“From our perspective, it is much more difficult to see violence against hospital workers than terrorists”, states Reuven Keren, Director of Security for the Israeli Ministry of Health.
All types of violence and criminal acts that exist in society are also present in hospitals. To Reuven Keren, General Director of Security, Israeli Ministry of Health, there are a plethora of examples: thefts, infrastructure damage, physical aggression, and attacks on the pharmacy to steal controlled substances…
According to Keren, it’s easier to identify a terrorist attempting to carry out an attack in a hospital than it is to identify potential criminal or delinquent acts. Hospitals are equipped with the physical and technological means, including security personnel, to identify potential terrorists according to certain suspicious signals.
“It’s much more complicated to identify a potential criminal or aggressor, because he tends to act normally, and there aren’t necessarily signs that suggest a potential violent act. Within 10 minutes the situation can explode; the criminal acts, security personnel restrain him or her, the authorities are called, and from there the incident is handled by the police. In other words, our involvement is typically a posteriori, a reaction to an incident”.
“One should always take into account the fact that when someone arrives at a hospital, he isn’t in the greatest of moods. He’s stressed, and demands immediate attention. He thinks that he is the most important patient, without regard to the 10 other patients waiting their turn before him. Most physical and verbal violence in hospitals is initiated by family members of the patient who have accompanied him to the Emergency Room. Therefore, security personnel are on a higher level of alertness when a patient arrives accompanied by family or friends”.
So what can be done to prevent violent acts against hospital staff members?
We implement various measures. First of all, we train the hospital staff – from doctors and nurses, to administrative personnel and security guards – with the proper tools needed to avoid or control potentially violent situations. This is achieved by means of very specified training. One of the main issues is how to preemptively reduce the stress level of those patients who are about to enter the hospital grounds. This is achieved, among other ways, through the creation of peaceful conditions for those waiting; a spacious waiting room, calming music, television monitors, etc.
Additionally, the hospital is equipped with monitoring technology, such as CCTV cameras. They are placed in obvious, visible areas so as to dissuade, but are also used to document incidents and capture footage.
Does the Mnistry of Health have statistics available regarding the distribution of violence in the various hospital departments, and the reasons for these acts?
We know that the number one cause for violence is low patient or family satisfaction with the medical services rendered. We also know that roughly 30% of violent incidents are aimed towards security personnel, 25% against doctors, another 25% against nurses, and the last 20% against other hospital staff. Also, as the rate of violence against security personnel is higher, it is lower for the remainder of the staff, because the violence is stopped at that first line of defense and doesn’t make its way to the other workers.
Earlier you spoke of training hospital personnel. Does the type of training from one department to another?
Despite very clear divisions among hospital departments, the staff training is unified. And this is because we believe that in regards to reacting to violence, doctors, nurses, administrative personnel, cleaning and security staff make up a single team. This is especially true for the Emergency department, the front line for these types of incidents.
Before beginning training, we gather statistics about past incidents that occurred in the hospital, creating as complete a picture as possible: what happened, where it happened, and why. Through our research we have discovered that 42% of the violent acts took place in the Emergency area, and that 64% of these incidents were initiated by a family member or friend, and not the patient himself. Today, all Emergency areas are equipped with security personnel, CCTV, panic buttons, and other similar means of security.
Have the Ministry of Health and the hospitals been satisfied with Israel police response to violence in hospitals?
It’s hard to say. But it’s important to mention that there’s not much more that the Police can do. When someone is arrested, he or she is brought to the judge the next day. A file may or may not be opened, and if one is, it may take years to reach a verdict.
So perhaps another type of mechanism could be created?
That’s exactly what we’ve done. This year we created a new body to deal with the issue of violence in hospitals. Every hospital has its own board to deal with criminal acts. It is headed by a representative from the Management, and all violent or criminal incidents are referred to the board. Occasionally the board meets to analyze the incidents that have occurred, and to draw conclusions. If, for example, the board notices that the majority of incidents have taken place in a specific department, security in that area will be strengthened. Or if we discovered that a certain doctor has been the victim of violent acts, we can explain to him what he might be doing wrong and give instructions as to how to avoid or change behavior.
Today there is also an inter-departmental board to deal with the issue of violence in hospital settings, of which I am the president. On the board sit representatives from the police, and the hospital unions. They meet to study the cases, and their conclusions and recommendations are then sent to every health-care body in Israel.
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