The prudent practice will ensure that it has a plan, and staff members know their roles.

We come to work every day with one thought: to treat patients with ocular disease to the best of our abilities. A second thought, that violence, or even the threat of violence, could happen in our workplace likely never occurs to us. Yet with more such incidents taking place in all types of businesses, perhaps we should all ask ourselves, “What would we do if someone threatened our practice?”

IT HAPPENED TO US

When I was a practice administrator, there came a day I had to answer that question and fast. A patient threatened during a phone conversation to come into the office with a gun. Staff had called him to confirm his appointment, and the patient said he was coming to obtain marijuana for his glaucoma. The call center tried to explain that our office did not write prescriptions for or dispense marijuana, which at the time was still illegal, even for medical purposes. The patient became belligerent and said he was coming in with a gun and was going to shoot everyone in the office. Call center staff were visibly shaken and upset.

We had a choice to make. Do we take the threat seriously, or do we ignore it?

We decided to take the incident seriously. After we called the police, officers arrived to take a report. Because the man had provided his social security number when he made his appointment, the police were able to learn that the patient had a serious criminal record, which included acts of violence against others. Officers stayed that night until all of our staff went home for the evening. Police returned the next day in case the patient showed up.

I must admit that until this incident occurred, I had not given this type of scenario much consideration. We had a well-established practice with wonderful patients. However, on that day I began giving this scenario lots of consideration. I concluded that as physicians and leaders, we have a responsibility to ensure that our practices have emergency action plans in place. We must do everything we can to minimize potential threats to our staff and patients by creating a safe working environment.

TAKING ACTION

Here are some pointers to consider that this incident taught me:

• Threats can become real. While we chose to take this call seriously, we easily could have ignored the caller’s ravings. After learning of this person’s previous criminal background, I was glad we called the police. It was the prudent thing to do.
• Experts can help. Since we were unsure if the patient was going to show up for his appointment, we had police presence in the parking lot and waiting room. The day after receiving the patient’s call, we had a security expert come to the practice and complete a site assessment. The security expert walked our property and outlined access points throughout that we needed to better secure. We also discussed the best options for moving staff out of danger if someone threatening ever did come onto the property.
• Every practice needs an emergency preparedness plan. Every business needs to outline instructions on what to do in case of emergency. Plans should contain contingencies for natural disasters (such as fire, hurricanes, or tornadoes), workplace violence (such as an active shooter or domestic incident), and patient issues (such as a patient fall or threat of suicide). As owners and leaders, we need to set aside time for staff members to be trained on how to respond and then to practice their prescribed responses. To paraphrase the Navy SEALS’ precept: Under pressure, people don’t rise to the level of expectations, they fall to the level of their training. That is why the SEALS train so hard. Without consistent training, your staff will not know what to do in the face of danger.
• Consider a surveillance system. Video cameras strategically installed throughout the office can provide additional security for patients and staff. For example, if the reception desk’s view of the front door is limited because of the office’s configuration, a video camera and a small monitor would allow staff in the front office to see individuals as they approach. Video cameras can also capture other incidents such as a patient falling or a traffic accident taking place in the practice’s parking lot. An added benefit: the business may receive a discount on its general liability insurance policies by having live video cameras throughout the establishment. Before installing a surveillance system, practices should check with their state requirements, as most companies are obligated to inform staff and patients that they are being captured on video.
• Practices can promote safety through customer service. Smiling and noticing patients in hallways or the waiting room are not just part of providing great customer service, but it is also about staff members being aware of the people around them. Staff needs to pay attention to their surroundings. Should a situation be observed, staff should know what to do — whether it’s to try to diffuse the situation or report it to a manager — through practice-provided training.
• If you see something, say something. Following the incident at my practice, I learned that our disruptive patient exhibited bizarre behavior when he first called to book his appointment. During his initial call, he had asked about a prescription for marijuana. Thinking back on that initial phone call, the staff member who booked his appointment could clearly recall the odd conversation but had failed to document it or notify a supervisor. In response to this, we provided additional training to the call center and front office staff on the importance of reporting issues they felt were outside the norm.
• Stay in-tune with your staff. Workplace violence often involves people who know each other. Violence initiated by an upset spouse, significant other, a friend, a patient or a current or former coworker is much more likely to occur than a random act of violence. Physicians and practice leaders need to take seriously any domestic issues or bullying (including cyberbullying) concerning staff.

I learned these lessons as an administrator and they continue to be reinforced by the educational offerings BSM provides to practices, including a course on how to handle workplace violence.

We all hope that a serious incident does not occur in our practices, but recent events teach us that no one is exempt; practice leaders can’t rely on luck. Set aside time for staff training, and also make the monetary investment required to provide a safe, secure work environment. OM

Ms. Holloway is a senior consultant with BSM Consulting in Clearwater, Fla. Her current certifications include Professional in Human Resources (PHR) and Certified Patient Service Specialist (CPSS).