Grande Ronde Hospital’s rural location and the limits that come with it were big factors in its safety program planning.

Image courtesy of Grande Ronde Hospital

Workplace violence is a common threat to health care workers, who see four times more serious incidents compared with private industry, according to the Occupational Safety and Health Administration. The high rates of workplace violence create a significant challenge to hospital administrators tasked with creating safer environments for staff and patients.

To identify the best strategies for addressing workplace violence, the Oregon Association of Hospitals and Health Systems (OAHHS) created the Workplace Safety Initiative (WSI) Work Group in 2014. The work group included associations, agencies and hospitals across the state seeking to create and implement evidence-based workplace safety strategies. The group launched a pilot project among five Oregon hospitals. The hospitals’ experiences contributed to the creation of a toolkit that other facilities can access for their own security initiatives. 

Despite its small size and rural location, Grande Ronde Hospital is no stranger to workplace violence. Located in LaGrande, Ore., Grande Ronde is the only hospital in Union County, covering 2,038 square miles. This places considerable limits on how the hospital manages violent patients and visitors. Patients who lash out at staff often cannot be transferred to other facilities that may be better equipped for their situation. For example, many mentally ill individuals who are picked up by police are brought to Grande Ronde’s emergency department, as there are no dedicated behavioral health services available locally.

“We didn’t know what to do; we just knew we had a problem,” says Elaine LaRochelle, Grande Ronde Hospital’s director of facilities.

LaRochelle met with the local police chief as well as insurance consultants before learning about the OAHHS pilot project and joining the WSI Work Group. LaRochelle and other hospital leaders conducted a gap analysis, meeting with different facility staff to discuss workplace violence issues and potential solutions. Through the work group, the hospital determined a direction and ideas for improvements. After sharing strategies, participating hospitals later regrouped to discuss the success of the different techniques.

Grande Ronde identified its high-use clinics and hospital lobby as prime targets for security improvements. Previously, the lobby had been kept unlocked, giving visitors access to hallways that took them to other departments in the facility. As part of its security strategy, the hospital added doors to the hallways to limit access. More staff received badge access instead of keys, which allows security access to be turned off remotely if the badge is lost or stolen.

The hospital took a “containment approach” to addressing workplace violence, says LaRochelle. The addition of live video monitors helped discourage visitors from becoming belligerent. While the hospital will not refuse emergency room services, it has implemented a zero-tolerance policy for violence and will dismiss patients in other departments who refuse to cooperate. Unarmed security staff are now available to talk to patients and visitors at risk of violent behavior. This is often helpful with individuals with mental illness, as this can de-escalate a problem and leave nurses free to tend to patients with more urgent medical needs.

LaRochelle says that hospital staff are “much happier” since the changes have been made. Satisfaction has increased among personnel because they feel that their concerns have been acknowledged and their safety is a priority. “We have seen no decrease in incidents, but we deal with it better,” she says.

Because the pilot program involved hospitals of different sizes and locations, the resulting toolkit and its recommendations can be tailored for a wide variety of facilities. For other hospitals struggling to address workplace violence, “I would really recommend the toolkit, because it has a way to assess where you’re at, and with that assessment, you define your goals,” LaRochelle says.