Health Care System Using Evidence-Based Program to Help Prevent Workplace Violence Situations

“Workplace violence is a workplace hazard and should not be accepted,” said Jamin Homan, Registered Nurse and Director, Patient Safety Officer at ThedaCare.

Homan’s comments capture the essence of why ThedaCare has strengthened its efforts to help curb the likelihood of violence on its campuses. Homan is one of the experts leading the movement to reduce and prevent incidents of violence at ThedaCare.

According to the Occupational Safety and Health Administration (OSHA), workplace violence (WPV) is a recognized hazard in the health care industry. WPV is defined as an act or threat of physical violence, harassment, intimidation or other threatening disruptive behavior that occurs at the work site.

WPV ranges from threats and verbal abuse to physical assaults and even homicide. In 2010, Bureau of Labor Statistics (BLS) data showed health care and social assistance workers were the victims of approximately 11,370 assaults by persons – a greater than 13% increase over the number of such assaults reported in 2009. Almost 19% (i.e., 2,130) of these assaults occurred in nursing and residential care facilities alone. More incidents likely are unreported.

De-escalation is Key

In October 2024, ThedaCare began a stronger push to train team members in de-escalation techniques. At ThedaCare Regional Medical Center-Neenah nearly 100 clinical and security team members have since undergone training as part of the ThedaCare Workplace Violence Prevention program, Homan said. Once trained, individuals become part of the Behavioral Emergency Response Team (BERT).

“Because we are dedicated to the safety of our patients and their families, visitors and, of course, our team members, creating this program was a top priority,” Homan said. “With support and empowerment from our hospital leadership, we adopted a framework to address patients when they become agitated. For example, furrowing their brows, staring our team members down and getting in their personal space. We wanted our team members to be more assertive at that point to address that agitation.”

Homan noted that in recent years, caregivers have been increasingly desensitized to agitation and aggressiveness from patients.

“Caregivers are often focused on providing patients the best care possible, even during instances where a patient is growing increasingly agitated,” Homan said. “If we do not de-escalate that agitation, we know at that point it’s like a tinderbox. We want to do everything we can to support the patient and help prevent an incident of violence.”

BERT team members are better equipped to handle aggressive, agitated patients and family members, visitors and others, Homan said. They train under the following guiding principles:

• At ThedaCare, WPV is a workplace hazard. It is not acceptable for health care workers to be assaulted, threatened, harassed or intimidated by patients, visitors or other ThedaCare team members.
• Our goal is to reduce WPV events by better anticipating potential events, preparing our team members in reacting to events and creating partnerships between clinical team members, security and local law enforcement.

The evidence-based framework and program were first implemented at ThedaCare Regional Medical Center-Neenah. Trained team members include experts from Safety and Security, Patient Safety, Employee Health, Nursing and Psychiatry.

Clear Need

“Around the time of COVID-19, it just seemed the prevalence of workplace violence started to rise, particularly for those of us in health care,” Homan said. “Add to that the increased number of patients living in our communities with cognitive and neurologic conditions such as stroke, dementia and Alzheimer’s disease that can impact decision-making, and it was evident the challenge many of our team members face in their day-to-day vocation.”

This group of patients is the largest subset of people who become violent toward caregivers, Homan said.

“We empathize with these patients,” he said. “They may act this way toward us because within their homes they are oriented to their surroundings and familiar with those who care for them. Then, they are brought into a hospital setting and they can become easily confused. So, when someone new to them begins providing care to them, they may get scared, increasingly confused and consequently, lash out violently.”

These increasing incidents of workplace violence are why Homan and a team of safety experts collaborated to create the BERT program to help team members identify situations that have the potential to escalate to violence. The program gives them tools to help de-escalate such situations.

“The framework includes scenario-based training,” Homan said. “We present different scenarios in a mock-up of a patient room to our clinical team members after they’ve received training to see how they react. It’s eye-opening to see the learnings. Once participants are finished with that, they feel much more confident and empowered in de-escalating patients. They’re applying the education.”

ThedaCare is sharing its Workplace Violence Prevention framework and program with safety experts statewide. Homan and Kevin Verdine, Security Supervisor at ThedaCare, presented the program during a Wisconsin Hospital Association meeting in August. The presentation highlighted ThedaCare’s industry leadership in preventing workplace violence.

ThedaCare is leading the effort at the local level, too. Homan continues to present to local aspiring medical professionals, further spotlighting the organization’s leadership in curbing workplace violence.

Homan said plans to train team members at other ThedaCare sites are evolving.

 “The Workplace Violence Task Force is determining future rollouts of the program,” he said. “Workplace Violence Prevention preparedness and training is a collaboration. It’s different disciplines coming together to say we all agree we that we need to make sure our team members are better prepared to handle these potentially violent situations. And it’s showing great outcomes.”

That includes positive support for system recruitment and retention, for example.

“It’s truly taking care of our caregivers and making sure that we promote a healthy work environment to enable longevity on our teams,” Homan said. “That comes when caregivers  feel safe at work and understand how to safely and properly de-escalate situations that have the potential for violence.”

About ThedaCare

For more than 115 years, ThedaCare® has been improving the health and well-being of the communities it serves in northeast and central Wisconsin. The organization delivers care to more than 650,000 residents in 17 counties, and employs approximately 7,000 providers and team members at 180 points of care, including nine hospitals. As an organization committed to being a leader in Population Health, team members are dedicated to empowering people to live their unique, best lives. ThedaCare is a not-for-profit health system with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs, as well as primary care. ThedaCare also partners with communities to understand needs, find solutions together, and encourage health awareness and action. In 2024, ThedaCare and Froedtert Health combined to form one system to strengthen local health care and provide high-quality services for treatment and prevention in a coordinated manner.