Shownotes
As we observe AHA’s 8th annual #HAVHope Day, it's an important reminder that many hospital and health system leaders are looking for solutions to address the root causes of violence in their organizations and communities. Some AHA members have already figured out how to make their organizations a safer and more peaceful environment in which to receive care. In this conversation, Kenneth Rogers, M.D., vice president and chief medical officer at WellSpan Health, discusses how the implementation of their Behavioral Health Emergency Response Team has successfully de-escalated workplace violence incidents by 75% since 2019, by increasing capacity for their team members to respond to situations that could result in violence. #HAVhope
Transcripts
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Tom Haederle
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Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this podcast hosted by Jordan Steiger, senior program manager of Clinical Affairs and Workforce with the AHA, she is joined by Dr. Kenneth Rogers, who shares how WellSpan health is leading the way in implementing training and increasing capacity for their team members to respond to situations that could result in violence.
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Tom Haederle
Dr. Rogers is vice president and chief medical officer of behavioral health at WellSpan Health.
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Jordan Steiger
So Dr. Rogers, thank you so much for joining us today. We're really excited to learn more about your work, given that workplace violence is, you know, a problem that a lot of our hospitals and health systems across the country are dealing with.
00;01;30;24 - 00;01;47;12
Kenneth Rogers, M.D.
Yeah, you know, it is a huge issue everywhere. Violence against healthcare professionals is going up substantially over time. And so it is such a huge issue, especially post-Covid, with everybody being frustrated, upset about things. And just on edge.
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Jordan Steiger
Absolutely. I know that that will resonate with a lot of our listeners. So before we get started learning about your work, I'd love for you to tell us a little bit about WellSpan Health and just your role within your health care system.
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Kenneth Rogers, M.D.
Sure. WellSpan health is a health system with about 20,000 employees. We're located in south-central Pennsylvania. We cover five counties in that area. Comprehensive integrated delivery system in those five hospitals: Behavioral health. We have inpatient services. We have emergency room services. We have Philhaven Hospital, which is a freestanding psychiatric hospital with 137 beds, about total, about 200 beds across the entire system for behavioral health.
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Jordan Steiger
That's great. And what is your role within the system?
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Kenneth Rogers, M.D.
So my role is the chief medical officer for Behavioral Health.
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Jordan Steiger
For Behavioral Health. And you are a physician, correct?
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Kenneth Rogers, M.D.
I'm an adult child and adolescent psychiatrist.
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Jordan Steiger
Wonderful. Okay. So I know we're here today to talk about the success that WellSpan has had in de-escalating issues of workplace violence. But before we do that, I would really like to learn just about, you know, your own personal perspective as both a psychiatrist and an administrator. What led you to being so passionate about this work?
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Kenneth Rogers, M.D.
So I spent the first part of my career in corrections. A lot of work in juvenile justice. And so one of the things that you learn in juvenile justice is really de-escalation, trying to keep environment safe and really just trying to really think about the environment almost constantly. And so as I progressed throughout my career and working on inpatient child units and in other kinds of settings, you sit there and you look at situations where you're saying that could have been handled so much better.
00;03;34;03 - 00;04;01;05
Kenneth Rogers, M.D.
And a situation escalated that really didn't have to escalate. And one of my positions I had before this was at Parkland Hospital in Dallas. And in Parkland, there was a huge initiative around workplace violence, largely because it's a city-based hospital. There's a mixed population. There's really not a majority population. And so there was a lot of work that was being done in the largest emergency room in the United States around
00;04;01;05 - 00;04;17;29
Kenneth Rogers, M.D.
how do we think about cultural issues? And in those cultural issues, how do we think about workplace violence issues that really arise out of things that people aren't really thinking about, because the perspectives are just so different between the two individuals that often are involved in the situation.
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Jordan Steiger
I mean, that makes a lot of sense. I think that context, you know, in the care environment is so important. And I think a lot of this can often arise from just misunderstandings and miscommunications between people.
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Kenneth Rogers, M.D.
Absolutely. The vast majority of them are simply misunderstandings or lack of communication.
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Jordan Steiger
Right. Which seems like it should be a simple thing to fix, but we know that that's not always the case, right?
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Kenneth Rogers, M.D.
When people are stressed, communication is usually the first thing to go.
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Jordan Steiger
s been since the beginning of:00;05;05;13 - 00;05;06;09
Jordan Steiger
Is that right?
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Kenneth Rogers, M.D.
That's correct.
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Jordan Steiger
Tell me about that. Tell me how this got started and how you've had such success.
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Kenneth Rogers, M.D.
So the BERT team has actually been around for a while. And initially it was a very nursing driven model that really focused on inpatient care and trying to figure out how do we help nurses on inpatient units do a better job. My background is largely from emergency departments. I've spent most of my career working in and out of various emergency departments as a consulting psychiatrist.
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Kenneth Rogers, M.D.
And so when I arrived, a thing that became increasingly clear was there were issues on the floor, but a lot of our workplace violence issues were actually happening in our emergency departments. It was happening in places outside of kind of your traditional patient in bed kind of situation, whether it was with families, whether it was with staff members getting into disagreements with each other.
00;06;02;06 - 00;06;22;06
Kenneth Rogers, M.D.
Those are some of the areas where I felt that it was really a problem. And so as we kind of looked at and talked through some of this and we looked at the training we gave a lot of our mental health professionals, we felt like this is something that we could really roll out to the system in general, so that folks had a greater capacity to be able to actually engage in de-escalating situations.
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Jordan Steiger
That sounds great. So it sounds like this is a nursing led initiative, or has that changed at all, as it's evolved over time.
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Kenneth Rogers, M.D.
Still tends to be largely nursing driven. for most of the inpatient work. However, in the emergency departments and some of the other areas, there are lots of other people that tend to be more involved, especially mental health professionals. Some of our behavioral health counselors, which are master's level clinicians, that are engaged in a lot of that work.
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Kenneth Rogers, M.D.
And so trying to really be more specific based on the areas where people are located.
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Jordan Steiger
That's great. It's always important, I think, to bring up the workforce, you know, because a lot of, hospitals and health systems are struggling with workforce issues right now. So trying to think about who is involved, who it takes to make this successful.
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Kenneth Rogers, M.D.
Absolutely.
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Jordan Steiger
So you mentioned, you know, the on the floor professionals, those master's level clinicians, those nurses, the people that are really doing this de-escalation. But let's talk about leadership and leadership buy-in. Obviously you as the CMO for behavioral health know that de-escalation works. You know, this is a practice that is evidence based that shows a lot of success.
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Jordan Steiger
But how did you get other leaders in your organization on board with this?
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Kenneth Rogers, M.D.
You know, it really wasn't me trying to get other leaders in the organization engaged. It was the leaders of the organization saying that, Ken, you need to be engaged. Because it becomes increasingly clear, if you're the CEO of a health system, that you've got employees getting hurt. You've got a clear vision that they're folks that their morale is dropping, they're frustrated about coming to work.
00;07;58;16 - 00;08;25;13
Kenneth Rogers, M.D.
They don't find the joy at work anymore, and nobody wants to go to work to be attacked by a patient or a family member. And so that, I think, was the vision that our senior leadership of the organization was seeing. And it was really their vision to say, you know, we need to do what we need to do to figure out how to make our employees feel safe, how to help them and enjoy work and help to send a message that this is a safe place to be.
00;08;25;15 - 00;08;56;04
Kenneth Rogers, M.D.
And so that was where we kind of started this entire process from. And I think the other driver was looking at our emergency departments, which were increasingly busy. We had a lot more boarders at that particular point in time. And as people are staying in emergency departments for, you know, days on end, looking at four walls and you already have some degree of agitation in the background, it leads to issues that you just, you know, shouldn't have in hospitals.
00;08;56;04 - 00;09;05;27
Kenneth Rogers, M.D.
And so there was kind of this buy-in from kind of everybody in the organization from almost day one. This is definitely something that we should address and do something about.
00;09;05;29 - 00;09;29;08
Jordan Steiger
That's great that everybody's on the same page. And I mean, you bring up a lot of really important issues. You know, the joy in work, decreasing burnout, you know, increasing worker well-being. Those are all things that I think we all care about right now, especially as you know, we know that that has kind of ebbed and flowed a little bit over the course of, you know, caring for people through Covid and, you know, kind of this period that we're in right now.
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Jordan Steiger
So I think that that's, thinking about this not only from how this benefits your patient population, but also your workforce, I think is really, really important.
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Kenneth Rogers, M.D.
Absolutely.
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Jordan Steiger
So walk us through maybe a patient situation, de-identified, obviously, but something that sticks out to you that, where this BERT program really was successful.
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Kenneth Rogers, M.D.
Sure. I can think of many examples, but I'll give you one that I really think encompasses kind of lots of issues. And this one actually happened on an obstetric service. I had a patient that was there with her family from a Latino background. And if you look at the situation, she spoke relatively good English.
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Kenneth Rogers, M.D.
It seemed like she was understanding things, but there was this sense that she was getting increasingly frustrated. And so BERT ended up getting called because she, the husband, the nursing staff, things just seemed to really blow up. She was getting angry, loud, volatile. What's happening here? And so there was a sense that there were risks to the nurses she's about to deliver
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Kenneth Rogers, M.D.
so there's risks to the baby. Husband's there, so you know what's really going on? So you arrive in a situation and what was, I think, apparently clear from day one, from moment one, is that you had a person whose English skills weren't great. And so there were pieces of things that she could communicate outward but didn't necessarily fully understand especially in a health care context.
00;11;07;19 - 00;11;31;27
Kenneth Rogers, M.D.
And so some of the health care discussions that were occurring weren't really clear. Her husband was less fluent than she was, and so she was trying to translate things that she was understanding to him, and he really wasn't understanding. And so you had this family that was sitting there frustrating because of lack of communication. And so the intervention had nothing to do with medications or anything.
00;11;31;29 - 00;12;01;00
Kenneth Rogers, M.D.
It had to do with, let's get a translator or someone who is Spanish speaking, to help really work the family through what's happening next so they could become much more engaged and involved in their care and feel more empowered. And so that was actually the intervention that BERT did for that particular day. It seems relatively simple, but it's things like that in a health care context that happen all the time.
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Kenneth Rogers, M.D.
People are busy, nurses are busy trying to get things done. Doctors are getting in and out and doing rounds and so people don't pick up on the fact that the patient may not be fully understanding what's going on. So are there things that we can do differently?
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Jordan Steiger
I really love that you use that example, because I think oftentimes when we think about, you know, de-escalating situations, we think of a situation of violence. And this is not something that required any kind of intervention in that perspective. It was just really taking that moment, like you said, to understand the patient's needs and course correct. Right. So I think that's a great example.
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Kenneth Rogers, M.D.
Right. And so in that particular situation, I think there were really a number of super positive things that happened. One, the nurse that actually did the birth call recognized that things were escalating before they really got to kind of that violence place. So that was the number one thing. I think the other thing was the level of support that she felt to be able to do that, because having done a lot of work to make people feel comfortable that, you know, if you need help, just call.
00;13;05;20 - 00;13;26;22
Kenneth Rogers, M.D.
And so there wasn't a hesitance to do so. But then there were also people that could respond relatively quickly. And having the resources and understanding of those resources to be able to provide them in real time to the staff and patients. Because that was a situation that could have spiraled out of control very quickly, because you could see that the family was getting increasingly upset.
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Kenneth Rogers, M.D.
The staff was a little nervous and scared, and you put those two things together and it doesn't lead to a great outcome. But, able to get her calm pretty quickly. Family was actually happy with the situation and the rest of the delivery went smoothly.
00;13;42;04 - 00;13;56;18
Jordan Steiger
Sounds like best case scenario. And again, a great example of why a program like this in your hospital can really be beneficial. One thing I'm realizing I didn't ask you that I think our listeners would be curious about is how are people trained to be on the BERT team?
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Kenneth Rogers, M.D.
Our behavioral health professionals working on any behavioral health unit, inpatient or outpatient, go through a three day mandatory training. And in that three day training, the first portion of it is really looking at the phases of escalation and de-escalation and being able to recognize when somebody's at really low level and when they're kind of going up to some of the higher levels and looking at de-escalation techniques to be able to get them to that place. Day two and three are looking at more mental health based interventions and trying to think about more hands on figuring out how do you get people really calm when they're beyond, the place that they can be
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Kenneth Rogers, M.D.
de-escalated. So what we've done with BERT is really trying to make sure every employee in the health system gets at least part of day one, so every employee is able to recognize the levels of escalation, levels of de-escalation, and some basic skills to be able to do that. Then for people that are going to do more mental health or BERT related work is really thinking about day two of a lot of that work where you're getting some more in-depth skills to be able to manage some of those more difficult situations.
00;15;20;10 - 00;15;43;25
Jordan Steiger
That makes sense. I love that you focus on giving training to all of your workforce and then, you know, really kind of, focusing in on those behavioral health providers. That's great. So I think, Dr. Rogers, your example of your program is truly one of the best that I've heard of across the country. I mean, being able to de-escalate, you know, violent situations by 75% is pretty incredible.
00;15;43;28 - 00;15;53;20
Jordan Steiger
So if another, hospital or health system is maybe inspired by this conversation to think about this in their own, you know, care setting, what advice would you give them?
00;15;53;23 - 00;16;17;18
Kenneth Rogers, M.D.
So I do think that it's important to make it part of your culture. Because one of the things, for example, that you want is to make sure that the folks that are going to respond to any kind of aggressive incident have training in how to manage it. So, for example, if you think about security force, for example, a lot of security officers aren't really trained in de-escalation in a hospital setting.
00;16;17;20 - 00;16;45;07
Kenneth Rogers, M.D.
They're really trained to manage situations really well. But if you've got somebody that's really in distress in the hospital situation, that training may not work, but security's often the first folks that we're going to call. So making sure that those folks are able to incorporate those de-escalation skills into what they're what they're doing. I think the second thing that's really important is to look at the administrative culture. We started talking about earlier,
00;16;45;09 - 00;17;15;01
Kenneth Rogers, M.D.
what's the buy in? Some hospitals and clinics find themselves really engaged in behavioral health work. It's what they do. They feel very comfortable with it. Others really want to keep it at arm's length. And so trying to develop a culture where responding to behavioral issues becomes the norm and people can do that compassionately and do it without becoming frustrated very easily because it's very patient-centered work.
00;17;15;01 - 00;17;38;01
Kenneth Rogers, M.D.
And I think the more people understand the patient centered-ness of what we do, the more people are able to really, really engage and be a lot more, lot more involved. And then the third piece I think that's important is to look at the outcomes for staff. If you think about trying to retain staff, trying to train new staff, that's one of the hardest things for health systems to do.
00;17;38;05 - 00;17;57;27
Kenneth Rogers, M.D.
And so trying to think about the return on investment, even if you feel like the time for training, the extra effort we're putting into it may not be worth it. If you're able to retain additional staff members and not have to retrain, I think that's definitely one of them. One of the huge benefits.
00;17;58;00 - 00;18;14;01
Jordan Steiger
Absolutely. Thank you so much for, you know, sharing those quick pieces of advice and your wisdom about this work. I think that you really are kind of leading the way in terms of the outcomes you've been able to achieve. And so we're really, really appreciative that you were able to come share with us today.
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Kenneth Rogers, M.D.
Thank you so much. I appreciate you having me.
00;18;16;13 - 00;18;24;23
Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.
