A Little Less Talk, A Lot More Action

It is time to put workplace violence prevention into practice

I heard Elvis singing “A Little Less Conversation” recently, and it got me thinking about our approach to workplace violence prevention and how it is seen through the eyes of frontline staff.

Probably not what the songwriters had in mind.

But after reading comments from hospital employees about violence, unanswered concerns, and changes they are still waiting to see, the connection was hard to miss.

Employees have heard about the policies. They have heard about the training. They have been told that their safety is a priority.

They want to see what happens next.

Will help arrive? Will someone address the concern they reported? Will anything be different when they return for their next shift?

They want to feel safe—and they want reasons to believe they are.

We need to stop talking about workplace violence prevention and start acting on it.

What changes on the next shift?

There is considerable effort involved in developing a prevention program. Policies, assessments, training, and committee work all have a purpose. Their value depends on what they change in practice.

An employee who repeatedly reports threatening behavior needs someone to evaluate the concern and establish a plan. A department with an unreliable alarm needs it repaired and an interim way to summon assistance. A team struggling with the same visitor conflict needs consistent expectations and leadership support.

Those are concrete actions. Employees can see whether they happen.

Another reminder to remain vigilant does little for someone who already recognizes the risk and has been asking for help.

The question for leadership is straightforward: What will employees experience differently because of the work we are doing?

If we cannot answer that, we need to look closely at where our effort is going.

Frontline prevention starts with human interactions

A hospital cannot place a security officer or police officer in every patient room or supervise every interaction. Security coverage matters, but prevention also depends on what happens before assistance is requested.

It starts with people.

How we approach someone. What we notice. How we explain what is happening.

Whether we listen. When we recognize that the situation requires help.

These are actions employees take throughout a shift. They deserve the same deliberate attention we give to what happens after an emergency is declared.

By the time a patient or visitor reaches us, their experience is already underway. They may have spent hours in pain, received frightening news, struggled to find the right entrance, or worried about what comes next.

We meet them at registration or the bedside. We did not see everything that happened beforehand.

Their anxiety, fear, or frustration may already be well above their usual level. That is what I mean by an escalated emotional state. It does not mean they are violent. It means we should pay attention to where they are emotionally when the interaction begins.

We cannot know their normal mindset at a glance. We can observe, listen, and adjust our approach.

Sometimes the first useful action is a simple “Hello.”

Acknowledging someone creates an opportunity to understand what they need, clarify confusion, and notice behavior that requires assistance. It will not resolve every situation. It gives us a place to begin.

How we are seen—and what we are seeing

Two things should guide how we enter a conversation: how we are seen and what we are seeing in front of us.

Our expression, posture, tone, pace, and approach communicate something before we finish the first sentence.

We may intend to be efficient and appear impatient. We may be concentrating and appear dismissive. We may explain a reasonable boundary in a way that adds unnecessary tension.

Paying attention to our approach is part of professional practice.

At the same time, we need to assess what is happening in front of us. Is the person confused, frightened, or increasingly frustrated? What are they saying and doing? Are they making threats, blocking someone’s movement, or displaying a weapon?

Behavior and circumstances should guide that assessment. Appearance, diagnosis, or background should not substitute for it.

The response needs to fit the situation. A person struggling to understand directions needs help navigating. A person making an immediate threat requires a protective response.

Employees should know when to step back and summon assistance. They should never believe they must continue a conversation at the expense of their safety.

The facility has a role in the interaction

The employee is only one part of what a patient or visitor experiences.

The building communicates, too. So do the processes inside it.

Can people find where they need to go? Does anyone acknowledge them? Are expectations clear? Do different employees provide conflicting information? Does a delay come with an explanation, or are people left to guess?

Imagine a worried family member who cannot find the entrance, receives unclear directions, and then waits without an update. The next employee encounters the frustration produced by that entire experience.

Telling that employee to improve their communication addresses only part of the problem.

Look at the process. Walk the route. Read the signs. Ask where people repeatedly become confused or frustrated. Fix what can reasonably be fixed.

These conditions do not excuse violence, and correcting them will not eliminate every threat. They are conditions the organization can influence.

Prevention includes reducing avoidable tension instead of leaving frontline employees to manage it repeatedly.

Put non-escalation, de-escalation, and response to work

An effective approach requires all three.

Non-escalation includes how we acknowledge people, explain what we are doing, communicate expectations, and avoid adding unnecessary tension. It also requires employees to observe their surroundings, recognize how the person in front of them is behaving, and notice changes as the interaction develops.

De-escalation involves responding when behavior intensifies, using appropriate communication and boundaries, and involving others before the situation becomes unmanageable.

Response provides protection when the situation becomes unsafe. Employees need to know how to summon assistance, what to do while it is coming, and who will coordinate the response.

These do not always occur in sequence. Some situations require immediate emergency action.

The practical task is to make each capability work. Employees need role-specific preparation, functioning equipment, clear responsibilities, and opportunities to practice together.

Ask a registration employee, nurse, environmental services employee, physician, and security officer what happens when someone reports a threat. Their responsibilities will differ. Their understanding of how the response works should fit together.

If they give conflicting answers, there is work to do.

Shared responsibility requires dependable support

“Everyone has a role” cannot become another way of telling employees to handle danger themselves.

If we expect early calls for assistance, someone needs to respond. If we expect appropriate boundaries, supervisors need to support them. If we expect employees to report hazards, someone needs responsibility and authority to address them.

Frontline employees should be able to expect:

• A concern will be assessed before it is dismissed. Someone needs to understand the behavior and circumstances being reported.

• Help will be available across shifts. Overnight and weekend employees need a workable response, too.

• The plan will be clear. Employees should know what to do next and who is responsible.

• Known hazards will receive attention. Assign an owner, establish a timeframe, and provide interim safeguards when necessary.

• Follow-up will reach the people affected. Explain what was done and what still needs to happen.

• Support will continue after the incident. Determine what employees need and whether the conditions are safe for them to resume their work.

Action may involve additional staffing, a coordinated care plan, visitor boundaries, an equipment repair, or a change in procedure. The choice should fit the circumstances.

Employees need to understand how that action addresses the concern they raised.

Their responsibility is to act within their training and role. The organization’s responsibility is to give them the resources and support to do so. An assault is not proof that an employee failed to communicate well enough.

Give employees reasons to feel safe

Reassurance needs something behind it.

A security officer’s presence may provide comfort, but employees also need to know that the officer and clinical team have appropriate training, demonstrated skills, and a shared plan to respond effectively. An alarm mounted on the wall needs to work, reach the right people, and produce the expected response.

Test those arrangements. Ask employees whether they understand them. Address the gaps.

Feeling safe and having effective safeguards are both important. Employees may remain anxious after a serious incident even when improvements have been made. Listen to that concern and explain the protection now in place.

Confidence develops through repeated experience: assistance arrives, a supervisor follows through, a reported hazard is corrected, and the change holds up during a busy shift.

Those experiences give meaning to leadership’s commitment.

Count the work that happens before an injury

Action also needs evaluation.

When an employee recognizes escalating behavior, requests assistance, and the team resolves the encounter, learn from it. What was noticed? What helped? Was the response timely? What still needs attention? Document what happened, including the intervention and outcome. Apply consistent definitions to distinguish incidents, near misses, and early interventions.

Make it practical to document threats, near misses, and meaningful early interventions.

A threat remains an incident even if no one is physically injured.

Do not assume every resolved encounter represents an assault prevented. Use the information to identify patterns, reinforce sound judgment, and improve how the program works.

Then examine whether corrective actions produced the intended result. A completed work order or revised procedure is a starting point. Did the equipment work when tested? Did response improve? Are employees still reporting the same concern?

A completed action item needs to produce a change employees can count on.

Start acting where employees are already asking

Begin with a concern employees have already raised.

Go to the department. Listen to the people dealing with it. Include the people who can change the conditions. Decide what will be done, who will do it, and when.

If the full solution takes time, establish what protection is available now.

Then return.

Ask whether the change helped. Check whether it works at night and on weekends. Find out whether it created a different problem. Adjust it where necessary.

We have spent years explaining what a workplace violence prevention program should contain. Employees need to experience what it actually does.

That takes deliberate human interactions, dependable assistance, functioning safeguards, and leaders who follow through.

The next shift is where employees will find out whether our commitments mean anything.

A little less talk, and a lot more action.