Andrea Greco 00:00:00 Workplace violence is just not acceptable.

Keith Reynolds 00:00:15 Welcome to Off the Chart, a business and medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. I'm your host, Keith Reynolds, and this week we've got a conversation between medical economics assistant editor Austin Littrell and Andrea Greco, senior vice president of healthcare safety at workplace security firm CENTEGIX. They're talking about keeping practices safe and how failing to do so can impact patient care.

Austin Littrell 00:00:48 All right, Andrea Greco, thank you so much for joining me today. It's great to be here, Austin.

Andrea Greco 00:00:53 Thank you.

Austin Littrell 00:00:54 So this is a really important topic that of workplace safety especially in health care. So I wanted to talk about there was a stat from National Nurses United that over 80% of nurses experienced some type of workplace violence within the last year. Could you talk a little bit about what kind of effect this has, obviously on the nurses themselves, but on, you know, a broader scale on patient care?

Andrea Greco 00:01:16 Well, I think you're right.

Andrea Greco 00:01:17 If that first level of impact is to the employee themselves. And so there can be a degradation in employee satisfaction, employee engagement, which then translates to an impact on patient care and patient engagement and patient satisfaction. When the folks that are tasked with taking care of them and and those caregivers see that as their core mission, if they can't do that with focus, then that directly does impact those patients. They feel it and see it as well. And so we've seen literature across, the healthcare spectrum that say that patients feel less safe when employees feel less safe in the workplace as well. They can they can read that distraction, that comes from their employees as well. so the quality of care can be impacted. Also, just that feeling of satisfaction of that level of engagement as well. So there is a correlation there of those two entities working together. Right. The employees giving that care and those receiving it really need to be in sync with each other. And when there's not a safe environment or one that one of those areas feels threatened or those groups feel threatened, it impacts the other as well.

Austin Littrell 00:02:25 Yeah. No, absolutely. That makes a lot of sense. so next there was a McKinsey and company survey, that determined that for nurses in early middle stages of their careers, workplace safety was the most influential factor in deciding whether or not to leave their current role. so obviously, I mean, safety is important in staff retention, but could you talk a little bit about, you know, why that is, why that's so important to these health care workers? And what are some effective strategies that organizations or practice managers can implement, to kind of foster a culture of safety and well-being.

Andrea Greco 00:03:00 Well, I think that's why we're also seeing that impact of those younger workers or those that are entering the field, newly that there's a less of a tolerance for that acceptance of, well, this is part of my job or violence in the workplace is just part of what you sign up for. And so more and more, as leaders are getting behind creating a culture of safety and evangelizing that, that workforce tolerance is, is decreasing as well.

Andrea Greco 00:03:29 You're seeing either more folks leave because that's not being addressed or is being addressed more, more widespread as well. And there are there are several ways that folks put practices into a place to either increase retention, be more attractive during recruitment, as well as then impact employee satisfaction and patient satisfaction, like we talked a bit about before as well. So it's about doing a couple of things. One, making sure that you are listening to your employees. So ask right. Ask and surveys. Ask in one on ones, ask in huddles, write safety huddles, etc. things that happen both planned and unplanned conversations throughout the day, throughout the week, etc.. Different cadences, but really ask the question. Listen. Demonstrate that you're listening, but then also take action. And I think that's where people then feel the most comfortable of being heard, but then also supported. And that can then be displayed in a variety of different ways. One continuing the conversation, acknowledging that something needs to be addressed or tackled, and then also delivering on that.

Andrea Greco 00:04:35 And that can be tricky when it comes to safety in a workplace setting, because there is no silver bullet answer to how to provide the most safe environment. It happens in a layered approach. You need different things to make sure that you can protect people in different scenarios, in different places and when interacting with different people. So that's everything from very tangible support of cameras and weapon detection systems, from training to how to de-escalate a situation, and then solutions more like hours of how do you get help directly to where it's needed as quickly as possible as well. And so there's a variety of ways to hit all of those different levels. But but keeping or allowing a gap. And one of those areas, can be problematic as well and have people feel like they're not being listened to that their their concerns are not being addressed and then impact downstream areas like we talked about as well.

Austin Littrell 00:05:33 Sure. So when these situations do unfortunately occur, how can facilities better enable situational awareness for incident responders?

Andrea Greco 00:05:43 What I think again, what we focus on is the people.

Andrea Greco 00:05:47 Right. And getting help to folks. So if you don't know that there's a problem, you certainly can't address it. So that's the first step in situational awareness of knowing that there there is an issue. so allowing for a staff to duress solution, or a way that employees can ask for help, whether or not that is discreetly or not. That's the first step. Making sure that there are tools and or protocols and training in place to make sure that there is awareness of a situation happening. Also, it's important to make sure that staff feel like they are empowered and encouraged to utilize those tools to report. Every time, a situation comes up that they may need support, and instead of not reporting that, we find that up to over 80% of incidents that happen are not even reported. So you cannot create that situational awareness. You can't address a wide scale problem if you don't know or realize that it is a a widespread problem in and of itself. and then also making sure that folks then enact those protocols or processes that you put in place to make sure that as much information as possible is given during a time that help is needed as well.

Andrea Greco 00:07:00 So it really comes down to tool implementation, listening to your staff, but then also encouraging utilization of those tools. Again, supporting that and making sure that any follow up that's needed for improvement for, you know, action that needs to be taken after the fact is done. So that follow through is really important as well.

Keith Reynolds 00:07:23 Oh, you say you're a practice leader or administrator. We've got just the our sister site Physician's Practice. Com your one stop shop for all the expert tips and tricks that will get your practice really humming again. That's physicians practice.com.

Austin Littrell 00:07:42 You mentioned there that I think it was 80% of incidents aren't reported. could you talk about some of those barriers and really what is preventing that incident reporting?

Andrea Greco 00:07:53 Yeah, I think it's it's a couple of things. I think there are sometimes still a feeling within care settings That while there are tools in place, there's sometimes still discouragement of using those and bringing to light the the high frequency in which those situations, occur. and so that's an unfortunate kind of byproduct of lack of cohesive communication, right.

Andrea Greco 00:08:17 Or that support of a culture of safety that is deployed across an entire organization. And then I think there's still to be tackled. The whole the whole idea of workplace violence is just not acceptable. Right? So the need for zero tolerance, both from displayed to patients, their family members, other folks that may come into a care setting from then the top down within a healthcare organization of that is our policy. That is our stance. it needs to be enacted more widespread as well, in a genuine way, so that folks know that that is our true policy. That's what we're going to take action on, and that is what is in part there to protect me as well.

Austin Littrell 00:09:00 For those family members that may come in or just visitors in general. what are some steps that primary care practices could take to strengthen those visitor management protocols to reduce these safety risks?

Andrea Greco 00:09:13 Well, there's a couple of different things. Everything from simple signage. Right. So acknowledging we have a zero tolerance policy here within this facility.

Andrea Greco 00:09:21 And make sure that that signage is front and center, easy to read, but also very direct and to the point so that it conveys that message, to those visitors, you don't expect everyone that comes into your organization to know all your protocols, your policies, but that's a key one that is very important to display and have part of the conversation from the minute that they walk in the door and setting that expectation. We can do that through some other tangible ways, through positive visitor management protocols, everything from having reduced access, right. So one access point in and out, etc., so that you know and can control who's within the care setting and doing things like immediate background checks and and checking against go no go list, right? So unfortunately, there are likely locations within an organization where they know that there are certain members of the public that they don't want to allow into their facility for one reason or the other. So we can check against those kinds of lists if they are being compiled, but also against a national background check that we can conduct as well, to make sure that there are safe or law abiding citizens, right, that are coming into your organization as well.

Andrea Greco 00:10:34 So even just having those practices in place is a demonstration of how important it is to create a culture of safety, right? By knowing who is in your building and also preventing those that shouldn't be or can't be in the building, that they're not allowed access as well.

Austin Littrell 00:10:51 And just on a broader scale, health care is constantly changing with things, you know, staffing shortages, whether it be kind of patient distrust or agitation. just looking forward for healthcare leaders, practice managers, what are some things that they should prioritize to ensure that workplace, the workplace is safe really just moving forward.

Andrea Greco 00:11:13 Well I think it comes down to a couple of key things in. The first one is making sure that that that culture of safety is a priority for the organization and making that known to both those that operate within the organization and those that come into a care setting as well. So that's first and foremost, if you have to make it a priority and then communicate that priority, and you can do that through investment and tools.

Andrea Greco 00:11:37 The signage that we were talking about around a zero tolerance policy and those kinds of things. So it's really about, addressing an issue, acknowledging it, communicating around it effectively, and then really upholding, the policies that you've established and communicating, those things as well, that will create trust and credibility both from internal employees as well as external. You can can train and set the right expectations for those that come into your facilities. And if you do that on a consistent basis, they will adopt that behavior. Right. And those policies that you've enacted. And so it's really around that listening, taking action and enforcing and following up.

Austin Littrell 00:12:20 Right. Well that's all the questions that I have for you. Is there anything that I didn't ask you that you think is important for practice managers or, or primary care physicians to keep in mind?

Andrea Greco 00:12:31 I really think it's just around putting the people first, right? We we ask so much of our caregivers, and many of them have that just caring, personality or character about them anyway.

Andrea Greco 00:12:43 Right. That's why they've walked into these chosen professions. But again, just supporting them and everything they do, being transparent, communicate clearly and again, follow up with action to support them, within the care settings so that their satisfaction, their engagement remains high so that they can do the same and create that environment for their patients as well. That's why they're all there is to provide a safe, caring and healing environment for folks. And really that starts by providing a care, a culture of safety for all of them to operate within.

Austin Littrell 00:13:17 All right. Well, thank you so much again for joining me. This is a really important topic, and I'm glad that we could talk a little bit about it.

Andrea Greco 00:13:23 Yeah. Thank you.

Keith Reynolds 00:13:36 Again, that was medical economics assistant editor Austin Littrell and Andrea Greco, senior vice president of health care safety at workplace security firm CENTEGIX. My name is Keith Reynolds, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening and ask that you please subscribe to the show on Apple Podcasts and Spotify.

Keith Reynolds 00:13:56 Also, if you'd like the best stories, medical Economics and Physicians practice published, delivered straight to your email six days a week. Subscribe to our newsletters at Medical Economics. Com and Physicians Practice. Com. Oh, and one more thing. Be sure to check out Medical Economics Pulse, a quick hitting news podcast that offers concise updates on the most important developments affecting your practice, your bottom line, and the broader health care landscape delivered by the editorial team at Medical Economics. Off the charts A Business of Medicine podcast is executive produced by Chris Mazzolini and produced by Keith Reynolds and Austin Littrell. Medical economics, Physicians Practice, and Patient Care Online are all members of the MJC life sciences family.

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