Latest / Becker’s Healthcare Podcast / Advancing Workplace Violence Prevention Through Research and Leadership with Dr. Christian Burchill

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Advancing Workplace Violence Prevention Through Research and Leadership with Dr. Christian Burchill · Becker’s Healthcare Podcast

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  - Hello everyone and welcome to the Becker's Healthcare
• 1:02
  - Clinical Leadership podcast. I'm Mackenzie Bean, assistant vice
• 1:06
  - president and managing editor of Becker's Hospital Review.
• 1:10
  - Today I am so thrilled to be joined
• 1:12
  - by Doctor. Christian Virgil who is associate chief
• 1:15
  - nursing officer for research evidence based practice and
• 1:18
  - innovation at Penn Medicine.
• 1:20
  - He also serves as director of nursing research
• 1:23
  - and evidence based practice at Penn Medicine Lancaster
• 1:27
  - General Hospital.
• 1:29
  - Doctor Virgil has spent over a decade researching
• 1:32
  - workplace violence prevention and emergency care, and this
• 1:35
  - September he'll be inducted
• 1:37
  - as a fellow into the Emergency
• 1:39
  - Nurses Association's
• 1:40
  - Academy of Emergency Nursing,
• 1:43
  - one of just two twenty nurses recognized this
• 1:45
  - way out of the association's
• 1:48
  - 45,000 members nationwide.
• 1:50
  - Quite an impressive accomplishment. So, Chris, thank you
• 1:53
  - so much for joining us today. And first
• 1:55
  - off, congratulations.
• 1:56
  - Well, Mackenzie, thank you so much. I really
• 1:58
  - appreciate
• 1:59
  - the time to talk to you and to
• 2:01
  - your listeners, of course. Yeah. It means so
• 2:04
  - much to us that you're here.
• 2:06
  - And I wanna start off maybe talking a
• 2:08
  - little bit more about
• 2:09
  - your
• 2:10
  - journey
• 2:11
  - in research. As I understand it,
• 2:14
  - you know, you
• 2:16
  - really had a significant and scary personal
• 2:19
  - research while working as a a a nurse
• 2:21
  - on a a night shift in Philadelphia.
• 2:24
  - Can you talk more about how that moment
• 2:27
  - redirected
• 2:28
  - your research career and focus?
• 2:30
  - Right. So I'm gonna back up even further,
• 2:33
  - to be honest with you, and tell you
• 2:35
  - that,
• 2:37
  - when I was looking into
• 2:39
  - grad school,
• 2:41
  - after working probably three or four years as
• 2:44
  - a clinical nurse,
• 2:45
  - at the bedside and then, you know, you're
• 2:47
  - sort of your average medical surgical unit,
• 2:51
  - I really thought I wanted to work with
• 2:53
  - patients
• 2:54
  - experiencing
• 2:55
  - psychiatric,
• 2:56
  - psychological
• 2:57
  - complications
• 2:58
  - of their,
• 3:00
  - hospital stays.
• 3:01
  - And so, I went back to school to
• 3:02
  - get a master's degree in psychiatric mental health
• 3:05
  - nursing,
• 3:06
  - where basically I was learning to be a
• 3:08
  - therapist.
• 3:09
  - And what I learned was that I didn't
• 3:10
  - want to be a therapist.
• 3:12
  - But the program I was attending
• 3:13
  - was really a family systems
• 3:16
  - focused program.
• 3:18
  - And so I really became interested in
• 3:21
  - how I could apply
• 3:22
  - sort of the family systems model to the
• 3:25
  - organizational
• 3:26
  - family
• 3:27
  - system that exists in every single hospital.
• 3:30
  - And so
• 3:31
  - I I
• 3:32
  - never did become a family therapist. I never
• 3:35
  - practiced as a clinical nurse specialist.
• 3:37
  - And but I went back to school to
• 3:38
  - learn more about how teamwork
• 3:41
  - in health care really impacts,
• 3:44
  - both patient outcomes
• 3:45
  - and provider outcomes.
• 3:47
  - So that was always my goal. I did
• 3:49
  - a big study looking at teamwork and intensive
• 3:51
  - care units.
• 3:52
  - That study has been cited
• 3:54
  - probably well over 200 times in the literature.
• 3:58
  - I I participated in another study where we
• 4:00
  - look at teamwork,
• 4:02
  - perceptions,
• 4:04
  - of emergency patients
• 4:06
  - and their willingness to follow discharge instructions,
• 4:09
  - and that's actually been used,
• 4:11
  - as evidence for, the TeamSTEPPS program from AHRQ.
• 4:16
  - And so I was really headed down this
• 4:17
  - pathway
• 4:18
  - of being both,
• 4:20
  - at a stretcher site emergency nurse clinician
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  - and a scientist,
• 4:25
  - investigating teamwork. And I really wanted to improve
• 4:27
  - teamwork in emergency departments.
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  - Then late
• 4:32
  - one night shift, so actually early in the
• 4:35
  - morning,
• 4:36
  - I noticed a patient I had seen much
• 4:38
  - earlier in the evening.
• 4:40
  - And, you know, here he is still sitting
• 4:41
  - in the waiting room, and I thought, oh,
• 4:42
  - please tell me we haven't missed somebody or
• 4:44
  - he didn't hear his name being called. And
• 4:47
  - so I call him over, and I see
• 4:48
  - he's got his discharge paperwork with him. And
• 4:50
  - so I thought, well, let me try to
• 4:51
  - help him while he's here.
• 4:53
  - Maybe he's scheduled for you know, maybe he
• 4:55
  - needs a follow-up appointment. Let me see if
• 4:57
  - I can get him an appointment.
• 4:59
  - And so I start to ask him some
• 5:00
  - questions about what he needed and what I
• 5:02
  - could do. And and I said, well, let's
• 5:04
  - try and get you an appointment. They want
• 5:05
  - you to see a neurologist. Let's see if
• 5:06
  - I can get you an appointment. And I
• 5:07
  - I called the social worker
• 5:09
  - and,
• 5:11
  - and had was starting to have a conversation
• 5:12
  - with the social worker when the patient stood
• 5:15
  - up and just started to punch me in
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  - the face.
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  - So I'm sitting in what is essentially a
• 5:20
  - closet for those people who've been in emergency
• 5:22
  - department. You know, the triage room is often
• 5:24
  - a small sort of separate space,
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  - for some privacy there, and I'm on a
• 5:28
  - rolling stool, and so all of a sudden
• 5:30
  - I'm getting pushed back further away from where
• 5:32
  - anybody can see me. And I'm screaming for
• 5:34
  - help, and this man is punching me. And
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  - I'm trying to protect myself as much as
• 5:38
  - I possibly can, but I dropped the phone,
• 5:40
  - I guess, thankfully.
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  - And the social worker heard what was going
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  - on, and she called,
• 5:44
  - she called the security officers who eventually sent
• 5:47
  - somebody over to pull the man off of
• 5:49
  - me.
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  - And so
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  - probably from that point forward,
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  - my interest really changed from
• 5:57
  - teamwork,
• 5:58
  - investigating teamwork to really thinking more about, well,
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  - you know, if we're not physically
• 6:04
  - safe with our environment,
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  - we're never gonna have teamwork.
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  - And so I totally shifted my research focus
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  - to start looking at,
• 6:14
  - workplace violence, especially in emergency departments since that's
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  - where I was practicing,
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  - and found that at least at the time,
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  - and this is,
• 6:23
  - oh, jeez, probably
• 6:24
  - 2010,
• 6:25
  - that there wasn't a whole lot of work
• 6:27
  - being done around this area.
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  - And so
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  - from an operational perspective, I got to work
• 6:33
  - with,
• 6:35
  - the clinical director, of the emergency department at
• 6:37
  - the time and
• 6:39
  - develop some,
• 6:40
  - some interventions we could put in place within
• 6:42
  - the, department itself and some safety measures we
• 6:45
  - could put in. But then, of course, since
• 6:47
  - I was also a a scientist, right, I
• 6:49
  - wanted to investigate more about what actually made
• 6:51
  - people feel safe from
• 6:54
  - violence from patients and and family members.
• 6:57
  - And so that led me to
• 7:00
  - develop
• 7:01
  - a survey instrument,
• 7:03
  - that basically
• 7:05
  - quantifies
• 7:06
  - the perception of safety
• 7:08
  - for emergency nurses.
• 7:11
  - And that's where I've been today. I'm still
• 7:13
  - working on trying to figure out,
• 7:16
  - anything I can to
• 7:18
  - help make emergency departments and health care in
• 7:22
  - general safer from patient and visitor violence all
• 7:25
  - because of that one event.
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  - Mhmm.
• 7:27
  - Well, that one event is shaped so much,
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  - and,
• 7:31
  - I I appreciate your candidates
• 7:33
  - in speaking to it. I think it's something
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  - that, unfortunately,
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  - many other people in the industry
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  - can relate to.
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  - So I think it's so admirable the work
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  - that you're doing
• 7:44
  - to help. And we'll talk about the survey
• 7:46
  - a bit more in a moment, but
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  - first I wanna zoom back and just talk
• 7:50
  - a little bit more about
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  - the scale of
• 7:54
  - workplace
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  - violence.
• 7:56
  - You know, you've said it's statistically more dangerous
• 7:58
  - than coal mining. Is that right? Yeah. So
• 8:02
  - that's that's, that's not my quote, by the
• 8:04
  - way. I I think I pulled that from
• 8:06
  - either the CDC
• 8:08
  - or NIOSH or OSHA. Somewhere on a website,
• 8:11
  - I read that.
• 8:13
  - And,
• 8:14
  - and and when you look at the statistics
• 8:16
  - around
• 8:17
  - workplace violence so workplace violence
• 8:19
  - in health care in particular,
• 8:21
  - what's interesting is that,
• 8:24
  - the vast majority
• 8:25
  - of nonfatal
• 8:27
  - injuries,
• 8:28
  - in any industry come from
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  - the health care and social service industries.
• 8:34
  - And so,
• 8:36
  - you know, that that, is just pretty amazing.
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  - And I'm I'm thankful that there's not a
• 8:40
  - whole lot of fatalities,
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  - but, the fact is that something like, I
• 8:45
  - wanna say, sixty or seventy percent
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  - of nonfatal
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  - injuries,
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  - in the workplace
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  - from violence,
• 8:53
  - come from health care.
• 8:55
  - And, of course,
• 8:56
  - that means it's mostly women,
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  - that they tend to be
• 9:02
  - younger people,
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  - and,
• 9:07
  - and so there's just, you know, so much,
• 9:10
  - so much of a problem around this.
• 9:12
  - Yeah.
• 9:14
  - What do you think is maybe
• 9:16
  - under recognized or misunderstood about
• 9:19
  - workplace violence in the health care setting based
• 9:22
  - on your years and years of experience in
• 9:23
  - research?
• 9:26
  - Unfortunately,
• 9:27
  - I think,
• 9:29
  - a large part of the problem
• 9:32
  - comes from
• 9:34
  - this perspective that
• 9:36
  - we are here to sacrifice ourselves,
• 9:40
  - in the name of the patient.
• 9:44
  - And
• 9:45
  - that's not what I went to school for.
• 9:48
  - You know, no one ever told me I'd
• 9:50
  - have to protect myself from someone trying to
• 9:52
  - attack me. I didn't learn to box,
• 9:54
  - you know, or, you know, have a a
• 9:57
  - personal safety course in my undergrad degree.
• 10:01
  - But for some reason,
• 10:03
  - in health care,
• 10:05
  - we are
• 10:07
  - accepting of a certain level of
• 10:10
  - incivility,
• 10:11
  - disrespect,
• 10:14
  - physical violence
• 10:16
  - from patients, and we tend we excuse way
• 10:19
  - too much of it.
• 10:21
  - You know, oh, they're drunk. Oh, they're, you
• 10:23
  - know, they're high. Oh, they're, you know, demented,
• 10:27
  - delirious.
• 10:28
  - You know? Right? We just tend to let
• 10:31
  - it go. And then that means
• 10:33
  - that
• 10:34
  - clinicians aren't reporting it.
• 10:36
  - And then that really hamstrings
• 10:39
  - people in leadership positions because if they're not
• 10:41
  - getting
• 10:42
  - the data that says people at the front
• 10:45
  - lines are suffering,
• 10:47
  - then they don't have anything to work with.
• 10:49
  - Right? You know? I've had conversations with numerous
• 10:53
  - CNOs around the country,
• 10:55
  - who said to me things like, you know,
• 10:57
  - I don't hear enough about this or I
• 10:59
  - need to I need to make sure that
• 11:00
  - I'm asking my directors,
• 11:03
  - you know, are they tracking this data? Can
• 11:05
  - they report it more to you know, can
• 11:07
  - they can they give me a monthly report
• 11:08
  - on the numbers that they hear? And then
• 11:11
  - I think, you know, the problem is that
• 11:12
  - we also know that
• 11:14
  - most clinicians only report
• 11:17
  - incidents where there's been some type of physical
• 11:19
  - altercation
• 11:20
  - or they are worried that they're gonna be
• 11:23
  - blamed for something,
• 11:25
  - that came out of this incident. Right? So
• 11:28
  - there's a huge problem with underreporting.
• 11:31
  - And, you know, that that falls more on
• 11:34
  - the clinician.
• 11:35
  - But I think from a leadership perspective, it's
• 11:37
  - also important
• 11:38
  - for leaders to get out there and say,
• 11:40
  - I need you to report every single incident.
• 11:43
  - And I don't care if it's somebody who
• 11:44
  - cursed at you or called you names or
• 11:48
  - treated you disrespectfully in some way.
• 11:51
  - They need to it needs to come through
• 11:52
  - the formal reporting system
• 11:54
  - so that we can have a clear record
• 11:56
  - of that, and I can do something with
• 11:58
  - that information. If you don't report it, I
• 12:00
  - don't know about it, and then I can't
• 12:02
  - go to the people who really control the
• 12:04
  - resources
• 12:05
  - to get more resources
• 12:07
  - directed toward you.
• 12:09
  - Really tackling that underreporting is such a important
• 12:12
  - step to
• 12:14
  - that goes right along with creating that culture
• 12:16
  - of safety, of physical and psychological safety as
• 12:19
  - well.
• 12:19
  - Right. Let's dig deeper into the survey instrument
• 12:22
  - that you
• 12:23
  - developed.
• 12:24
  - Maybe you can talk a little bit more
• 12:25
  - about why you thought it was important to
• 12:27
  - first and foremost have it measure perceptions of
• 12:30
  - safety, and then I'd love to dig in
• 12:31
  - a little bit more operationally of,
• 12:34
  - how you've seen systems really use it once
• 12:36
  - they have the data.
• 12:37
  - Great. So we're we're never gonna stop every
• 12:40
  - single
• 12:41
  - violent event,
• 12:43
  - from happening. We're never gonna stop violent people
• 12:46
  - from coming in. We've seen a rise in
• 12:48
  - incivility
• 12:49
  - and violence in our society, so, of course,
• 12:51
  - it's just gonna come into our hospitals.
• 12:53
  - But
• 12:54
  - what we need is for people to feel
• 12:57
  - safe while we're while they're at work.
• 13:00
  - We know that nurses,
• 13:02
  - physicians,
• 13:03
  - other allied health personnel
• 13:06
  - aren't gonna be able to deliver the to
• 13:07
  - deliver the high quality of care that we
• 13:09
  - expect from them when they're looking over their
• 13:11
  - shoulder wondering where the next attack is coming
• 13:14
  - from or when they're feeling burned out because
• 13:16
  - they've had to be they've had to listen
• 13:18
  - to someone curse at them all day.
• 13:21
  - And so that idea of investigating
• 13:24
  - the perception of safety,
• 13:27
  - is about as close as we're gonna get
• 13:29
  - to measuring
• 13:30
  - real safety.
• 13:32
  - Right? You know, perception is reality. So,
• 13:35
  - that's why I started to measure that.
• 13:37
  - And, basically, I developed the instrument
• 13:40
  - first by talking to a lot of emergency
• 13:42
  - nurses about what made them feel safe and
• 13:44
  - developing items. I sort of went through the
• 13:45
  - standard process you would go to to make
• 13:47
  - a survey,
• 13:49
  - and,
• 13:50
  - developed this instrument
• 13:52
  - and,
• 13:53
  - tested it with,
• 13:56
  - across numerous hospitals across The United States,
• 14:00
  - participated in this study,
• 14:02
  - and,
• 14:02
  - and basically found that,
• 14:05
  - there are really about six
• 14:08
  - factors that make people feel safe from,
• 14:12
  - patient violence.
• 14:14
  - So unit institutional support. So that's feeling like,
• 14:18
  - you know, the people that lead your unit
• 14:20
  - in your hospital are behind you.
• 14:22
  - A sense of belongingness that you have a
• 14:24
  - sense of teamwork. You know, here we are
• 14:26
  - talking about teamwork again. Right? We have a
• 14:28
  - sense of teamwork
• 14:29
  - in the unit we work in.
• 14:32
  - We have a sense of trust around the
• 14:33
  - fact that when we report incidents that something's
• 14:36
  - going to be done around that, we understand
• 14:39
  - the process
• 14:40
  - that, that needs to happen
• 14:42
  - to,
• 14:43
  - prevent and deal with workplace violence.
• 14:46
  - We believe that we have enough training
• 14:50
  - to be able to deescalate and handle some
• 14:52
  - of these situations. And finally,
• 14:54
  - that we believe that the security personnel that
• 14:57
  - work with us are gonna do everything they
• 14:58
  - can to try and keep us safe. So
• 15:00
  - from an operational point of view, somebody who's
• 15:02
  - using the survey, certainly, you get a cumulative
• 15:05
  - score where you could understand,
• 15:08
  - what the current sense of safety is right
• 15:10
  - now, but then you will also get subscale
• 15:13
  - scores
• 15:14
  - for each of those elements.
• 15:16
  - And if you you were using this in
• 15:19
  - your emergency department at your hospital, then you
• 15:21
  - could look at those subscale scores and say,
• 15:23
  - oh, jeez. You know? You know? The the
• 15:25
  - training,
• 15:26
  - the training subscale score is really low. We
• 15:28
  - need to provide more training. Oh, and it
• 15:30
  - looks like maybe the next one up from
• 15:32
  - that is, is security personnel. So maybe we
• 15:35
  - need to do more about getting
• 15:36
  - the,
• 15:37
  - nurses and the security personnel
• 15:40
  - to meet and really talk about what they
• 15:42
  - can do together to sell to help solve
• 15:44
  - this problem.
• 15:45
  - Right? So there's those subscale scores. And then,
• 15:47
  - hopefully,
• 15:49
  - how, you know, I hope that people are
• 15:51
  - using this really to,
• 15:53
  - put interventions in place and then test them.
• 15:55
  - You know? Is that does the score go
• 15:56
  - up after you put something in place? Right?
• 15:59
  - Does the score go up when you put
• 16:00
  - training in place,
• 16:02
  - when you improve the the relationship between the
• 16:04
  - security personnel and the nurses?
• 16:06
  - And so I think that's really the ideal
• 16:07
  - way to use it. Mhmm. Yeah. Very helpful
• 16:10
  - to know. For nursing executives or other leaders
• 16:14
  - who are interested in learning more about the
• 16:16
  - survey, where should we draft them? Where can
• 16:18
  - they access it? Oh oh, for sure. People
• 16:20
  - should just reach out to me, and then
• 16:22
  - I will send them directions. And I'll for
• 16:25
  - the most part, if people have questions for
• 16:27
  - me, I just tell them to call me
• 16:28
  - or email me. And, I I sort of
• 16:31
  - give them a little curbside consult along with
• 16:33
  - the directions.
• 16:35
  - I love it.
• 16:36
  - I'm curious,
• 16:38
  - zooming out a bit,
• 16:40
  - as you're thinking through
• 16:42
  - measuring perceptions of staff safety,
• 16:45
  - taking actionable steps to improve workplace violence,
• 16:48
  - what's the biggest piece of advice that you'd
• 16:50
  - leave
• 16:51
  - hospital executives with?
• 16:54
  - The biggest
• 16:55
  - piece of advice
• 16:57
  - I would give
• 16:59
  - hospital leaders
• 17:01
  - would be
• 17:02
  - to make that personal contact
• 17:04
  - with
• 17:06
  - the people who are experiencing
• 17:07
  - the problem.
• 17:09
  - The
• 17:10
  - nurse manager
• 17:11
  - probably knows when
• 17:13
  - one of their staff has been
• 17:15
  - assaulted by a patient or when something bad's
• 17:18
  - happened. Right?
• 17:19
  - But what clinicians especially wanna know is that
• 17:22
  - they can trust the people who are sitting
• 17:25
  - in the C Suite,
• 17:27
  - that those people have your back.
• 17:30
  - Trust is a huge issue
• 17:32
  - right now in health care between
• 17:34
  - the people at the sharp edge of care
• 17:35
  - and the people sitting in the C Suite.
• 17:38
  - And one of the ways that executives can
• 17:40
  - improve that level of trust is by making
• 17:43
  - up some sense of, some type of personal
• 17:45
  - contact with people who've been
• 17:48
  - victims of workplace violence to say, I heard
• 17:52
  - this happened to you. I'm so sorry.
• 17:55
  - I I never want this to happen again.
• 17:57
  - I wanna do something about this. Help me
• 17:59
  - solve this problem,
• 18:01
  - and and really
• 18:03
  - make that personal connection so that
• 18:06
  - everyone knows that
• 18:08
  - leadership cares
• 18:10
  - Okay. And is really actively doing something about
• 18:13
  - this. Oftentimes,
• 18:14
  - I hear from nurses, well, I didn't fill
• 18:16
  - it on an incident report because it just
• 18:17
  - goes into a black hole and nobody does
• 18:18
  - anything with it anyway. Right?
• 18:21
  - And so getting that message out that, yeah,
• 18:23
  - we are doing something about this,
• 18:26
  - and that we do actually really care about
• 18:28
  - you,
• 18:29
  - is just the most important thing, someone in
• 18:32
  - an executive position can do. Mhmm. Showing that
• 18:35
  - you're listening to those voices and then not
• 18:37
  - only that, but actually acting on it for
• 18:39
  - change. Yeah. For sure. Absolutely.
• 18:42
  - Wonderful. Well, Chris, thank you so much for
• 18:44
  - joining us on the podcast and,
• 18:46
  - sharing your expertise with us. It really is
• 18:50
  - so commendable, the work that you're doing, and
• 18:51
  - I hope that our audience members find this
• 18:54
  - helpful.
• 18:55
  - So thank you.
• 18:56
  - Sure. And thank you. Thank you, Mackenzie.