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- [00:01]
A
Welcome to Advancing Health. Coming up. In today's podcast, we hear how SSM Health is taking a whole team approach to combat workplace violence. And it's working.
- [00:17]
B
Hi everyone, my name is Jordan Steiger. I am a senior program manager on the clinical affairs and workforce team at the American Hospital Association. I am joined today by Todd Miller, who is the Vice President of security, and Amy Wilson, who is the Chief Nurse Executive at SS Health, to talk about how they're making their hospital safer for everyone, including patients, their families and the healthcare workforce. So to get us started, I'd love for all of our listeners to learn a little bit more about SSM Health and also about the roles that you're playing within your organization. So, Amy, why don't we start with you?
- [00:51]
C
So thank you, Jordan, and thank you for having us here today to talk about this really important topic. SSM Health is a fully integrated healthcare network located in the Midwest. We're across four states. We have 23 acute care facilities, a post acute network, and approximately 500ambulatory care site settings across those states. My role at SSM Health is chief nurse executive and also I am responsible for our clinical workforce and.
- [01:20]
D
Hi, Jordan. I'll introduce myself. Todd Miller, VP of Security with ssm. Obviously my role is really just overseeing the physical security program, security, technology, as well as just all the programmatic elements that make up our department system wide.
- [01:35]
B
That's great. So two really important perspectives here. I mean, somebody overseeing the clinical workforce and especially that nursing perspective and then also the security perspective. And one thing as I was learning a little bit more about the work that you all do at SSM Health that I was just so impressed by is the way that you bring every single person in your workforce together to tackle the issue of workplace violence. Because I think we all know on this call that it can't be just one person or one group. It can't just be security or nursing or administrators working on this. It has to be everyone together.
- [02:08]
C
Absolutely, Jordan. And I would tell you, I think that is the magic at SSM Health is the fact that we have taken a fully integrated approach to thinking about safety, security and workplace violence prevention in many organizations and in organizations I've been in in the past, this has really been the role of security or the role of facilities. And we don't actually have perspective at SSM Health. And I think that is the reason, the number one reason actually for why you're seeing some of our successful results is because we really think about the whole team, what the role is of that team and how they interact together. And one of the things that I'm most proud of, especially as we think about the clinical work team, is that our clinical work team believes that our security team is an integral part of that team and helps us take great care of our patients and our families and our communities every single day.
- [03:01]
D
I'm going to add on to that, Amy. When Amy joined the organization, within two weeks or so, I said, amy, I would love some time to sit down and go over the security program. If you remember, we met and it was awesome to see an executive at her level engaged in what is security doing? How are you supporting our clinical staff? And probably the most important sentence that really rung with me was, how can I support you and your team? And again, it was just that comforting feeling that there was understanding about what we do, there was understanding we are part of the patient care team to some degree. And then again, that high level of support from the top down in the programs, what we're doing in that ultimate goal of lowering workplace violence, right from the start, it was a good, strong relationship reinforced at the highest level, which we appreciated.
- [03:55]
B
That's great. That leadership buy in piece is so, so important, as I think all of us know. Let's take a step back even, because I'm hearing that there's this commitment across the organization to lowering the incidence of workplace violence. And I don't think we need to explain to anybody on this podcast that healthcare workers are far more likely at this point to experience violence than the everyman. Right. And that trend seems to be increasing. That's not what we want to be seeing. So what were you seeing within your organization at SSM Health that led you to start developing some of these programs and getting that leadership buy in for it.
- [04:31]
D
When I first joined SSM, which is actually 10 years ago, I remember when there was a workplace violence incident. Let's just say a nurse got assaulted. It was a big deal. It still is a big deal. But I would say it was more of a rare occurrence that got a lot of focus and even within my first year, I was starting to notice that. So again, around 2015, you started to notice more incidents, higher volume. And the sentiment just from the nursing staff was something was changing. Whether it was at huddles or just informal conversations, something was changing. And then you started to hear about it nationally and the trend kept growing and growing. And then my peers in healthcare security industry, there was that conversation happening in forums through our trade organizations where something was changing. It was about, I would say, 2017, 20, 18, when really the focus started to grow and grow and grow to say we have to be more proactive and not as reactive. So what are we doing to get ahead of that curve of just the assault in general? How are we looking at our data? How are we communicating with our nursing staff? That was really, for me, the start of it was around then. And I can probably speak for a lot of my healthcare security peers. That's about the point where the curve started going up almost exponentially, where we knew there was an epidemic across the US and then globally as well, as far as healthcare workers.
- [05:58]
C
Yeah. And I would add to that, Jordan. I wasn't here during that time, but I would say that my frame of reference around the timeframe is similar. About that same time, I was in a different organization, rounding in the ED one day, and one of my most strong charge nurses was visibly upset about something. I was surprised to see this. Pulled him off to the side, said, hey, tell me about what's going on. Seems like it might be a rough day. And it wasn't one thing that had happened that day. It was really the weight of the world on his shoulders with him saying, amy, something's different than it used to be. We used to have all of our patients and families come into our emergency rooms, and no matter who they were or what they might have been involved in outside the walls of the hospital, once they walked over that threshold, there was this respect for the fact that the doctors and the nurses are caring for them in a very important time, in a very vulnerable time. And there was just total respect. And he said, we're seeing that change, and we're seeing people come in and demand things or verbally escalate or be disrespectful. And it's really hard to see. And then I think if you fast forward to what we all experienced in the pandemic, we start to see this happening across the society. And unfortunately for us and healthcare, what's happening outside the walls of all of our facilities and our ambulatory care settings, as well as our hospitals and acute care settings, is being brought across the threshold now into that. And so all of the turmoil that we feel as a society, all of the kind of polarization that we feel, the lack of empathy and understanding other people's perspectives and just a little bit of respect each other and humanity now gets brought into the facilities, into our hospitals, our healthcare settings, and now we are dealing with all of that burden at a very vulnerable time in people's lives. Because in healthcare, we're dealing with everything from birth to death and everything in between. It's one of the most stressful times people ever have in their life. And so you couple that with what's been happening in our society and we just see this escalating violence on the inside of our walls too. And so as leaders, we would be amiss if we did not address that differently than we thought about this a few years ago.
- [08:24]
D
I'll tack onto that, Amy. A common thread that we've noticed in our healthcare security teams is the external risk has now been brought internal and that's the chain. It used to be a sacred space and we're losing that. Churches, schools, hospitals, there's a change and unfortunately we've had to adapt to that.
- [08:44]
B
It does seem like those places that seemed untouchable. Now we are seeing more violence and it's not a trend that we certainly want to see. We know that it's affecting the well being of our healthcare workforce, our patients, our families. This is something that's not beneficial to anybody. Right. So I'm hearing from both of you as you're starting to talk about what you're doing at SSM Health, that there isn't just one solution or set of activities that you can just implement and everything's going to be fine. It seems like you are using a lot of just layered approaches, lots of different things. You know, it's not just physical security, it's not just de escalation training, it's thinking about this problem holistically. So could you tell us a little bit about some of the activities you have that are helping your team members and your patients and families stay safe?
- [09:33]
C
One of the most important things we're doing around thinking about the entire team and thinking about security as part of a team member is team training. So those teams are trained together, they practice together, they're in simulation together, and they are simulating real live events so that when something happens, not if something happens, but when it happens, that they know how to respond together as a team. And we've invested a lot of time and resources into finding the right tools to train with the right settings to train with and providing the time and the space for training. And I think that has been instrumental in part of our success. We have a really wonderful partner right now in our de escalation training and we are seeing results that I've never seen before with our care teams and our security teams telling us that they feel 93% more capable of dealing with the violent situation than they have ever felt before. And I think those results are astronomical. And we're doing that by not just thinking about de escalation training, which has been kind of the historical view of the world in the healthcare setting. It's what happens when de escalation doesn't work. How do you stay safe? What do you do? What happens if this escalates to physical violence and actually talking about protecting themselves and their team members and keeping themselves safe and also integrating into that this concept of trauma informed care. So the trauma that the person who is escalating might be experiencing and if you're thinking about that, what could be happening and also your own trauma in the situation and thinking about how that is impacting your reaction to the situation. And so that as well as a concept called HeartMath is also an integral part and is really about self regulation in order to be able to hopefully de escalate, but then also acknowledging that every situation will not be de escalated and could turn into a violent situation. And what do you actually do if it, if it does become violent? And I think for a long time we've been afraid as clinicians to have that conversation. You know, we always thought that we had a magic wand and we were going to de escalate everything and everyone and everybody was going to be okay. And we now know that that may not happen and in some circumst it will not happen. And so we train for when that happens. What do you do as well? And what we're hearing from our team members is that makes them feel safer and well equipped when the situation happens.
- [12:15]
D
If we back up even to before we chose that the partner we have for our de escalation program, really evaluating what was of value in the de escalation programs and for us even how it's delivered, to me was one of the more important aspects of that vetting process for all these de escalation programs. They all have value. They're in there, you know, apples, the gala apples, they're. They're similar enough, right? And I think when we were looking at that and saying, well, our old program that we were using really focused more on the intensity model. The idea that on January 1st you have an eight hour training, congratulations, you know how to de escalate somebody great. And then the incident happens on December 31, are you going to remember those physical intervention skills? Are you going to remember all those verbal de escalation skills? Maybe that's not realistic. And saying, okay, so what are we going to do to change? And moving more towards that consistency Model of more training, smaller increments, more touch bases throughout the year. And even just that change to me is showing value because people are remembering it instead of having to sit there and go what did I do? And we all know in a time of panic, in a time of crisis, actually dealing with somebody in crisis, you're kind of reverting back to fight, flight or freeze. And sometimes the thing left out of the critical thinking, especially when dealing with our patients. So that to me was a big advantage in how we were moving forward with the program we have now and really how we're delivering that education to be retained.
- [13:46]
B
So many things that you both just said resonate. I think this move of the month or you know, remember this verbal de escalation tactic, you know, that repetitive kind of education I think is so important. You know, I'm a social worker by background, I've worked in the hospital and I can say that that would have been very helpful to know and you know, to train with the interdisciplinary team because that's how you're responding to incidents when they happen. It's not just the nurses that are responding or just the social workers, it's everybody coming together and you have to know how to work together. So I think these are practices that I think a lot of different organizations could try to implement.
- [14:22]
C
And Jordan, you referenced earlier kind of our multi prong approach. But then if you even start to peel back the layers of the onion more, you start to see in our system many other things that we're doing. And I think Todd's approach to physical security of our buildings and what that looks like has been instrumental.
- [14:42]
D
Yeah, when you start and you look at just historically and again base like foundational level, no pun intended, but the construction of our buildings and how they were built. Our hospitals are built for convenience, not security. We want to make sure the non ambulatory patients park close walk directly in. So if you look and this isn't just an SSM issue, this is across the United States, even globally. That's how we were building and designing our hospitals, which made sense at the time. We're all now dealing with what we call sins of the architectural past and saying, well now we have these open environments, these open campuses, numerous ingress points, how do we site harden these now while still making it convenient? What are we doing to re look at how we're designing and re evaluating how we are having people come into our buildings. And that has been one of the hardest challenges. Just from a physical security perspective. If you think about even how A bank is designed, and you walk into any bank across the United States, there's certain standards you see immediately. The desk height, the glass, how they talk to you, the way the doors and entrances are designed. Those standards have been in place for decades and decades, if not a century or more. Now hospitals are having to think the same way and saying, how are we designing our buildings? Or if we do a renovation, how are we incorporating what kind of a nerdy security term? Crime prevention through environmental design? How are we designing our facilities to reduce crime without even doing anything other than just how it's built and how that can lower the risk for violence? Because it does. Now we're looking at, we're going to redesign it. And when that person enters in, what is the process now that we're going to employ to keep our staff safe? And we know through our trade organization, International association of Security and Safety, there are guidelines and standards. So when they say visitor management, weapons detection is now a standard to hold ourselves to, that's a big change from where it was 10 years ago, 15 years ago. And so now we're having to rethink about how our patients and visitors are coming in, even our staff. How are they entering the building? And what are those security controls that can make our staff safer? I will say, when we started doing these renovations and redesigning some of our entrances, especially in the high risk departments and with our emergency departments especially, it's staggering what we've turned up. And let's just be honest about it. Anybody that employs weapons detection, there's kind of a shock that happens. We say, oh my God, look at all the things that we're preventing coming in. And it doesn't have to go straight to firearms or knives. It can be a screwdriver, it can be a can of mace, you name it. Anything that can be used as a weapon against our staff. So some of those successes have been game changing for us as an organization. And again, in all transparency, we're not done.
- [17:34]
B
Absolutely. And Todd, I won't be totally surprised if you get some outreach after this podcast because you both just shared some incredible advice and insight. Thank you both so much for being here with us today. We really appreciate you sharing the work that you're doing and we look forward to hearing about more of your success.
- [17:53]
A
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.