Becker’s Healthcare Podcast: In-Depth Conversation with Dr. Raj Chand, President at Inova Fair Oaks Hospital

Release Date: July 23, 2025

Introduction

In the latest episode of the Becker’s Healthcare Podcast, host Grace Lynn Keller engages in a profound discussion with Dr. Raj Chand, the President of Inova Fair Oaks Hospital. The conversation delves into Dr. Chand's extensive experience in healthcare leadership, with a particular focus on workplace culture, safety, and the pervasive issue of workplace violence in the healthcare sector.

Dr. Raj Chand's Journey in Healthcare Leadership

Dr. Raj Chand opens the conversation by sharing his multifaceted career path. With nearly two decades of clinical practice as an emergency medicine physician and over ten years in healthcare leadership, Dr. Chand embodies a blend of hands-on medical expertise and strategic executive experience.

"[...] I have been practicing clinically for almost two decades and have over a decade of experience in healthcare leadership." ([00:18])

He highlights a significant achievement of Inova Fair Oaks Hospital being recognized as a Leapfrog Top Hospital for five consecutive years, underscoring the institution's commitment to excellence.

The State of Inova Health System

Dr. Chand provides an overview of the Inova Health System, emphasizing its substantial scale and ongoing transformation.

"Inova Health System is located about 30 minutes west of Washington D.C. We are a five-hospital system with more than 1,800 licensed beds, over 300 ambulatory sites, $6.5 billion in revenue in 2024, and more than 25,000 team members." ([01:25])

Since 2018, under the leadership of Dr. Steven Jones, the system has embarked on a transformative journey aimed at enhancing healthcare delivery and organizational effectiveness.

Reframing Workplace Violence and Its Connection to Psychological Safety

A pivotal moment in Dr. Chand's career highlighted the normalization of workplace violence in healthcare. Reflecting on an incident from his residency:

"[...] we just went about our normal business. We just accepted this. That was part of what happens in healthcare." ([02:08])

This realization propelled his focus towards cultivating a culture that prioritizes psychological safety—a cornerstone for both patient and team member safety. Dr. Chand underscores the importance of an environment where team members feel safe to speak up without fear.

"Psychological safety is the foundation for both patient safety and team member safety." ([03:56])

He references Tim Clark's work on psychological safety, emphasizing principles like inclusion and safety at various levels of team engagement.

Current Scope of Workplace Violence in Healthcare

Dr. Chand paints a concerning picture of workplace violence in the healthcare industry:

"Healthcare is one of the industries that's most prone to workplace violence. I believe we have five times the rate of workplace violence compared to other industries, and 82% of nurses experience workplace violence at some time during their careers." ([05:25])

He identifies three key contributors to the rise in workplace violence:

1. Broader Societal Polarization
2. Exacerbation Due to the Pandemic
3. Increased Workforce Pressures: Including more complex patients, time constraints, and resource limitations.

Inova's Strategic Approach to Workplace Violence

Addressing workplace violence requires a comprehensive and strategic approach. Dr. Chand outlines Inova's multifaceted strategy, emphasizing the need for systemic solutions rather than isolated interventions.

Zero Harm Philosophy and Zero Tolerance Policy

Inova adopts a Zero Harm philosophy, rejecting the notion that workplace violence is an inevitable aspect of healthcare.

"We have a zero tolerance policy, setting clear boundaries for patients, families, and visitors." ([06:41])

This policy ensures that all stakeholders understand the unacceptability of violent behaviors, fostering a safer environment for both staff and patients.

Training and Education

Recognizing the critical role of training, Inova mandates annual sessions tailored to different roles within the organization.

"We have annual training... around recognition, de-escalation, response." ([06:41])

This proactive education equips team members with the skills to identify and manage potential violence scenarios effectively.

Engaging the Multidisciplinary Team

Transitioning beyond a nursing-centric approach, Inova integrates physicians and advanced practice providers into the violence prevention framework.

"We're moving beyond a nursing-only lens to include the entire multidisciplinary clinical team." ([06:41])

This inclusive strategy ensures a holistic approach to mitigating workplace violence across all departments.

Tactical Elements and Specific Tools Implemented by Inova

Dr. Chand elaborates on the specific tools and programs Inova has deployed to combat workplace violence, highlighting both common industry practices and unique initiatives.

Industry-Standard Tools

1. Broset Scale Integration: A standardized risk scoring system implemented within EPIC to assess the risk of workplace violence among patients.

   "We have the Broset Scale, which gives everyone visibility around the risk of workplace violence with a given patient." ([08:48])

2. Weapons Detection Technology: Installed at key entry points to enhance security measures.

3. Armed Officer Program: Provides a deterrent against potential violent incidents.

Inova-Specific Initiatives

1. Safe Teams Response System: A rapid response mechanism involving a multidisciplinary group that swiftly addresses potential violence situations.

   "Safe teams... bring a multidisciplinary group who comes to the room to determine the best course of action." ([08:48])

2. Workplace Violence Magnet Program: Utilizes yellow magnets placed on doors of high-risk patients to alert all staff, including non-clinical personnel, fostering a community-wide awareness and vigilance.

   "We saw about a 10% reduction in physical events since implementing the magnet program." ([08:48])

3. Administrative Discharge Policy: Allows for the removal of persistently violent patients, ensuring the safety and well-being of staff.

4. Support Programs: Including chaplaincy services, employee assistance programs, and the CARE Peer Support Program, which provides frontline team members with trained peers for emotional support post-incident.

   "CARE Peer Support... being present, listening without judgment with compassion." ([08:48])

These combined efforts form a robust framework that not only addresses violent incidents when they occur but also proactively works to prevent them.

Leadership Lessons Learned

Dr. Chand shares three pivotal leadership lessons gleaned from his experience addressing workplace violence:

1. Understanding Complex vs. Complicated Problems

   "Workplace violence is not complicated. It is complex... it requires a very different mindset." ([14:27])

   Recognizing the multifaceted nature of workplace violence necessitates adaptive management and continuous strategy refinement.

2. Systems Thinking and Ecosystem of Solutions

   "Investing in an ecosystem of solutions with multiple reinforcing interventions helps create sustainable change." ([14:27])

   A holistic approach ensures that various measures synergize to address the issue comprehensively.

3. Reframing Team Member Safety as Foundation of Patient Safety

   "Team member safety is the foundation of patient safety." ([14:27])

   Prioritizing the well-being of healthcare workers directly correlates with improved patient outcomes and overall healthcare quality.

Advice to Other Healthcare Leaders

Emphasizing the enduring nature of workplace violence, Dr. Chand advises:

"This has to be managed. It's not something that really goes away." ([16:39])

He advocates for persistent leadership focus, cultural integration of safety priorities, and the continuous adaptation of strategies to sustain changes and protect team members effectively.

Conclusion

Dr. Raj Chand's insights offer a comprehensive roadmap for healthcare institutions grappling with workplace violence. His strategic, multi-layered approach underscores the importance of cultural transformation, proactive prevention, and unwavering leadership commitment. For healthcare leaders seeking to enhance workplace safety, Dr. Chand's experiences at Inova Fair Oaks Hospital serve as a valuable guide.

Notable Quotes

• "Psychological safety is the foundation for both patient safety and team member safety." ([03:56])

• "Healthcare is one of the industries that's most prone to workplace violence. I believe we have five times the rate of workplace violence compared to other industries, and 82% of nurses experience workplace violence at some time during their careers." ([05:25])

• "Team member safety is the foundation of patient safety." ([14:27])

• "This has to be managed. It's not something that really goes away." ([16:39])

This episode of Becker’s Healthcare Podcast provides invaluable perspectives on fostering a safe and supportive environment in healthcare settings, emphasizing that the well-being of healthcare professionals is intrinsically linked to the quality of patient care.