Peter Steinfeld: The U.S. Bureau of Labor Statistics consistently ranks healthcare as the highest-risk industry for workplace violence, requiring healthcare organizations to rethink their approach to employee safety and well-being.

Eric Clay is Vice President and Chief Security Officer at FMOL Health.

Today he draws on more than 20 years of security leadership to explain how organizations can better prevent workplace violence.

Hey Eric, thanks for being here.

Eric Clay: Hey Peter, thanks for having me. I appreciate it.

Peter Steinfeld: I have seen just how closely you follow workplace violence in healthcare. You’re constantly out there sharing incidents, lessons from across the industry on platforms like LinkedIn, and unfortunately there never seems to be a shortage of examples. It really drives home just how much this issue is changing the job for healthcare security leaders. So with that in mind, what’s most concerning to you about the healthcare risk landscape today?

Eric Clay: Well, I think, as you alluded to, workplace violence is really the number one concern for caregivers, for security practitioners, and really it should be for our communities that we serve. With so many individuals leaving the healthcare space to look for opportunities in safer environments, I think we’re going to see a lot of downstream effects that people aren’t really thinking about. Things like increased cost of healthcare, longer wait times in our EDs, diminished patient outcomes, just the overall physical and mental toll that it has taken on some of our caregivers. So to me, anytime I’m asked that question, it’s always going to be: I think workplace violence is probably the greatest threat facing healthcare as we know it.

Peter Steinfeld: And what do you think healthcare organizations often misunderstand about workplace violence?

Eric Clay: I think that there has been a long-standing perception that violence is just a part of healthcare. I don’t think that that’s accurate. I think that we have created certain environments where violence is allowed to flourish more than other locations. So I think that really we just need to be cognizant of the fact that caregivers deserve to have a safe environment to provide care. Patients deserve to have a safe environment to focus on healing. And so we really need to focus on providing the warm, welcoming, caring, healing place for people to come when they need us.

Peter Steinfeld: What initiatives are you and your team putting in place to better prevent workplace violence and strengthen overall security across your health system?

Eric Clay: I think there’s a number of different things you can do. It really comes down to training your staff — that’s probably first and foremost. We try to train them to look for signs of aggression, signs of agitation. We try to teach them how to de-escalate people before things become incredibly heated or become violent.

Other things that we’re doing are around just the design of facilities. Sadly, we’re seeing more and more gun violence in and around hospitals. So some of the things that we’re doing are in our EDs, where we see an increased amount of violence compared to other spaces within the hospital. We’re looking at things like adding Kevlar material to the millwork and to the walls to stop bullets, to keep people safe. On the other side of those partitions, bullet-resistant glazing or bullet-resistant film applied to glass surfaces to try to stop those things.

We are looking at making our security officers and our security vehicles more visible — just having a uniform that’s easier to identify, in the hopes that that will sometimes prevent people from committing crimes or allow people to easily find security when they need them. We are adding body-worn cameras and tasers. Those are devices that have shown a tremendous impact on violence. We are increasing the number of armed officers just in response to these things that we’re seeing across the country, where we’re seeing more and more gun violence. We want our officers to be able to respond to those sorts of situations. We employ some off-duty law enforcement officers as well, to have that sort of connection to our law enforcement partners in the community.

We just purchased a new training center. We are building a training center for our security team to better prepare them to face the threats that we see in the world today. We’re putting in a firearms training simulator to give them some experience in situations that we hope they will never experience, but to provide them some sort of idea of how things can evolve very quickly, how to respond to those situations, and it allows them to de-escalate people verbally. It’s one of these large-screen projectors that is interactive.

And then, again, just integrating ourselves into the care team. We see ourselves as part of the care team. So we are working to make sure that we are a partner to our caregivers and not siloed, the way you sometimes see in other organizations. We have a program called purposeful rounding, which really encourages our officers to be up and moving, to have interactions with patients and caregivers — they attend huddles. If they find out that there is a particular patient who has shown signs of aggression or violence, they will go and try to have a positive interaction with that person early on, so that whenever we are called back to that room, we’re not the security officers coming to cause additional conflict. We’re the person who was in there earlier talking about baseball, or about their family, or what they need, why they’re here — anything we can do to develop that sort of rapport.

Peter Steinfeld: We actually talk about that a lot on this show, not just in the healthcare space but across all industries — making sure that security is part of the care team. For any organization, if security is part of the team day in and day out, then when something happens, it’s not like this stranger coming in out of the blue and everyone’s afraid of that person. It is a huge thing to make them just part of the daily interaction between customers and employees. It makes for an overall better experience.

Eric Clay: Absolutely.

Peter Steinfeld: One thing you mentioned earlier was interesting — this idea of training the healthcare workers, which got me thinking that it seems counterintuitive that they have to look at potentially patients or people coming in with a bit of suspicion, because the nature of a healthcare worker is to reach out and help, drop everything, run into the fire, help people out. What kind of issues do you find when you’re training people? How difficult or counterintuitive is it for them to step back and think a little bit about security, and not just jump into the situation the way their nature would have them do?

Eric Clay: Caregivers are very tolerant. They’ve gotten into this role because they want to help people. They see the best in people, and they’re there to try to make those people feel better. But I think things are starting to change. I think as workplace violence has become more and more pronounced, caregivers are becoming more aware of the level of violence. I think they’re a little more cautious sometimes in their interactions with people, which is good and bad, because we want to keep them safe, but we also want to provide that quality care.

So I think that really the training piece comes down to just recognizing characteristics or behaviors that could indicate an increased chance of violence. I think some of the other things that we can do to try to alleviate that anxiety are some of the more visible things that we’ve done around FMOL, which is — we’re implementing concealed weapons detection systems at various locations, which are great for keeping guns out of facilities. We have a new K9 unit in our Baton Rouge market, with K9 officers walking around the facility, interacting with people. They’re trained to look for firearms, or smell for firearms, solvents, bullets, explosives, things like that. So it’s a very visible deterrent, and it makes the caregivers feel better protected.

And then the training piece, again, is really just on recognizing those behaviors early — things like positioning yourself in the room in an appropriate way so that you’re not boxed into a corner, which would allow someone to keep you from exiting the room when you need to. Wearable duress alarms are another thing that we’re implementing, which I think are great because they give caregivers the knowledge that whenever they need security, wherever they’re at in the facility, we’re going to be able to find them. If they’re moving from one location to another, either by force or fleeing from someone, we’re able to look on the monitor and see where they’re headed, so we can go and get ahead of them and hopefully get to where they’re going to be, rather than where they were when they pushed the duress alarm. So really, a lot of things we’re trying to do to better protect our caregivers.

Peter Steinfeld: I think that real, tight connection between the healthcare provider and the security personnel is huge, because when you’re training the healthcare worker, you tell them: look, you don’t need to become a security expert, but here are the top five or ten things you can do to make yourself safer, and signals that you can watch for. And then you know that team is over there, that you can point to, and silently wave them in or bring them in as necessary to do their job. It’s kind of a one-two punch to make sure the overall workplace is safer and the caregivers are safer.

Eric Clay: I think we’re very fortunate here that the culture is probably the best I’ve ever seen. There is a sense of partnership and family that you don’t see in a lot of different organizations. So we’re very fortunate to have that, and we’re very fortunate to have an organization that is very committed to security and willing to spend a significant amount of money to get us to the level that we think our caregivers deserve. So really, just a lot of great things that are allowing us to do some of what we’re able to do here.

Peter Steinfeld: A topic you brought up before was this idea of becoming much more proactive with your security folks by giving them lots of training, so they’re not just reactive. And that really shifts the security job from muscle to mind — the best security people are those who can predict things and stop them from happening, and do de-escalation. That’s really using the mind, not the muscle. Do you have some good examples you can share of how investing in your security team has made a meaningful difference across the organization?

Eric Clay: Over the course of my career, I’ve been in healthcare about 12 years now, and I can tell you that investments in security have made tremendous differences in the way caregivers operate.

We started a lot of different initiatives, like the purposeful rounding program. The officers would carry little three-by-five cards in their pocket with questions we had determined would be important for caregivers to know — kind of just-in-time training, is what we were calling it. We would come up, and if they weren’t busy, we would pull out a card, and it would say something along the lines of: “A man just walks into the ED, fires two shots in the ceiling, tells everyone to get on the ground. What are you going to do?” And then we would ask them, and we would work through the problem with them and say, well, here’s something you didn’t consider, but maybe you should have done this — or, yes, you did that absolutely right.

One of the things I think was really insightful for the care team was a large-scale exercise we did on an active shooter in one of our hospitals. Just seeing the response by this security team really made those caregivers feel like we had an amazing security force. We had an armed security force — they got to the person within, I believe, 60 seconds and engaged that person, stopped the threat, at a point where it still took law enforcement, I think, five to seven minutes to show up on property.

And the worry is, you never know how people are going to respond in those situations. Are they going to run to the sound of gunfire? Are they not going to run to the sound of gunfire? But the security team responded as trained — they went toward the sound of gunfire, blocked the person into an area where they couldn’t leave, and engaged in a gunfight with that person using simunition rounds until we were able to stop the threat.

And then you could hear the caregivers for weeks after that talk about how amazing it was, what a great job the security team did. I think it really elevated the opinion of security in people’s eyes, and to me, it was all because of the training investment we made in those security officers. We saw fewer security officers leave the organization. When they did leave, they typically went to another organization in a leadership role. But it was just an amazing experience to see the change — from how things were viewed originally to how they were viewed much later, when we really did take the opportunity to recognize security as being equally as important as the highest-paid physician or the highest-paid executive in the organization. They were deserving of the investment, and we gave it to them, and they responded as we hoped.

Peter Steinfeld: I’d like to dig a bit more into that big exercise. Could you talk more about how you put that on?

Eric Clay: It was put on in conjunction with our emergency management team — we partnered on it. It was a very large-scale exercise involving a large Level One trauma center. We had tabletops for probably two months prior, to really make sure we worked through exactly what we hoped to accomplish. We made sure all the stakeholders felt they had something to gain from participating. We involved local police, the local sheriff’s office, the FBI was involved, and a couple of other law enforcement agencies that had some sort of connection to our facility. We also brought in students from the college as the victims of our shooting — we moulaged them up so they looked like actual victims.

We ran a media campaign for probably two weeks ahead of time to make sure everyone understood there was going to be an active-shooter drill undertaken at the hospital. We did not want off-duty law enforcement or an armed citizen to mistake what was being seen if they were at the facility. On the day of, we had large signs outside at every entrance, plus a greeter handing out a flyer that said there was an armed-intruder active-shooter exercise that day, and that people might hear simulated gunfire and should not be alarmed. We went so far as to create a 20-by-20-foot sign that we laid on the ground in the courtyard, so anyone looking down from one of the upper levels would see it — it read “active shooter drill, may hear simulated gunfire,” the same as the signs at our entrances.

On the day of, again, we had people handing out the signage. Our “active shooter” had a yellow vest on to make them clearly visible, so people knew that was the person playing the threat, and they had someone walking with them looking for potential issues if someone had actually brought a gun into the facility, so we could intervene. We had a contingent of security officers acting as our response team that day, using simunition rounds. We were aware that anyone who might decide to do something bad that day could be aware of what we were doing, so we had armed security officers still working elsewhere in the facility that day, not participating in the drill — so that if something did happen, we weren’t caught with everyone unarmed.

And again, it went very quickly. Within the first sounds of gunshots ringing out, the call went out — active shooter, particular location. The security team responded, ran to the location, engaged the “bad guy,” and took him down within probably 60 to 90 seconds. A very quick response time. Law enforcement, again, was aware this was happening, but we wanted it to be very realistic, so their average response time for anything at that point was five to seven minutes, and that’s what we got.

But again, I think the biggest takeaway for me was just how much the perception of security was elevated that day. The caregivers knew that if there was a real threat, our security officers would respond, that they were equipped and trained to handle that type of situation. In my opinion, it couldn’t have gone better.

Peter Steinfeld: What are some of the other things you do to help leadership see that investing in this is worthwhile?

Eric Clay: Some of the things I’ve done are around exit surveys — when caregivers leave the organization, adding a question that asks something to the effect of: did your perception of security play a role in your decision to leave? Because that gives us a number we can point to and say, we know we’re losing X amount of nurses each year, and we know that the national average is around $65,000 to replace a registered nurse. That gives us a number we can quantify and say: this technology, or this training, or this initiative is going to cost X amount of dollars, which translates to about five nurses. If you give me this money, I think we can prevent at least five nurses from leaving next year — which gives us the ROI we’re shooting for.

At the end of the day, I think things like town halls — I’m a big fan of town halls. A lot of times security leaders don’t want to talk about security initiatives, because they think someone’s going to figure out a way to undermine security, or maybe they’re not confident in their security measures. But to me, letting the caregivers know, letting the employees know these are all the measures we’re taking to keep you safe, these are the investments we’re making in your security, goes a long way toward building the brand — being seen as a trusted partner to the organization, being seen as high-performing. So I like to do town halls and answer questions, even difficult ones, because that gives us transparency.

There’s always going to be something we can’t talk about, but for the most part, most everything we do, we can say yes to. We added weapons detection. We’re tuning the weapons detection to look for this particular type of weapon. Just really talking about anything we’re doing — I think it can be done. Typically we try to have what I call a “culture of yes,” which is that we’re going to say yes to any question that comes along. If you ask us for our help with anything, we’re going to say yes. But then, of course, there may be a caveat — we say, yes, we can help with that, but we’re going to need an additional resource, or we’re going to need a cost center to assign it to. Our default is going to be yes. We’re not going to come out with no, unless it’s something that’s just beyond our ability to do.

So I think really looking at how all these different initiatives translate back to an organizational goal matters. Organizations are looking for ways to prevent care interruption. So how do our initiatives tie back to those organizational goals, and how are we going to prevent care interruptions? How are we going to ensure caregivers are able to provide care regardless of the situation, and that patients are going to be able to come see us and get the care they need?

I think a lot of great security leaders are in their roles because they were great security officers. But I think to really make it to that next level, you’ve got to learn the business side of things and be able to develop pro formas, to be able to develop the kinds of documents that show ROI to your C-suite. I was so concerned about that when I got my first senior role with an organization that I went back and got an MBA, just so I could speak the same language, so I knew what was expected of me. Budgeting is not my strength. Looking at the financials was not my strength — I still struggle with it today, but I have a better understanding of it than I did. They would come in and drop a document that was two or three hundred pages of just lines of financials, and I was like, there’s no way I’m going to be successful if I don’t learn how to do some of these things. So if you know you’re in that role, or you want to get into that role, take the time to read books or speak to people in your finance section and say, I need some help with this. They were very, very willing to sit with me and go through the lines and help me understand what I was looking at. So I think to be successful, you’ve just got to learn to do some of these other things.

Peter Steinfeld: Yeah, absolutely. And it sounds like you understand that fundamental lesson — you have to speak their language. Fundamentally, what executives do is keep the organization going so it can do what it’s supposed to do, whatever that mission is. And they really think about three things: how do we make money, how do we save money, and how do we eliminate risk. If you can position everything you’re trying to accomplish in your role into one of those three buckets, then they start listening. And that’s really important.

Eric Clay: I wholeheartedly agree. I think it’s a lesson that not everybody knows, but it’s important.

Peter Steinfeld: Well, what do you think leaders in other industries can learn from how the healthcare industry is approaching workplace violence?

Eric Clay: We do see more workplace violence than any other industry. OSHA says we see about five times more violence than any other industry, including law enforcement and corrections. Those of us who work in the industry know that that number is grossly underreported — that caregivers typically, unless it’s a significant event, aren’t going to report it. So we think the real number is a lot higher.

I think what other organizations or industries could learn is to focus on workplace violence. OSHA has the general duty clause that they will use if someone is not protecting their employees, so that’s a very real concern for organizations. If you are doing risk assessments and looking at issues such as violence at your facilities, you should be taking steps to better protect your caregivers, because you don’t want a citation from OSHA for that — and civil lawsuits are a real concern too.

So I think really just focusing on these issues to the degree that healthcare has had to would be beneficial, because providing that safe environment means you’re going to have more productive employees. As you alluded to earlier, employees who feel protected are going to be more invested in the organization, more invested in their work. What can we do to mitigate some of these threats? That’s the question every industry should be asking.

Peter Steinfeld: Eric, thank you so much for being on the show. You’ve got such great ideas and insight into how to bridge the abstract of security into the real world and make it very effective. So thank you for sharing all those insights.

Eric Clay: Thanks for having me. I really appreciate it.

Peter Steinfeld: To learn more about Eric and his work with FMOL Health, click the links in the episode description. You can also watch the video highlights on AlertMedia’s YouTube channel. Stay safe out there.

Outro: Thank you for listening to The Employee Safety Podcast from AlertMedia, the world’s leading provider of risk intelligence and response solutions. To learn more about how to protect your people and business during critical incidents, visit alertmedia.com.