Unfortunately, scenes of violence marked by individuals acting out in dramatic fashion have become a fixture of the daily news cycle, too often taking place in a hospital, medical office building or other care centers. Clinicians and healthcare executives carry the responsibility of initiating actions to minimize and mitigate the risk of these events at their facilities.

These events invariably cause leadership of organizations to review current security measures in place and explore what adjustments can be made while being economically responsible. All too often, initial reaction might be to contract with a security firm or hire a consultant to first conduct an assessment and then provide an action plan with targeted recommendations.

This paper will identify strategies and tools for managing security risks with minimal cost by promoting the utilization of readily available resources which in many cases are available at no cost.

These programs have the potential to dramatically improve your organization’s risk awareness, underlying factors of volatile incidents and provide practical solutions to dramatically improve your organization’s security management program.

Developing communication.

It comes as no surprise that many incidents of violence in the healthcare setting come from a disgruntled patient or family member lashing out following a deeply traumatic event. Many of these individuals involved had no previous history of violence or threatening behavior. There are an endless number of reasons an individual chooses to take radical and violent action against a healthcare employee, but the majority stem from incidents involving an agitated patient or family member. In many cases, actions follow an initial frustration of being ignored, disrespected or marginalized by a staff member.

Tools are often available within organizations to assist staff with these moments. Many organizations have active ongoing educational programs on “Disclosure” (Communicating an adverse outcome to patients and family members), “Managing the agitated patient,” “Communication repair with the patient” and numerous other educational programs focused on providing the clinician with communication skills to manage an agitated disgruntled patient. These programs are not promoted as “security” training, but effectively deliver the elements of a comprehensive training program for identifying escalating situations and implementing communication tools to de-escalate these situations. Leaders should carefully consider these programs for all staff, not solely clinicians, especially as frustrations over changes and complications in the healthcare system continue to mount.

Quality resources at no cost.

Appointing responsibility to an individual or committee is a practical place to start. As a first step, reference the OSHA document, “Guidelines for Preventing workplace violence for healthcare workers,” which can be accessed at https://www.osha.gov/publications/osha3148.pdf. These guidelines provide excellent information for structuring a security management program for healthcare workers.

The next potentially expensive element is staff training. Again, hiring a consultant or security firm may provide a desired result but require significant costs. A less expensive alternative that in no way compromises quality is NIOSH’s training program for healthcare workers. This is an excellent free resource consisting of 13 video units each running 15 minutes (CEs are available). The program can be accessed at http://www.cdc.gov/niosh/topics/violence/Training_nurses.html.

As your program develops and you begin to focus on specific risks, you’ll eventually address “the active shooter.” Active shooter procedures are often referred to as “Code Silver” in acute care organizations. An excellent tool for assessing your organization and developing a process to respond and train staff is available by the State of California at no cost. This detailed document is available at: Hospital Code Silver Activation – Active Shooter Planning Checklist. Your designated individual or committee will be able to easily extract the program components pertinent to your care setting and tailor the plan to your facility.

Other resources.

Exploring the safety resource recommendations listed above should provide ample material for establishing a comprehensive program. There is no cost to the organization other than the time staff dedicates to the project. We look forward to providing you with more details on specific safety components as your programs develop.


The information contained herein is offered as insurance industry guidance and provided as an overview of current market risks and available coverages and is intended for discussion purposes only. This publication is not intended to offer legal advice or client-specific risk management advice. Any description of insurance coverages is not meant to interpret specific coverages that your company may already have in place or that may be generally available. General insurance descriptions contained herein do not include complete insurance policy definitions, terms, and/ or conditions, and should not be relied on for coverage interpretation. Actual insurance policies must always be consulted for full coverage details and analysis.

Insurance brokerage and related services to be provided by Arthur J. Gallagher Risk Management Services, Inc. (License No. 0D69293) and/or its affiliate Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. (License No. 0726293).


About the Author

John K. Walpole, Area Senior Vice President with Gallagher’s Healthcare Practice, has 20 years of experience focused exclusively on the provision of risk management services to the healthcare industry. John has been recognized for his expertise in integrating the risk management function into a healthcare organization’s clinical and operational processes. He has worked closely with the American Hospital Association and The Joint Commission in standards development and compliance. John developed and implemented a broad range of risk management products and services ranging from clinical and operational consultations to educational programs/seminars to publishing. In addition to providing consultations to healthcare organizations around the country, John has served as faculty on numerous ASHRM, AHA, JCAHO and ASHE sponsored events.

John is currently responsible for oversight of all client risk programs. These services include (but are not limited to) clinical consultations, operational consultation, accreditation support and mock surveys, regulatory compliance, seminars and conferences, carrier relations and the overall management of the myriad of healthcare risk exposures.