Workplace violence, practice safety and patient care with Andrea Greco, SVP of healthcare safety, CENTEGIX

Andrea Greco, SVP of healthcare safety at CENTEGIX

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Workplace violence and safety concerns have become pressing issues in health care, affecting not only staff morale and retention, but also quality of patient care and overall practice operations.

Andrea Greco, SVP of healthcare safety at CENTEGIX, sat down with Medical Economics to discuss the association between practice safety and patient care. Greco talks about the importance of proactive safety measures in medical settings, in addition to the surprising prevalence of workplace violence, the role of training and tools in improving staff security, and practical strategies practice managers can implement to protect their teams.

Editor’s note: The following transcript has been edited for brevity and clarity.

Medical Economics: According to National Nurses United (NNU), over 80% of nurses experienced some form of workplace violence within the last year. Could you talk a little bit about what kind of effect this has, obviously on the nurses themselves, but on patient care?

Andrea Greco: Well, I think you’re right. That first level of impact is to the employees themselves, so there can be a degradation in employee satisfaction and employee engagement, which then translates to an impact on patient care and patient engagement and patient satisfaction. When the folks that are tasked with taking care of them — and those caregivers see that as their core mission — if they can’t do that with focus, then that directly does impact those patients. They feel it and see it, as well.

We’ve seen literature across the health care spectrum that says that patients feel less safe when employees feel less safe in the workplace. Patients can read that distraction that comes from their employees, so the quality of care can be impacted, along with the feeling of satisfaction and the level of engagement. So, there is a correlation there. Those two entities working together, right? The employees giving that care and those receiving it really need to be in sync with each other. So, when there’s not a safe environment, or when one of those groups feels threatened, it impacts the other as well.

Medical Economics: A McKinsey and Company survey determined that, for nurses in the early and middle stages of their careers, workplace safety was the most influential factor in deciding whether to leave their current role. Obviously, safety is important in staff retention, but could you talk about why that is? Why is it so important to health care workers?

Andrea Greco: I think we’re seeing the impact of those younger workers, or those that are entering the field newly. There’s less of a tolerance for that acceptance of, “Well, this is part of my job. Violence in the workplace is just part of what you sign up for.” So, more and more, as leaders are getting behind this and creating a culture of safety — and evangelizing that — workforce tolerance is decreasing, as well. You’re seeing either more folks leave because that’s not being addressed, or it is being addressed more widespread.

Medical Economics: What are some effective strategies that organizations or practice leaders can implement to foster a culture of safety and well-being?

Andrea Greco: There are several ways that folks put practices into place to either increase retention, be more attractive during recruitment, as well as impact employee satisfaction and patient satisfaction — like we talked a bit about before. So, it’s about doing a couple of things. One: making sure that you are listening to your employees. So, ask in surveys, ask in one-on-ones, ask in huddles — safety huddles, etc. Things that happen, both planned and unplanned, conversations throughout the day, throughout the week, etc., in different cadences. Really ask the question and listen. Demonstrate that you’re listening, but then also take action. I think that’s where people feel the most comfortable of being heard, but then also supported.

That support can then be displayed in a variety of different ways. One: continuing the conversation, acknowledging that something needs to be addressed or tackled, and then delivering on that. And that can be tricky when it comes to safety in a workplace setting, because there is no silver bullet answer to how to provide the safest environment. It happens in a layered approach. You need different things to make sure that you can protect people in different scenarios, in different places, and when interacting with different people. That’s everything from very tangible support of cameras and weapon detection systems, from training on how to deescalate a situation, and then solutions more like CENTEGIX’s, focused on how you can get help directly to where it’s needed as quickly as possible.

So, there’s a variety of ways to hit all of those different levels, but allowing a gap in one of those areas can be problematic, as well, and it can have people feel as if they’re not being listened to, that their concerns are not being addressed, and then that can impact downstream areas, like we’ve talked about.

Medical Economics: So, when these situations do unfortunately occur, how can facilities better enable situational awareness for incident responders?

Andrea Greco: I think, again, what we focus on is the people, right? Getting help to folks. So, if you don’t know that there’s a problem, you certainly can’t address it. So that’s the first step in situational awareness: knowing that there’s an issue. So, allowing for a staff duress solution, or a way that employees can ask for help, whether that is discreetly or not, that’s the first step — making sure there are tools and/or protocols and training in place to make sure that there is awareness of a situation happening.

Also, it’s important to make sure that staff feel like they are empowered and encouraged to utilize those tools to report every time a situation comes up that they may need support in, instead of not reporting the incident. We find that over 80% of incidents that happen are not even reported. So, you cannot create that situational awareness, you cannot address a wide-scale problem if you don’t know or realize that it is a wide-scale problem. Also, it’s important to make sure that folks then enact these protocols or processes that you put in place to make sure that as much information as possible is given during a time that help is needed.

So, it really comes down to tool implementation, listening to your staff, but then also encouraging utilization of those tools against supporting that and making sure that any follow up that’s needed for improvement, for action that needs to be taken after the fact, is done. So, that follow through is really important.

Medical Economics: You mentioned that over 80% of incidents aren’t reported. Could you talk about some of those barriers and really what’s preventing those incidents from being reported?

Andrea Greco: It’s a couple of things. I think there’s sometimes still a feeling within care settings that, while there are tools in place, there’s sometimes still discouragement of using those and bringing to light the high frequency in which those situations occur. So, that’s an unfortunate byproduct of a lack of cohesive communication, right? That support’s a culture of safety that is deployed across an entire organization.

Then, I think there’s still to be tackled the whole idea of “workplace violence is just not acceptable,” right? The need for zero tolerance, both displayed to patients, their family members, other folks that may come into a care setting, from then the top down within a health care organization, of “that is our policy, that is our stance,” needs to be enacted more widespread as well in a genuine way, so that folks know that it is our true policy. That’s what we’re going to take action on, and that is what is, in part, there to protect me, as well.

Medical Economics: For the family members or other visitors that may come into a practice, what are some steps that practices could take to strengthen visitor management protocols and reduce safety risks?

Andrea Greco: There are a couple of different things. Everything from simple signage, acknowledging that we have a zero-tolerance policy here within this facility. We should make sure that that signage is front and center, easy to read, but also very direct and to the point, so that it conveys that message to those visitors. You don’t expect everyone that comes into your organization to know all of your protocols, your policies, but that’s a key one that is very important to display and have part of the conversation from the minute they walk in the door, setting that expectation.

We can do that through some other tangible ways, through positive visitor management protocols, everything from having reduced access — one access point in and out, etc., so that you know, and can control, who’s within the care setting. And doing things like immediate background checks and checking against go/no-go lists. Unfortunately, there are likely locations within an organization where they know that there are certain members of the public that they don’t want to allow into their facility for one reason of the other. We can check against those kinds of lists if they are being compiled, but also against a national background check that we can conduct to make sure that there are safe, law abiding citizens coming into your organization.

So, even just having those practices in place is a demonstration of how important it is to create a culture of safety. By knowing who’s in your building and preventing those that shouldn’t be or can’t be in the building — making sure that they’re not allowed access.

Medical Economics: On a broader scale, health care is constantly changing. With challenges like staffing shortages, patient distrust and agitation on the rise, how can health care leaders ensure that practices stay moving forward?

Andrea Greco: Well, I think it comes down to a couple of key things. First, that culture of safety should be a priority for the organization, and that should be made known to those who operate within the organization and those that come into a care setting, as well. So, that’s first and foremost. You have to make it a priority and then communicate that priority. You can do that through investment in tools, the signage that we were talking about around a zero-tolerance policy, and those kinds of things. So, it’s really about addressing an issue, acknowledging it, communicating around it efficiently, and then really upholding the policies that you’ve established.

Communicating those things will create trust and credibility, both from internal employees as well as external. You can train and set the right expectations for those that come into your facilities, and if you do that on a consistent basis, they will adopt that behavior and those policies that you’ve enacted. So, really, it’s around that listening, taking action and enforcing and following up.

Medical Economics: Is there anything that we didn’t talk about that you think is important for physicians and practice leaders to keep in mind?

Andrea Greco: I really think it’s just around putting the people first, right? We ask so much of our caregivers, and many of them just have that caring personality or character about them anyway, right? That’s why they’ve walked into these chosen professions. But again, just supporting them and everything they do, being transparent, communicate clearly and again, follow up with action to support them within the care setting, so that their satisfaction and their engagement remains high, so that they can do the same and create that environment for their patients, as well.

That’s why they’re all there, to provide a safe, caring and healing environment for folks, and that starts by providing a culture of safety for all of them to operate within.