Chubb Executive: C-Suite Leaders Need to Implement Tough Anti-Violence Policies

A survey published by the Charlotte-based Premier Inc. on its website on June 1 found that “Forty percent of healthcare workers experienced an incident of workplace violence in the last two years.” Further, Premier leaders noted that, “According to the survey,” published in conjunction with the Agency for Healthcare Research and Quality (AHRQ), “violence occurs most frequently among nursing staff at the hands of men between the ages of 35-65. More than half of all reported incidents were at the hands of combative patients.”

Indeed, “Among those who responded that experienced workplace violence,” Premier noted, “they indicated the incidents occurred most often while explaining or enforcing an organizational policy, or while providing an update on a patient’s condition to the patient or to the patient’s family members. Women responding to the survey reported that incidents of workplace violence were evenly split between emotional or verbal assaults (50 percent of women responding) and physical or sexual abuse (50 percent). Men responding to the survey were more likely to experience physical abuse (62 percent) versus verbal or emotional assaults (38 percent). More than half of all respondents felt that workplace violence incidents had increased during their tenure.”

Further, “Breaking down incidents based on role, 60 percent of those who experienced violence identified as a bedside nurse. Thirty-four percent of the population of nurses reported emotional or verbal violence, while 66 percent experienced physical or sexual violence.”

What’s more, according to an article published by Patrick Boyle and posted to the website of the American Association of Medical Colleges (AAMC) on Aug. 18, 2022, entitled “Threats against healthcare workers are rising,” The Bureau of Labor Statistics reports that the rate of injuries from violent attacks against medical professionals grew by 63 percent from 2011 to 2018, and hospital safety directors say that aggression against staff escalated as the COVID-19 pandemic intensified in 2020. In a survey this spring by National Nurses United, the nation's largest union of registered nurses, 48 percent of the more than 2,000 responding nurses reported an increase in workplace violence — more than double the percentage from a year earlier. The reasons for the aggression vary: patients’ anger and confusion about their medical conditions and care; grief over the decline of hospitalized loved ones; frustration while trying to get attention amid staffing shortages, especially in nursing; delirium and dementia; mental health disorders; political and social issues; and gender and race discrimination,” he wrote.

One expert who has been tracking these trends is Caroline Clouser, executive vice president, healthcare industry practice leader, at Chubb, the Zurich-based international insurance company whose U.S. division is extensively involved in the U.S. healthcare system, insuring hospitals and health systems nationwide. Within healthcare, Chubb focuses on helping healthcare organizations manage their exposure to financial risk, including via medical malpractice insurance. Recently, Healthcare Innovation Editor-in-Chief Mark Hagland interviewed Caroline Clouser to get her perspectives on the worrying trends around violence against healthcare workers. Below are excerpts from that interview.

We all know that there was a spike in violence against healthcare workers during the COVID-19 pandemic. What can you say overall about trends in that area?

Violence is happening more and more, unfortunately, now. We’ve been talking about it for a decade, and it really skyrocketed in 2022.

Did you also see a spike in 2020, during the worst months of the pandemic?

Yes, but the numbers really showed in 2022. There is an issue with unreported violence. One of the challenges in that regard is getting hospitals to engage in a zero-tolerance policy around violence.

What’s happening overall? How is the violence manifesting itself?

It’s between the patient and family members and the caregiver, or even employees among themselves. It can be patient against patient. It can be patient against a provider, or a family member against a provider. It can be employee versus employee. And it could be a security team handling a situation too roughly. And it also occurs family member against family member. Anxiety can bring out family issues.

But we’re seeing a significant increase?

Yes. 2022 saw a huge leap.

What do you tell leaders in patient care organizations about this worrying trend?

It really starts with a zero-tolerance policy and creating a culture where it will be identified early and managed. In 2018, Congress passed a workplace violence prevention in healthcare specifically. [In addition, on April 18 of this year, Sen. Tammy Baldwin (D-Wis.) and Rep. Joe Courtney (D-Conn.) this spring introduced a bill explicitly aimed at violence taking place in hospital facilities.] And in addition to any legislation that might be passed, at the facility level, you have to have the zero-tolerance policy embedded in the facility. There’s a whole host of things they have to do, all of which are costly and takeaway from the core patient care delivery mission, but are all necessary. Metal detectors, security—sometimes armed—at every doorway-hiring security professionals, holding drills. And how do they get out? How do they deescalate? How do they report? How do they identify aggressors, and then deescalate? There’s a lot we work on with our insureds at the c-suite level.

What have your conversations been like with c-suite executives?

There’s a high level of awareness among c-suite executives, along with, yes, a little bit of a “not-my-facility” denial. And it’s one of many, many priorities that they have, with very slender margins. So it’s added to a very long list of priorities. But they’re certainly made strides; the mentality of zero tolerance is being more widely adopted than a few years ago. I think nurses coming in no longer expect to be kicked or assaulted when they come in; people need to be held accountable. So it varies how c-suite-level executives are viewing this; but there are many priorities.

Do you offer a program with to-do lists? Ad hoc?

We sit down with the c-suite executives, loss control specialists and risk managers, whoever handles the risk, and begin the conversation with those individuals. And we’ll work with an outside consultant to fill in the areas needing attention. The outside consultant will come in and observe the facility. What do they have in place? Filling in the gaps, and then testing and measuring to make sure that people are fully on board. A three-prong approach; it’s not cookie-cutter in any way. And Chubb has a lot of resources. So we’ll work with outside security consultants. But we work closely with insureds and with outside security consultants.

How will all of this evolve forward over the next few years?

As our c-suite executives come out of COVID, and their margins get better, then they can invest. And no one wants to be the facility where an incident has occurred, no one wants that reputation. If they don’t feel safe in your facility, in many places, they can go elsewhere. So c-suite executives will start to invest more and more; and security, unfortunately, will just be an added layer. So there will be a great deal of investment and education in this area, and the consumer is going to see that added layer of security.

And that’s not a bad thing to see, right?

I can’t speak to the view of the average consumer walking in, but some will feel a level of confidence knowing they’re walking into a secure facility, such as with metal detectors. The downside is the cost: there’s a huge cost to managing this aspect of this. But this is the world we live in.

And you don’t want to be the site of a huge incident on the national news.

That’s pretty obvious, yes.

What advice would you like to leave with c-suite leaders industry-wide?

Working in concert with their insurance carrier that works on this, I would urge them to do a full assessment on their security processes. It’s not just about having a plan sitting on a shelf; it really is a living process. Everyone needs to be prepared in advance; everyone needs to know how to react, how to exit the building if necessary, how to stay safe. So it’s really about starting now. Find out where you are now, where your healthcare community is in understanding that and understanding your role, and building on that over time.