In the early 2000s, I was conducting a security assessment at a healthcare facility when I observed a telling moment in the waiting room. A mother, visibly stressed, had just learned from the receptionist that her doctor was delayed in surgery due to complications with a patient. The doctor was on his way, but as more time passed, both the mom and her kids grew increasingly restless and irritable, creating a scene reminiscent of that candy bar commercial where hunger exemplifies frustration.
All of this unfolded under the receptionist’s watch, separated by an access-controlled door and a sliding glass window. When the mother approached the window a second time, the receptionist, whom I often describe as the true first line of defense in managing patient frustration, responded with empathy rather than rigid policy. Smiling warmly, she asked how she could assist and offered the family three bottles of water and some snacks from a small refrigerator near her desk.
The effect was immediate. You could feel the stress in the room lighten. A simple act of compassion had defused a potentially volatile situation before it escalated further into the violence continuum. It was a reminder of how easily tension can be calmed through awareness, empathy, and small gestures of care.
What is most interesting is that the receptionist took it upon herself to come up with this alternative to calm the situation, despite having no formal workplace violence training. In my interviews, she shared that she had experienced positive outcomes using this approach. What she was doing, unknowingly, was practicing de-escalation.
Causes of Patient and Visitor Hostility and Violence in Healthcare
Violence towards healthcare workers has been on the rise in recent years. According to the U.S. Bureau of Labor Statistics, healthcare and social service workers experience workplace violence injuries at five times the rate of workers in other industries. Although various factors contribute to this issue — such as staffing shortages, limited resources to meet patient demand, and inadequate communication — patients’ and their loved ones’ expectations for greater access and expedient care have also increased.
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Whether it is food service, car services, banking, or online shopping, the expectation for speed and immediate gratification in today’s society is stronger than ever. This “cashier philosophy” has allowed people to grow accustomed to receiving what they want with little delay. The problem is that not all industries, particularly healthcare, can operate on this expectation.
Although some providers are attempting to make healthcare more convenient and accessible, they have yet to eliminate the waiting game.
A 2023 study by the American Association of Nurse Practitioners found that more than 40% of U.S. respondents have experienced a “longer than reasonable” wait for health care. Combine this with life-impacting decisions, high levels of anxiety, and an expectation for instant results, and it creates a recipe for inevitable frustration and potential hostility.
Anger frequently surfaces when patients encounter delays, feel neglected, or perceive a lack of compassion. Protective instincts become stronger when people struggle with the anxiety and fear that come with illness, especially when loved ones are involved. Emotional responses become more intense when people feel powerless, disrespected, or that their concerns are being ignored.
During the COVID pandemic, for example, I witnessed firsthand how difficulties conveying body language often created opportunities for hostility. Though essential for safety, masks obscured nonverbal cues, one of our most important tools for communication. The inability to see the person’s face or read subtle movements made misunderstandings and emotional escalation more likely.
Developing Violence Prevention Policies and Procedures
All successful workplace violence prevention programs begin with policies and procedures developed in consultation with the healthcare organization’s legal department. Fundamentally, the policy grants the authority to develop procedures and training, while the procedures themselves ensure the policy is enforced.
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An effective policy establishes the overarching authority and framework of the program. It should broadly and concisely define workplace violence to include all forms and locations while emphasizing the organization’s commitment to fostering a respectful, safe, and healing environment for all.
The accompanying procedures provide the practical steps and enforcement mechanisms, or “teeth,” that make the policy actionable and enforceable. Procedures should outline prevention and awareness measures, such as signage, posters, educational materials, staff training, and communication with staff, patients, and visitors. They should also detail investigative methods, documentation protocols, and response actions, which may include staff involuntary separation or banning/barring disruptive visitors and patients from the facility.
Once policies and procedures are developed, organizations should establish metrics to identify problem areas and apply treatment approaches that address environmental risks while also monitoring the effectiveness of existing controls. Central to these metrics is a consolidated reporting system that not only collects data on workplace violence incidents but also ensures that the information is reviewed and acted upon.
One of the most significant challenges in workplace violence prevention is the underreporting of incidents or the reliance on multiple, fragmented reporting channels. Without aggregation, organizations lose the ability to analyze trends by type of violence, location, and outcome along incident categorization (i.e., verbal abuse, physical assault, or the presence and intervention of security staff).
Utilizing Scenario-Based Training for Crisis Response
Education and training are at the core of procedural aspects and are essential for empowering staff to handle and report potential workplace violence. Training ultimately equips staff with strategies to reduce the risk of disruptive behavior and clearly defines the roles of reception, security, nursing staff, and other frontline employees who serve as the first line of defense in responding to workplace violence.
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However, many workplace violence prevention training programs fall short because they do not consistently convey complex, memorable concepts that staff can apply in real situations. Scenario-based training using simulations, charrettes, and role-playing can bridge the gap between knowledge and action. By helping to embed tactics, it can make a real difference in handling workplace violence, de-escalation, and preventing staff injury. As the adage goes, “practice makes perfect.”
By walking through or observing realistic simulations, staff learn how to recognize early warning signs, interpret subtle nonverbal cues and behavioral “tells,” and apply de-escalation techniques under pressure. These exercises emphasize the importance of situational judgment, listening to one’s gut, and knowing when continued engagement is appropriate. They also help individuals recognize when it is necessary to disengage, summon security, or escalate the response because the situation is no longer safe.
Another powerful element of in-person, scenario-based training is its ability to prepare staff for the realities of crisis situations, where stress, fear, and adrenaline can override logical thinking. In emergencies, the natural fight, flight, or freeze responses can cause individuals to lock up, forget protocols, or act impulsively, potentially escalating an incident. This physiological response is normal, but without preparation, it can significantly escalate an already tense situation.
Moreover, repeated exposure to scenarios in training builds muscle memory and confidence, allowing staff to respond more quickly and effectively when real incidents occur. It reinforces team coordination, clarifies roles and responsibilities, and ensures that staff understand both their individual and collective options in high-stakes moments.
Ultimately, scenario-based training transforms theoretical policies into actionable strategies that can be recalled under stress, strengthening both personal safety and organizational resilience.
Effective Interventions and De-escalation Techniques for Healthcare Staff
The real distinction between someone who is well-trained and one who received only perfunctory web-based training lies in how they manage a potential workplace violence situation. Poorly trained staff may inadvertently intensify the problem, further escalating the potential for conflict. It is essential that staff recognize the “tells” and intervene before violence develops.
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For example, a patient pacing around the waiting room may signal mounting frustration. This presents a golden opportunity for early intervention using an empathetic acknowledgment (“You seem upset. Can I help you?”). Another effective strategy is to provide opportunities for appeasement, like offering water or a snack, which can help calm irritable individuals and prevent escalation. It is difficult for many people to maintain anger when they are being given something.
If the situation continues to escalate, observation is critical. Staff need to look out for physical cues suggesting aggression, such as clenched fists, a flushed face, or throbbing veins. All of these are warning signs of imminent violence and should prompt immediate de-escalation efforts or requests for additional assistance, as an outburst may be imminent.
If the person begins yelling or using obscenities, staff should continue to attempt to stabilize the situation with additional de-escalation tactics. Gently reminding the patron about surveillance or recording systems can establish boundaries (“I want to remind you this call is recorded for quality purposes,” “This room is under surveillance.”)
If aggression persists, it may be necessary to set clear limits for behavior and outline the consequences (“The way you are treating me is not respectful, and I will call security if this behavior continues.”) When respectful patient or staff conduct policies are in place, referencing these agreements helps reinforce expectations for respectful behavior (“How you are treating me is a violation of our patient care agreement.”)
During de-escalation, the acronym STOPP can serve as a practical and memorable guide in the moment. STOPP stands for:
- Stabilize the Situation: Assess and maintain composure. Keep your voice calm, control your body language, and create an environment that slows the escalation rather than fuels it. Be mindful of your own stress response and avoid reactive behavior.
- Transfer the location: Stay situationally aware. Identify safe exit routes, nearby colleagues, security staff, or other individuals who may be able to assist. Position yourself with an escape option and avoid becoming cornered, especially if you are working alone.
- Observe the Person’s Actions: Pay close attention to body language, tone, and gestures that may signal a shift toward physical aggression. Clenched fists, pacing, pointing, or sudden changes in voice or stance may indicate rising hostility. Early recognition allows for a proactive response.
- Proximity: Maintain safe physical distance while ensuring you are close enough to communicate effectively. If the individual becomes hostile, adjust your stance by angling your body and moving your feet to make yourself a smaller target.
- Provide Opportunities to Appease: Offer options, choices, or compromises that allow the person to feel heard and regain control. Offer food, drink, water, or special accommodations.
Technology Solutions for Threat Awareness and Detection
When considering workplace violence prevention, the absence of witnesses or bystanders can create high-risk environments where individuals are more vulnerable to aggression, harassment, or even sexual assault. Like any comprehensive security program, technology must be paired with operations to achieve meaningful implementation.
Emerging technologies offer promising enhancements. Agentic artificial intelligence has the potential to continuously monitor (i.e., cameras) for behavioral or vocal cues of aggression, identifying risk factors before they escalate into violence. Such systems could even be trained to recognize duress words or code phrases, enabling a proactive and autonomous security response in real time.
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Real-time location systems (RTLS) also provide valuable layers of safety. These platforms can transmit person-down alerts, pinpoint staff locations, and establish two-way communication to quickly determine whether an individual is safe or in distress. When combined with traditional operations, RTLS increases situational awareness and improves incident response time.
Yet, technology is not a standalone solution. To be effective, it must be integrated with operational practices such as structured check-in times, two-person rules, and consistent staff training. These measures not only reinforce confidence in handling incidents but also demonstrate to staff that the organization is actively watching out for their well-being.
This assurance becomes increasingly important as healthcare expands into addressing the behavioral health service crisis, where incidents of violence are high and have increased in recent years, especially within pediatrics, which I have observed is happening more frequently.
Beyond management-level interventions, organizations can benefit from deploying frontline safety technologies that provide early warnings of violence. Examples include duress buttons, discreet code words that can be communicated via phone (e.g., “Dr. Strong, can you come to the waiting room”), and emerging systems such as aggression analytics and AI-based monitoring, which can automatically alert security to an unfolding incident via text/voice insertion over hand-held radio systems.
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When combined with thoughtful policies, training, and layered security controls, these measures can be a powerful tool for de-escalation, deterrence, faster response, and staff reassurance.
When considering the prevalence of violence in our culture, body-worn cameras provide a distinct opportunity to capture incidents in real time and can even be used as a de-escalation tool (“You’re being recorded”). Body cams can record violent behavior, enable two-way communication with supervisors, and create evidentiary and forensic documentation that supports follow-on investigation/prosecution. Body cameras also allow organizations to review both effective and ineffective management of incidents, serving as valuable tools for litigation, arrests, and post-incident learning.
However, a word of caution is warranted: the use of body-worn cameras comes with its own set of approvals, processes, procedures, and informed consent requirements. These must be carefully weighed against the potential impact on staff, patient privacy, and the possibility of escalating a situation. The use of body-worn cameras must be balanced against concerns for staff impact, patient privacy, and the potential to escalate situations.
Deploying K9s as Visible Security Deterrents
The use of K9s in security operations is extremely powerful. For many, the instinctive fear of being bitten can be far more immediate and impactful than the threat of either non-lethal tools or even lethal weapons. As a result, properly trained K9s serve not only as a visible deterrent but also can help immediately de-escalate behavior, reducing the need for force and enhancing overall safety. Their presence alone, in some instances, can be more effective than that of an armed officer.
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The primary challenges for canine programs are their cost and sustainability. Organizations must carefully weigh the substantial benefits of deterrence and de-escalation against the long-term financial and operational commitments required. Beyond the initial purchase price, there are ongoing expenses for specialized training, veterinary care, food, housing, and kenneling. Maintaining consistent training standards also requires recurring investment in both the dog and the handler to ensure readiness, reliability, and compliance with legal and operational requirements.
Simple Actions Can Make a Significant Difference
With burnout, turnover, and workforce shortages on the rise, there is no better time to strengthen workplace violence prevention efforts in healthcare. The American Hospital Association notes that violence in the healthcare setting not only threatens the safety of patients and staff but also increases staff turnover, absenteeism, loss of productivity, and risk of depression, posttraumatic stress disorder, and suicide. Organizations that are prepared, proactive, and compassionate will protect and retain their workforces while building lasting trust with patients and their families.
The most effective approach is simple: root training and practice in empathy and treating others with the same dignity and respect we expect for ourselves. And sometimes, something as simple as creating space for small comforts — like a stocked fridge — can help ease frustration before it escalates into violence.
Sean A. Ahrens, CPP, CSC, CHPA, FSyl, BSCP, is part of Affiliated Engineers, Inc.’s security consulting and design practice, where he leads consulting, assessments, and the development of security design and strategies to help healthcare organizations prevent workplace violence and reduce security risks. A certified security consultant, he is a premises liability expert and serves on the board of directors for the International Association of Professional Security Consultants (IAPSC). [email protected]
Note: The views expressed by guest bloggers and contributors are those of the authors and do not necessarily represent the views of, and should not be attributed to, Campus Safety.
