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Workplace Violence in Health Care

Posted By Administration, Tuesday, April 19, 2016
Updated: Monday, April 18, 2016

The healing professions are at greater risk of experiencing violence in the workplace than most professions,
but many are working to reduce the risk.

by Patricia McTiernan, MS

Ann Scott Blouin
Ann Scott Blouin, PhD, RN, FACHE,
will discuss workplace violence and
methods of de-escalating it at the
NPSF Patient Safety Congress.


In March of this year, a patient shot and killed a urologist in New Orleans, then turned the gun on himself. The incident was shockingly reminiscent of last year’s killing of a surgeon at a hospital in Boston by a distraught family member.


Although the murder of health care professionals is an extreme form of violence that is relatively rare, overall, health care professionals are at far greater risk than others of experiencing violence in the workplace. According to the Occupational Safety and Health Administration (OSHA), in the decade between 2002 and 2013, the rate of violent incidents requiring time off for the worker to recover was more than 4 times greater in health care than in other industries. OSHA data show that there are almost as many serious violent injuries in health care settings as there are in all other workplaces combined.


What do we know about the why of all this? Ann Scott Blouin, PhD, RN, FACHE, executive vice president, Customer Relations, at The Joint Commission (TJC), says part of it has to do with how open and accessible health care settings are, as well as the emotional state that patients and family members may be in while at a health facility.


“There are lots of entry points, making security more challenging. Also patients and family members in a health care setting often have reasons to be upset or concerned,” says Dr. Blouin. “Often health care providers need to have difficult conversations with patients and their families.”


Another factor is the incidence of patients having not only medical and surgical conditions, but also underlying mental illness, which can contribute to the risk of violence. And if patients, visitors, or family members typically live in an environment characterized by violence, they may bring that perspective and sometimes weapons into the health care setting, says Dr. Blouin.


If there is a bright spot, it is that many organizations now recognize this risk and are taking steps to educate the workforce and make health care safer for those on the front line of care.


The Joint Commission published a monograph in 2012 on the topic of workforce safety in health care and later this year plans to launch a web portal available to all with resources and tools. Among the resources will be the American Society for Healthcare Risk Management’s Workplace Violence Risk Assessment Tool.


In 2013, the National Patient Safety Foundation’s Lucian Leape Institute issued a report calling workforce safety a precondition to patient safety; Joint Commission fully supports that perspective and has published Sentinel Event Alerts and Quick Safety Alerts around the topics of escalating workplace violence.


If she could share only one piece of wisdom about this issue, Dr. Blouin says, “Don’t take your patients’ or your own personal safety for granted.” She points out that there are proven tactics to de-escalate a potentially violent situation, and that anyone can learn them.


“For those working in behavioral health, a standard part of the curriculum is to learn de-escalation techniques and be able to help people move from being angry and upset to a calmer state. Anyone regardless of their education and experience, whether a nurse, a physician, an environmental service worker, or a security officer, can benefit by learning these techniques,” she says.

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Ann Scott Blouin will be speaking on the topic of workplace violence and tactics to counteract it during Breakout Session 301 at the NPSF Patient Safety Congress, May 24, in Scottsdale. Find out more about her session and the full program at


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Patricia McTiernan, MS is assistant vice president for communications at the National Patient Safety Foundation and editor of the P.S. Blog. Contact her at

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Tags:  2016 NPSF Congress  workforce safety 

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Reliability at the Sharp End of Care

Posted By Administration, Tuesday, April 12, 2016

Breakout session at the NPSF Patient Safety Congress to focus on engaging frontline staff and physicians
in high reliability principles and safety culture.

by Patricia McTiernan, MS

Kate Kovich
For the past year, Kate Kovich's team
at Advocate Health has focused on
engaging frontline staff in principles of
high reliability and safety culture.


For Kate Kovich, MS, OT, CPPS, vice president for patient safety and a 26-year veteran employee of Chicago-based Advocate Health Care, the pursuit of high reliability began with a medical error that resulted in the death of an infant.


“We were always very committed to safety,” says Ms. Kovich, “but after that event, we realized that we needed to fundamentally change our approach.”


And so the organization embarked on a strategic, multiphase plan to improve safety culture and reliability. In the three years since starting the program, Advocate has seen improvements in the AHRQ Safety Culture Survey scores at all of its 12 hospitals, a greater than 25% increase in reports of safety events and near-misses, and a 38% decline of serious safety events in its hospitals across the system.


The program put into place three years ago began with leadership training developed with the help of a consulting group and implemented throughout the system. “If you don’t start with your leaders, you’re never going to get to high reliability at the front line,” says Ms. Kovich.


At the same time, the organization began positioning safety as foundational to the care it provides. This involved a giant step in transparency: posting a calendar of “days since last serious safety event.” When an event occurs, and the calendar needs to change, Ms. Kovich’s office sends a brief e-mail to leaders, physicians, and staff to alert them to the risk without identifying the site, department, or patient.


Were they ever concerned about being so transparent? Yes, says Kovich, but “The presidents of the hospitals stressed the importance of getting this information to the front line. The president of the system responded and made the decision that it was a risk worth taking.”


For the past year, the program has focused on engaging those on the front line of care through training in high reliability principles and tools, and recruiting and training “safety coaches” for each unit or clinical department.


What surprised Ms. Kovich during this work? “I didn’t realize how vastly different the cultures of the organizations were from one to another; they move at different paces, so it is challenging to get an entire organization of this size to move together.” Still, she says, the response from leaders and the frontline health professionals has been positive.


Personally, Ms. Kovich says that one of the most important things she has learned over the past few years is the importance of influencing people in her organization—to connect them to the “why” of what they are doing—through story telling. “Telling stories is such an effective way to get people’s attention,” she says. “We never use the patient’s name. But we try to personalize it so it is not just an event we’re talking about, it’s somebody’s life we are holding in our hands.”

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Kate Kovich will be discussing Advocate Health Care’s experience at the NPSF Patient Safety Congress. Get the details of Breakout Session 101: Implementing a Strategic Approach to High Reliability at the Sharp End and the rest of the Congress program at


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Tags:  2016 NPSF Congress  HRO 

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Patient Safety Awareness Week: March 13-19

Posted By Administration, Monday, March 14, 2016

Patient Safety Awareness Week began yesterday, with more than 500 individuals having already taken the patient safety pledge. This week is a central part of the National Patient Safety Foundation’s United for Patient Safety campaign. It serves as dedicated time and a platform to increase awareness about patient safety among health professionals, policy makers, and the public.


But it’s also a time to celebrate some of the small wins along the way and the people who are working to advance patient safety in their organizations and in their communities.


So far we are seeing lots of creative ideas from many people and organizations, including

  • CHI St. Vincent Hospital in Arkansas is celebrating safety catches, sharing social media posts, and hosting safety coach crossword and other contests.
  • The 579th Medical Group at AFMS-Joint Base Anacastia-Bolling is also promoting safety via games, contests, and “room of horrors” in which staff can identify the safety lapses.
  • Dawn Evans, MSN, RN, patient safety officer at Barton Memorial Hospital (NV) and a member of the American Society of Professionals in Patient Safety at NPSF, compiled tips for patients, and published a commentary in her local paper.
  • The staff of AFMC Surgeon General donned hospital gowns in solidarity with patients and the We are all patients tactic of the United for Patient Safety Campaign.

Why should you be involved? A conservative estimate is that medical error causes the deaths of 44,000 to 98,000 hospital patients a year – some estimates put the rate much higher. Despite some progress, the latest estimate from AHRQ is that 1 in 10 hospitalized patients experiences a hospital-acquired condition, such as a pressure ulcer or infection.


We want to hear what you are doing to recognize Patient Safety Awareness Week. Visit and let us know!

Tags:  engagement  patient safety awareness week 

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Is Patient Safety the New Anatomy?

Posted By Administration, Tuesday, February 23, 2016
Updated: Monday, February 22, 2016

In a special webcast moderated by NPSF President and CEO Dr. Tejal Gandhi, Drs. Don Berwick and Kaveh Shojania dove into questions about a new NPSF report and its recommendations for total systems safety and a culture of safety, with a call for leadership education being a key point of the discussion.

by Patricia McTiernan, MS


Should safety science be required learning for health system leaders and trustees? How do we more fully engage leaders in advancing patient safety? How do we get organizations to not just meet benchmarks, but to really work on the process of care?


Those were some of the questions posed to Don Berwick, MD, MPP, and Kaveh Shojania, MD, during a recent open webcast hosted by NPSF and moderated by Tejal Gandhi, MD, MPH, CPPS, president and CEO of NPSF. The session focused on the NPSF report, Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human, and was highlighted by question-and-answer sessions during which Drs. Berwick and Shojania expanded upon the report’s recommendations.


Dr. Berwick, former administrator of the Centers for Medicare and Medicaid Services and president emeritus of the Institute for Healthcare Improvement, and Dr. Shojania, director of the Centre for Quality Improvement and Patient Safety at the University of Toronto and editor-in-chief of BMJ Quality & Safety, served as co-chairs of the expert panel that produced the NPSF report.


The report’s 8 recommendations are:

  1. Ensure that leaders establish and sustain a safety culture
  2. Create centralized and coordinated oversight of patient safety
  3. Create a common set of safety metrics that reflect meaningful outcomes
  4. Increase funding for research in patient safety and implementation science
  5. Address safety across the entire care continuum
  6. Support the health care workforce
  7. Partner with patients and families for the safest care
  8. Ensure that technology is safe and optimized to improve patient safety
Tejal Gandhi, Don Berwick, and Kaveh Shojania
Drs. Tejal Gandhi, Don Berwick, and
Kaveh Shojania at the Free from Harm
expert panel meeting

One of the first questions got to the heart of the safety culture conundrum: how can we capture the attention of CEOs and top management when it comes to safety? Acknowledging this as a “hard problem,” Dr. Berwick said that putting patients and families in the room with leaders and trustees is one of the most powerful and effective ways to get them engaged.


Long term, he said, leaders and trustees need training and education in safety, “just as they need to learn to read a balance sheet.” But for an immediate impact, nothing beats putting patients and families who have experienced harm in the same room with leaders and executives. “It’s very, very hard to turn away when that voice is in the room,” Dr. Berwick said.


He emphasized that the leaders need to hear patients and families in an “authentic way,” meaning not in a focus group type session, but in a format where the patients and families get to tell their stories. In answer to a follow-up question, he added that public forums, private executive sessions, and board meetings could all serve as a means of sharing patient stories. “The more the better,” he said.


One listener asked how educational preparation in patient safety has changed since To Err Is Human came out, and what more needs to be done. Dr. Berwick said the changes that have come have not been enough. “This is the new anatomy,” he said. “Safety and quality generally are no longer appropriately dealt with as add-ons to the professional skill set. It’s core; it’s essential.”


Would Dr. Berwick require trustees and executives to take a foundational course in safety science? “I’ll just say it’s really, really smart to do,” he said, stopping short of a requirement, but acknowledging that leaders and trustees have a duty to understand safety science, just as they need to understand financial stewardship of their organizations.


Other areas touched upon include


Reporting: Drs. Berwick and Shojania agreed that there has been an overemphasis on reporting for the sake of reporting, and that there needs to be more focus now on addressing the problems and recognizing which types of events are necessary to report every time. Dr. Shojania said that falls, for example, represent an epidemiologic problem, and there might not be value to reporting each and every one but instead focusing on systematic prevention.


Centralized oversight of patient safety: Dr. Berwick stopped short of calling for a new agency, like the National Transportation Safety Board, to oversee health care errors. He said there is a need for high levels of coordination, but that “a national reporting system may not add the value that some think if might…I’m a very strong fan of national leadership here, but national aggregation of data I think is something we need to approach with some caution.


Patient and family engagement: Dr. Shojania emphasized that many of the methods in use that are supposed to engage patients are superficial. True patient and family engagement needs to be authentic, and health care professionals could do a better job of characterizing what aspects of health care would most benefit from patient and family engagement.


In closing, Dr. Gandhi asked both presenters to pick their top 3 of the 8 recommendations. Both chose recommendations 1, Ensure that leaders establish and sustain a safety culture, and 6, support the health care workforce, among their top 3. Dr. Berwick added engaging patients and families to his list, while Dr. Shojania cited recommendation 8, Ensure that technology is safe and optimized to improve patient safety.


If you were not able to attend the webcast, listen to the replay and download the report here.


Which recommendations would make your top 3? Comment on this post below. Note: to post a comment you must be logged in. Register or log in.


About the Author: Patricia McTiernan, MS is assistant vice president for communications at the National Patient Safety Foundation and editor of the P.S. Blog. Contact her at

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Throwback Thursday: Patient Safety Awareness Week 2015

Posted By Administration, Thursday, February 18, 2016

Memorial Hermann Tabletop game during Patient Safety Awareness Week
Memorial Hermann tabletop game during
Patient Safety Awareness Week 2015

This is the first of a series of posts that will highlight past events or success stories that others may want to emulate.

With the United for Patient Safety campaign—and the countdown to Patient Safety Awareness Week—under way, now is a good time to look back at what some organizations did to mark the week in 2015.


Memorial Hermann Health System, a large, not-for-profit health system in Texas, put together multiple activities at a number of sites to engage staff in learning about patient safety. A founding member of the NPSF Stand Up for Patient Safety program, Memorial Hermann comprises 13 hospitals and numerous specialty programs.

“Our hospitals, under the direction of the patient safety specialists, coordinated activities to reinforce knowledge of safety behaviors and increase engagement in promoting a safe culture,” says Lorraine Cull, MSN, RN, senior patient safety specialist at Memorial Hermann.

Activities held at Memorial Hermann facilities during Patient Safety Awareness Week 2015 included:

  • A Safety Coach breakfast to honor staff who mentor their peers in safe behaviors and procedures
  • A “Little House of Horrors,” in which staff were challenged to identify all of the errors in a simulated clinical scene
  • Patient Safety Jeopardy, which tested teams in their knowledge of best practices
  • A patient safety fair and poster contest

Patient Safety Awareness Week 2016 is March 13-19. Share your plans on the website, or comment on this post below. Note: to post a comment you must be logged in. Register or log in.

Tags:  PSAW 

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