patient or visitor about potential impacts of their behavior (up to and including removal) and escalate to management. Organizational leaders will receive special training on appropriate responses when cases are escalated.

Along with other trainings, such as AVADE, the PVCoC is one of the many measures that we are taking to ensure the safety and comfort of our dedicated caregivers. While we engage in this important work, it remains critical for us to continue to document all incidents of caregiver harm and abuse through our Safety Intelligence (SI) tool and provide support for impacted caregivers. It is my sincere hope that we will see a reduction in the frequency of these occurrences.

I'd love to hear what others are doing to tackle this issue. Thank you for reading!

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