Environment of Care Management—Is Your Security Plan as Strong as It Should Be?

Environment of Care standards aren’t just about compliance or accreditation — they’re the way to sustain a culture of safety for staff, patients, and visitors.

A deep dive into Joint Commission (JC) standards doesn’t make for the most exciting reading, we know. But as workplace violence in health care continues its alarming trendline, security plans — and their role in sustaining the environment of care (EC) — are vital to reducing the risk that staff, patients, and communities are currently facing.
 
JC Leadership Standard LD.03.01.01 states:

“Leaders create and maintain a culture of safety and quality throughout the hospital.” 

Broadly summarized*, the Elements of Performance for this standard emphasize practices like:

• The use of reliable tools and processes to build and sustain a culture of safety.
• The inclusion of all staff in a sustainable culture of safety.
• The provision of education and the facilitation of openness to discuss issues of safety and quality.
• The development of codes of conduct that identify the behaviors that support or undermine a culture of safety. 

Guidelines like Environment of Care standards, OSHA recommendations, and CMS requirements — to name a few — all form a comprehensive framework for a culture of safety in health care. Security plans are a unique opportunity to bridge these technical requirements with a person-centered strategy that supports the care and welfare of every org’s most priceless commodity: its people.

(Do your staff face verbal abuse from patients? Check out Verbal Intervention™ training.)
 
The JC’s Environment of Care standards name Safety and Security as the first of six functional areas [PDF] that require a comprehensive management plan. These expectations merge elegantly with the standards set for org leadership in health care. So an appropriately thorough strategy can both fulfill regulatory requirements and sustain a meaningful culture of safety.

Effective Environment of Care management plans succeed through staff collaboration — so what’s your plan to get everybody on the same page?  

The right safety and security training ensures that a team approach is consistently activated to keep your management plan up to date and compliant — and that staff, patients, and visitors can all benefit from the same level of quality within a culture of safety.   

“Your security program must include a plan for teaching new employees their responsibilities regarding hospital security. Give them ongoing security updates and in-service training.”

This places a hefty responsibility on security directors — not only informing staff across an organization that they all have a role to play in creating a safe work environment, but equipping them with the practical violence prevention resources that fit their respective levels of risk and responsibility.
 
Among the range of concerns that security departments strive to address, workplace violence is one that’s particularly challenging. It’s a fairly straightforward process to get everybody on the same page about what to do in a fire drill, or how to work with hazardous materials. But it can be more daunting to get health care workers in agreement about what constitutes workplace violence, and how to proactively and effectively address its associated risks of harm to the EoC.
 
Fostering this kind of collective understanding, and having it result in meaningful risk reduction, starts with making workplace violence education available to all staff at every level in an organization. For example — clarifying the complete continuum of violent behaviors is a way that staff across departments can embrace a common language and shared strategy for effective prevention and safe intervention.
 
The National Institute for Occupational Safety and Health (NIOSH), identifies four main types of workplace violence:

• TYPE I: Criminal violence — this type of workplace violence is perpetrated by individuals with no relationship to the organization or its staff.
• TYPE II: Patient violence — a customer, client, or patient who has a relationship to the organization and becomes violent while receiving care or services.
• TYPE III: Lateral violence — violence between coworkers, including attacks or threats.
• TYPE IV: Domestic violence — violence involving a personal relationship; the perpetrator of this violence has a personal relationship with the staff member. 

 Types II and III are typically the greatest threat to health care workers, but that’s a lot of detail to parse while simultaneously managing patient care.

At CPI, we’ve distilled our definition of violence to a continuum of behaviors that everybody can recognize — no matter where they work in your organization. Common language that supports a team approach to workplace violence prevention is essential when it comes to providing the security training that covers everybody in your EC management plan.

Creating visibility around the risks and manifestations of interpersonal violence, providing practical training that fits the level of risk and responsibility for every staff member, and including patient and community outcomes in your strategy are not only great ways to fulfill the expectations of regulatory and accrediting bodies like OSHA or the Join Commission — they’re essential to achieving a lasting reduction in the risks of harm due to challenging and disruptive behavior in the health care setting.

Achieving compliance is the first step — improving your Environment of Care will also translate to better patient outcomes and satisfaction scores, as well as better staff retention and less lost time.

Creating EC management plans that fulfill best practices is a way to keep your hospital in compliance on paper. But when staff get the right kind of education and training, they’re able to really live the philosophies that build safe, functional environments of care — which means that even more positive outcomes are achievable.
 
Why are these added benefits critical?

• Health care workers, when surveyed, have reported that they identify a link between disruptive behavior and adverse outcomes — including medication errors, near misses, and patient mortality.
• They’ve also reported that relational aggression impacts their ability to deliver care and even their longevity within their careers.
• Workplace violence in health care is linked to thousands of lost time claims each year and millions of dollars in claims paid — these are just some of the metrics that reflect the trauma, burnout, and fatigue that drive capable individuals out of promising careers.
• And that turnover has also been associated with adverse patient outcomes — for example, hospitals with lower RN turnover (RNs face some of the greatest risk of workplace violence in health care) see lower risk-adjusted mortality and shorter patient stays.
• Finally, orgs that make the time to establish truly inclusive, effective violence prevention strategies as part of their environment of care management plans see the return on investment in better HCAHPS scores and related patient and staff satisfaction surveys.

 Safety and Security are two of six total functional areas that require management plans, but when addressed with a comprehensive training solution that’s inclusive of all staff, they support the sustained well-being of the complete Environment of Care.
 
Learn more about how to boost your EC with time-tested violence prevention strategies. Check out our free, comprehensive resource for security directors. 

A systemic solution supports the foundational elements of the Environment of Care — and keeps a culture of safety thriving at your hospital.

Per the Joint Commission’s Comprehensive Accreditation Manual for Ambulatory Care (CAMAC), the Environment of Care is made up of three core elements:

• The building or space, including how it is arranged and special features that protect patients, visitors, and staff.
• Equipment used to support patient care or to safely operate the building or space.
• People, including those who work within the organization, patients, and anyone else who enters the environment, all of whom have a role in minimizing risks.

 That third element — people — is the most vital to the entire equation. A truly functional EoC is one in which staff, patients, and visitors can all expect enhanced Care and Welfare as a benefit of key functional areas like Safety and Security.

Security directors have reported that two of their biggest challenges in effectively addressing the threat of workplace violence to the care environment are:

• Getting the right people trained in the most time-efficient manner
• Finding training solutions that fulfill regulatory requirements and are easy to document

 
But they’ve also shared that top benefits of a successful security management plan include:

• Training solutions that fit all staff members, not just security
• Increased awareness about workplace violence across hospital staff and administration

Security directors, ask yourself three questions

If you’re a security or safety director, it’s important to ask yourself these questions as you evaluate your strategies for reducing the risks of harm and keeping your organization in compliance with best practices:

• Does our org’s plan allow for the education and training of staff about the risks of workplace violence and how to address them?
• Does our org’s plan align with the best practices prescribed by the Joint Commission, OSHA, and other industry authorities?
• Does our org’s plan maintain a person-centered approach that supports staff retention, optimal patient outcomes, and community safety?

Ready to create a safe, functional Environment of Care program that works for everyone in your facility?

If you’re ready to dive deeper into strategies that support best practices and regulatory requirements — and generate measurable reductions in risk, restraint use, liability, and lost time — make sure to grab our free eBook, Lead with Confidence: CPI’s Handbook for Hospital Security Directors. It’s got 20+ of our best tips that staff can use immediately, and plenty of case studies from successful security programs with outcomes you can duplicate.

 
_{*Editor’s note: We summarized where appropriate to save you time. You can find the full text of this and other Standards and EP’s on the Joint Commission’s website.}