CEO Report: Tackling Violence in our Hospitals
Posted on June 19, 2018
"I object to violence because when it appears to do good, the good is only temporary; the evil it does is permanent." - Mahatma Gandhi
As we approach the finish line of the 2017-2018 MHA program year and reflect on the many diverse issues confronted by the association and our members, we can be rightfully proud of the tremendous success we have had. We have protected critically needed funding for the Healthy Michigan Plan and traditional Medicaid program, graduate medical education, and rural access and obstetrical stabilization pools; we have preserved access to care for auto accident victims, re-authorized the Children’s Health Insurance Program (CHIP), improved the quality and safety of hospital care through our many MHA Keystone Center efforts, and so much more.
But there is one issue that was a distant blip on the radar screen of my own consciousness a year ago, and is now a “clear and present danger.” On one of my recent hospital site visits, I asked the CEO what was keeping him up at night. I expected to hear the typical list of public policy issues, or perhaps the dynamics of competition in the local market. Instead, without hesitation, he responded that, in fact, it was the issue of violence. Like a growing number of hospitals, they had been conducting daily “safety huddles” designed to identify on a unit-by-unit basis any risk for patient harm. But this CEO shared with me that, in recent months, these huddles were revealing a growing number of incidents of violence against front-line caregivers. Patients – or their family members – literally punching, kicking, biting, and otherwise verbally and physically assaulting the very people who show up to work every day to protect their health and well-being.
Last year, the American Hospital Association (AHA) worked with the Milliman actuarial firm to produce a special report on the impact of violence in healthcare. The conclusion: proactive and reactive violence response efforts cost U.S. hospitals and health systems approximately $2.7 billion annually. This includes $280 million related to preparedness and prevention to address community violence, $852 million in unreimbursed medical care for victims of violence, $1.1 billion in security and training costs to prevent violence within hospitals, and an additional $429 million in medical care, staffing, indemnity and other costs as a result of violence against hospital employees. If you have been following the MHA’s social media channels – always easy to find at the bottom of the MHA.org website – then you know that the MHA and our members have been fully supporting the AHA-led Hospitals Against Violence campaign. The idea is that awareness and visibility of an issue is the first step toward making a difference.
At his inaugural address at the 2017 MHA Annual Meeting, incoming MHA Board Chairman Loren Hamel, MD, president and CEO at Lakeland Health, lifted up the concept of the quadruple aim: improving the work life satisfaction of healthcare providers, which is essentially caring for the people who care for patients. Violence perpetrated against these caregivers is a major factor in rising burnout rates. Stated simply, if we cannot secure the physical and psychological safety of caregivers, we cannot maximize our effectiveness in patient safety and quality.
Physician burnout is not a new issue, but it is an issue that at long last is meriting the attention it deserves and has grabbed the spotlight in a significant way. Recent data indicates that some 54 percent of practicing physicians are suffering from burnout, and the costs are high: from the negative impact on patient safety, to the economic cost of physician turnover, to the tragic increase in physician suicide, which is now among the highest of any profession. Nurses and other clinicians are subject to these same stressors. The good news is that, with more science and rigor now available, there is a path forward to address burnout. In fact, a standardized culture assessment survey is available at no charge to all MHA Patient Safety Organization (PSO) subscribers. We have also facilitated access to Bryan Sexton, PhD, the highly regarded expert from Duke University, and will do so again at the next MHA Patient Safety & Quality Symposium Sept. 18 and 19 in Ypsilanti.
Convening our members and experts to facilitate shared learning on important issues will always be a core competency and role of the association. Last month, MHA Board Member Ed Bruff, president and CEO at Covenant HealthCare, collaborated with the MHA to host a special member forum on the issue of violence in healthcare. As you may know, Covenant experienced an active shooter situation with one of their patients last year. Ed and his team did a terrific job sharing the many lessons learned from that experience, which fortunately ended with no injuries to anyone involved. As evidenced by the significant number of hospitals that registered for this session, the interest in the topic is very high.
Finally, public policy will play a key role as well. In that vein, Jean Meyer, chair of the MHA’s Legislative Policy Panel, addressed the MHA Board of Trustees at its April meeting and specifically highlighted the growing matter of violence within healthcare settings, indicating that the Federal Bureau of Investigation and Occupational Safety and Health Administration both report that more assaults occur in the healthcare field than any other. In an effort to protect employees, it was reported that Michigan is one of a diminishing list of states that have not enacted criminal statutes specifically addressing assaults on emergency medical providers, with 32 states making it a felony to assault a healthcare worker or emergency medical personnel. Ms. Meyer indicated that the Michigan Penal Code makes it a felony to assault police officers, firefighters, paramedics, EMTs and other first responders and that Senate Bill (SB) 33, sponsored by Sen. Ken Horn (R-Frankenmuth), would extend this protection to emergency room personnel including, but not limited to, physicians, nurses, intake clerks, and any other individual employed in the emergency department, emergency room, operating room, or trauma center of a hospital. The Board ultimately adopted a resolution supporting the panel’s view that SB 33 should be supported, but also encouraging the inclusion of such protections for all personnel employed in hospitals, and potentially other healthcare settings as well.
The MHA is committed to being a part of the solution to the vexing problem of violence. As with other complex issues, working together will be critical, and on behalf of our entire team, we look forward to doing that in the months and years to come.
As always, I welcome your thoughts.
Posted in: MHA Rounds