How CMOs Can Combat Workplace Violence

Verbal abuse is the most common form of workplace violence in healthcare settings nationally and at Children’s Hospital Colorado, according to Shelby Chapman, MA, director of patient-family experience at the hospital. Verbal escalation and verbal violence refers to behavior such as yelling, cursing, and using demeaning language.

In 2018, Children’s Hospital Colorado surveyed its staff to see what kinds of workplace violence they were experiencing, according to Chapman.

“That survey in 2018 kicked off our journey toward addressing workplace violence,” Chapman says. “It spurred our organization to make addressing workplace violence one of our pillar goals—one of the top-level goals that we focus on.”

Workplace violence initiatives

One of the first workplace violence initiatives that the hospital launched was the creation of a safe and healing environment policy, which is promoted with flyers and signs throughout the institution, Chapman explains.

“It outlines the behaviors that we expect from our families and patients when they come into our facilities,” Chapman says. “It also talks about how we are going to partner with families.”

The safe and healing environment policy is helpful for having difficult discussions with families and patients about disruptive behavior, according to Chapman.

“It is also supportive of our families because when they are in an emotional or heated state, we don’t want them to feel they are being singled out,” Chapman says. “By having language accessible and on the walls, it helps our families know the expectations for everyone.”

Bunik says that hospital leadership gets directly involved in workplace violence incidents, including a communication reconciliation initiative.

Children’s Hospital Colorado has two projects it has launched to address verbal escalation in the outpatient setting.

“Our scheduling teams and nursing teams were experiencing frequent verbal escalations, which was taking a toll,” Chapman says.

The first project was a tip sheet to help team members deal with difficult families on the phone, according to Chapman.

“It is a one-page tip sheet on how to de-escalate an upset caller,” Chapman says. “Although we have an annual training that goes through some of these techniques, the tip sheet is helpful because it can be hard to remember the techniques in the middle of a difficult phone call.”

The tip sheet includes steps for team members to center themselves, advice on acknowledging a family member’s emotion and empathizing with them, as well as tips to reach a resolution with a family member.

The other project for outpatient clinics was recording a patient’s voice as part of the recording that greets callers, according to Chapman. The initiative originated from one of the hospital’s clinics.

“Their idea was to record the voice of one of our patients and have that play at the beginning of a call,” Chapman says, “as a way to turn down the temperature and remind the caller of what we are here for.”

“In our emergency department and urgent care centers, it can be stressful for our patients and families as well as our team members,” Chapman says. “We have recognized that one of the ways to prevent verbal escalation is to address common sources of frustration and to do some expectation setting.”

One of the sources of frustration addressed in the video is the triage process. The video explains how the triage processes work and lets families know the care team will be getting to their child as soon as possible.

“In the emergency room, we see the sickest patients first, and that is the opposite of everywhere else you go in your life. Everywhere else, it’s first come, first served,” Chapman says. “When you are in the ED or urgent care with a sick child, triage can be frustrating.”