Physician Safety and Protection in the Outpatient Setting

Physicians are experiencing a growing incidence of workplace violence in the outpatient office setting. Workplace violence can take on many forms such as emotional, mental, verbal and physical harassment or abuse. This can even extend online in the form of cyber bullying and stalking. According to the Occupational Safety and Health Administration (OSHA), approximately 75 percent of nearly 25,000 annual assaults occurred in the healthcare/social service arena. In addition, workers in healthcare settings were four times more likely to be victims than workers in other industries.

We are generally silent on this issue and underreport violence because we subconsciously accept it as a part of the job. Patients who exhibit violence or abusive nature may have physical injury or mental incapacity that affects their ability to appropriately control their behavior, which can lead us to excuse an outburst because we are empathetic to their vulnerable situation. However, with the dramatic changes in medicine that include longer wait times, less quality time with the patient, higher co-pays and deductibles, shrinking pharmacy formularies and endless bureaucracy, the environment is ripe for increased and sometimes misplaced anger against the healthcare community. Keeping yourself and your office protected from violent situations will allow you to continue to serve patients in a safe environment. Remember, most patients are very grateful for the care they receive.

Below are a few tips that can help keep everyone safe:

1) Anticipation – One of the best ways to avoid a negative situation is to be aware it could occur. Teaching your staff to identify situations that could lead to a patient breakdown should be a priority. For example, communication between patient care staff and reception staff can keep waiting patients updated. Usually, if the patient’s long waiting time is acknowledged by staff with a polite apology and explanation, anger can be diffused.

2.) De-escalation Techniques – Likewise, de-escalation protocols can be used for specific patient encounters. For example, using a combination of verbal and non-verbal techniques to build rapport with an agitated patient can do wonders for all parties involved. Taking the time for active listening, reflective language and creating a calm environment usually do the trick. Also, having a patient support representative or office manager on site can help bridge the situation to an amicable agreement and allow the physician to keep on track with patient care.

3.) Environmental Design – Patient care layout is key. First, empower your reception staff as the gatekeepers to the patient care area. There should be a physical distinction between the waiting area and the path towards patient rooms, preferably a locked door that can be operated electronically via office ID tag or remotely via button. Patients or visitors should only be allowed to enter the patient care area under direct supervision of office staff. 

4.) Video Surveillance Systems – Another idea is to consider an external and internal continuous video surveillance system. Important areas to monitor are reception desks, nurses’ stations, common patient thoroughfares and all entrances/exits to the building. Of course, abide by states laws regarding audio/video surveillance in patient settings, such as no surveillance in sensitive areas where undressing occurs and posting notification signs in public areas notifying visitors that video surveillance is occurring.

5.) Emergency Alert Plans – A variety of situational awareness alert systems can be established for both physician and staff. Set up a non-threatening code word or hand signal that only your staff knows that can be used to signal for help in the presence of an unstable situation. For example, asking staff to call for “Dr. Grey” can be a code for “privately call 911.” If financially viable, carrying a wireless panic button or having one installed in each patient care room would also be effective. It is also important to have a medical staff member assist as a patient chaperone and witness, however a code word or panic button can serve as an alternative in an emergency situation.

6.) Situational Awareness of Weapons – The reality is weapons can enter the office setting both legally and illegally. Having a weapons policy posted at the patient entrance should be strongly considered and consistent with state law to protect yourself, your staff and your patients. The other reality is the possibility of an armed intruder or active shooter. Every medical setting needs to be prepared and alert. At minimum, an emergency plan and establishing a relationship with the local police department is a must.

7.) Practice Drills – With on-site staff, help keep everyone informed and prepared if the worst-case scenario were to unfold. Professional trainers are also available to serve as mentors to combat these unique but increasingly common situations. The recent Workplace Violence Prevention for Health Care and Social Service Workers Act is a step in the right direction but more work is yet to be done for physicians in the outpatient setting.

For more information and guidance regarding the security of your office, please reach out to your MagMutual risk consultant. The following links to additional resources are also available:

• Workplace Violence and Active Shooter Response
• OSHA Safety and Health Topics: Workplace Violence
• CDC Workplace Safety & Health Topics: Occupational Violence
• WHO Framework Guidelines for Addressing Workplace Violence in the Health Sector