In the day to day of medicine, we're all pretty stoic. We work hard on behalf of the patient, many of us also innovating around care coordination, but we don't stop and think about our safety. I respect that ethos, but we all should be aware of this report in the New England Journal of Medicine.
James P. Phillips, M.D. reports workplace violence directed toward healthcare providers of all types. Of particular note is the very high rate in long term care -- both in skilled nursing facilities and home care.
As Dr. Phillips explains, "Employment in the home health sector carries particular risks. Because workers provide care in the client’s home, the environment is comparatively uncontrolled. Overall, 61% of home care workers report workplace violence annually. Unique concerns include the presence of weapons and drugs, family violence, robbery, and car theft. Homicide is the second leading cause of workplace death in this group, exceeded only by motor vehicle crashes.”
Those numbers are pretty astounding, and disturbing. When you combine these numbers with those about healthcare provider burnout, the picture for healthcare providers is pretty bleak.
The Bureau of Labor Statistics notes that health care workers are four times more likely to miss work as a result of violence than because of other injury, such as an injury at home. And perpetrators include anyone from former colleagues, to current or former patients, to unrelated individuals, to people with personal relationships to the providers.The statistics are sobering, but important:
- Acute Care: 46% of nurses reported work place violence in their past 5 shifts; one third physically assaulted.
- Long term care: 39% of aides in nursing home were assaulted weekly, 16% daily, 51% physically abused.
- 61% of home care workers reported violence yearly.
- From OSHA: While 20% of all workplace injuries happen to healthcare workers, 50% of all assaults in the workplace are to healthcare worker.
What can be done? OSHA has an exhaustive review of the problem and a set of checklists to assess safety. They also suggest training of in ways to handle aggression and defuse hostile situations.
Alternatively, what if a root cause of dissatisfaction could be addressed?
We believe that healthcare provider burnout, efficiency, satisfaction, and efficacy can all improve with collaborative care. Can collaborative care and healthcare collaboration save providers' lives?
It may be a stretch, but consider that an unhappy family and an unhappy patient can be expected to be more satisfied and thus less angry when their providers are coordinating with each other and communicating with them. Involved, connected patients and family become part of the solution rather than an addition took these problems. The logic and the hope is the diffused anger will result in more safety for all of us providers.
Having known three colleagues who were murdered, a respected teacher, a fellow resident, and an acquaintance, as well as having had a gun aimed at me, we are very aware of the risks.
We hope that our passion to make things better for the patients also make things better for everyone who cares for the patients. It's personal.
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