COVID-19 and Healthcare Security: Challenges and Opportunities for Building Enduring Systems of Safety


A randomized controlled study on a violence prevention program in healthcare showed that proactive, unit-wide violence prevention strategies mitigate harmful incidents (Arnetz et al., 2017). At the organization level, stakeholders worked collaboratively to create a standardized process of data collection, interpretation, and dissemination. This data was used by unit supervisors and their teams to devise action plans to reduce violence in their unit. Team leaders also worked with a checklist of evidence-based violence prevention practices. Six months after the program began, the intervention resulted in significantly lower rates of violent incidents in units that implemented violence reduction strategies. Intervention units experienced violent incidents at less than half the rate of units in the control group (0.48 Incident Rate Ratio). These differences mostly dissipated by 12, 18, and 24 months after this start date. However, well-designed “booster” interventions could translate these gains into sustained success (Arnetz et al., 2017). Studies to date on the effectiveness of reinforcement measures have seen mixed results, and more research is needed to determine the best booster interventions for different workplace contexts. The Arnetz et al. (2017) study demonstrated the importance of a participatory process that fosters buy-in from stakeholders at all levels. Within a structured framework, the flexibility to adapt strategies to the conditions of a particular unit may produce better outcomes (Stephens, 2019).

Many other evidence-based violence prevention programs have been developed (Somani et al., 2021). Not all programs are made equally. The most effective ones utilize a holistic approach that focuses on building a culture of violence prevention and emphasizes de-escalation methods, while teaching physical techniques that minimize harm (Somani et al., 2021). Clinical and non-clinical staff should be taught to recognize warning signs of aggression and be trained to use physical tactics only when necessary (Sawyer, 2020). Leaders are recognizing that a cohesive workplace improves safety, security, quality of care, and productivity. A strong culture based on mutual trust and respect does not simply emerge. It can take years to develop, and it requires all levels of the organization to embrace these values. This change starts at the top, as executives and managers must model these values early and often (Somani et al., 2021). Proactive, group-based educational sessions are more likely to boost self-confidence, social support, and job satisfaction than reactionary “crisis-oriented” meetings (Findler et al., 2007). While some incidents are difficult to avoid, it is more effective to prevent the conditions that contribute to violence than to deal with the downstream events.

During the height of the pandemic, violence prevention trainings moved online. This adaptation, although necessary from an infection control perspective, may have lessened the effectiveness of these trainings. Interviews with security professionals revealed that online violence prevention training does not facilitate the same level of learning for physical safety skills and de-escalation techniques as in-person programs. Moving forward, healthcare organizations should decide how to implement safe training programs without sacrificing effectiveness. This could entail smaller in-person group sessions, immersive virtual reality (VR) experiences, and other innovations (University of Nottingham, 2021; Somani et al; Rizzo et al., 2021). VR systems have demonstrated value for workplace safety trainings. A University of Nottingham (2021) study found that participants trained using VR showed more long-term knowledge retention, greater levels of engagement, and a more positive attitude toward occupational safety than those trained using traditional PowerPoint presentations.