Case Study: Addressing Workplace Violence in Healthcare

Case Study: Strengthening Community Partnerships to Stand Against Violence  

Leaders at central New York-based Oneida Excelsior Health partnered with the local community to build a culture of zero tolerance for hospital violence. President and CEO Jeanne Scofield recognized the devastating impact caused by an increasing number of violent incidents. A patient experiencing a behavioral health crisis destroyed a unit and created a weapon from a protective barrier. A nurse in the emergency department was attacked when discharging a patient. Developing a response to support frontline staff became his leadership team’s top priority.

Like other hospitals across the U.S., leaders in Oneida have been forced to confront growing rates of hospital workplace violence. Healthcare workers accounted for 73 percent of all nonfatal workplace injuries and illnesses due to violence in 2018. More than eight in 10 emergency physicians report violence in emergency departments is increasing, and 45% report seeing a significant increase in the last five years. Workplace violence in hospitals affects the physical and psychological well-being of healthcare workers, and greatly contributes to provider burnout. 

Oneida took action to review all incidents, raise community awareness, and reinforce the system’s supportive culture for employees. The result? A stronger workplace culture, data driven interventions to prevent future violent incidents, support from key stakeholders and policymakers, and positive feedback from employees and community members.

At Oneida, employees are encouraged to report all workplace violence, whether physical or verbal, through an incident reporting system. When incidents occur, the leadership team checks in with employees to offer support. The staff response team engages affected employees during and after violent events, and connects them to appropriate resources.  

A safety committee meets monthly to track all violent events, analyze trends, and identify interventions and solutions. Feedback from employees informs hospital policies. “We listen to staff, we take feedback, and we start taking action immediately,” says Joel Molitor, vice president for operations. “We’ve built an expectation where our teams feel that if they raise an issue, something’s going to change.”

Concerns by staff about security and communication processes during security incidents led Oneida to replace a contracted security team with in-house resources. Additionally, Scofield and Oneida’s leadership team comes on site after workplace violence incidents, rounds the units, and checks in with staff to take feedback and answer questions.

Oneida regularly debriefs violent incidents with community partners to review how to improve processes in the future. Those same partners play a central role in Oneida’s approach to increasing community awareness of the impact of hospital violence. Oneida engaged their board of directors, local police department, legislators, and community members to develop a zero-tolerance approach to hospital violence.

Oneida’s community-based board of directors met to review specific incidents and commit to the workforce that violence against hospital employees would not be tolerated. The board was shown footage from an actual incident that occurred in the emergency department. It was a real “a-ha moment”, according to Scofield. “Engaging your board in that conversation helps to develop a deeper awareness of the issues. That resounds with our staff and reinforces that they have the support of the broader community.”

Oneida deploys a data-driven approach to collect information on incidents, identify interventions, solicit feedback, report out to system employees, and facilitate a cycle of continuous improvement. 

 In addition to measuring incidents and outcomes, Barwis wanted to make sure that clinicians and staff saw firsthand support from the community. Oneida convened a sit-down discussion for frontline employees with state legislators. Employees detailed their firsthand experiences with workplace violence. The meeting was significant on all sides. “It was transformative for employees just to have an opportunity to share their story,” says Brian McCann, chief operating officer. “And it was also powerful for leaders to hear directly from the staff who are affected.”

Oneida’s healthcare workers have responded positively to the initiatives underway. Employee engagement survey results reflect positive feedback. Anecdotally, staff have shared that they feel their concerns are heard and acted upon. 

What are the most significant takeaways for other hospital leaders solving for the same challenges? Oneida’s leadership team acknowledges data collection and analysis has been important, but points to a strong culture as the most critical element for success. 

Shared governance is a core strategy. “We engage frontline team members in decision-making, evaluation of new efforts, and adjustments to our approach, taking their feedback all along,” Scofield says.  “It works well and generates great buy-in among our staff.” Engaging employees strengthens culture and creates a safe environment within the system.

 Oneida wants their employees to feel fully supported. “It’s our commitment, but it’s also our honor as executive leaders to take care of our team members,” says McCann. “They are taking care of our patients and community, and our role is to make sure that they’re safe.”