A Workforce at Risk: Securing the Frontlines of Care | With Eric Sean Clay at FMOL Health

Speaker A: Physical violence costs hospitals around $18 billion a year. It's the greatest threat facing healthcare as we know it today. It's pervasive. It's escalating. Um, it's a problem that's not going away. Prioritizing the safety and well being of caregivers really has to come first. But I don't think you can say it enough. I don't think people realize the amount of violence that occurs. I've seen firsthand how it's driving caregivers out of the industry. They're very concerned about their safety. Rightly so. Around 180,000 caregivers leave the industry each and every year due to concerns about their safety. Causes burnout, it causes distraction, it erodes patient safety and patient outcomes. At the end of the day, I, um, have a goal in mind. I want to see, you know, workplace violence eliminated. Ah, if possible, more should be spent up front in preventing incidents and not responding to them after the fact.

Speaker B: Welcome to the Digital Healthcare Experience brought to you by Taylor Healthcare.

Speaker C: Hello and welcome to the Digital Healthcare Experience podcast presented by Taylor Healthcare. I'm your host, Chris Civitarise, and today I'm joined by Eric Sean Clay, transformational security executive with more than three decades of law enforcement and security experience. Currently serving as the Vice president and Chief Security Officer for the Franciscan Missionaries of Our Lady Healthcare System, Eric is sought after as a subject matter expert in security issues. He's delivered keynotes and presentations at international conferences, and he frequently appears in national publications and media interviews on the topics of healthcare security and workplace violence. He is also the immediate past president of the International association of Healthcare Security and Safety. Welcome, Eric. It's great to have you on the show.

Speaker A: Thanks so much. It's great to be here and to start.

Speaker C: Can you share a little bit about your background and the work that you're doing today at Franciscan?

Speaker A: Of course. I spent most of my life working in law enforcement. Um, I've worked as a private military contractor. I've done some work leading hotel security and then got into healthcare security around 2015, where I felt like I really found my niche. Um, got a bachelor's degree in criminal justice, master's degree in criminology and mba. Numerous certifications including the, um, IHSS chpa, which is the certified Healthcare Protection Administrator. Um, currently working as the vice president and CSO of security for fmol, uh, Health here in Baton Rouge. Um, where we're really working around the issue of workplace violence and really trying to try to move the needle on that. Um, I also have my own consulting firm that works with law firms that represent healthcare organizations.

Speaker C: Yeah, that's awesome. And I know you and I were talking kind of backstage on this podcast. We've sure talked a lot about security through the lens of data breaches and information security and things like that. So I'm really excited to dive into safety and security from this point of view. Can you give us some context, I guess, as to why the conversation around physical safety is so important? I think we all know that intuitively, but help us contextualize what we're actually talking about here?

Speaker A: Yeah, I think, um, this, it's, to me, in my opinion, it's the greatest threat facing healthcare as we know it today. Um, there's a lot of back and forth around cyber security versus physical security and which one uh, really has, um, should be the priority. And I think you know that uh, there's, there's significant enterprise risks in both areas. The compromise patient safety, they can hurt the financial stability of an organization, the uh, operational continuity of a hospital. Um, but from my viewpoint, I think that uh, prioritizing the safety and well being of caregivers really has to come first. Um, that's not to say that we stop investing in resources that can prevent, uh, cyber attacks, but I think that both areas are critically important, uh, not only to healthcare organizations, but to our community. Uh, I've done a lot of research on this, uh, and I know that um, cyber attacks cost a lot of money. We um, spent a lot of money on preventing them. I think, uh, I read around 25 billion spent each year trying to prevent cyber attacks, uh, from uh, occurring while physical violence, um, costs hospitals around $18 billion a year, um, which is a significant amount of money, um, that doesn't really include some of the hidden costs that you see, such as the depression, the anxiety that caregivers feel after uh, going through an event such as that, um, the ptsd, um, that they feel even when they just witnessed the violence, that the violence wasn't perpetrated against them. Um, and caregivers are four times more likely to take off time from work, um, due to workplace violence related injuries and other injuries. So you know, when we look at that $18 billion that's being spent around uh, workplace violence, um, only 3 billion is being spent on pre event costs such as security investments, um, training, facility upgrades. That 15 billion is really spent to treat injuries, uh, bring in additional staffing, legal, uh, issues, facility repairs and upgrades. But it's all after the fact. Um, so my feeling is what we really need to do as we do with cybersecurity, I believe more should be spent up front and preventing incidents and not responding to them after the fact.

Speaker C: That, yeah, those are some pretty stark and shocking, if you will, statistics there. Um, and I know from somebody who's not an expert in this field, you kind of see what you see on the news, and obviously these types of events may m. Be well covered, but your experience on the ground, um, in a way that probably the average person like myself, just would never have a lens to. So help us understand how widespread is workplace violence in healthcare now. And what are you seeing on the ground?

Speaker A: You know, I think, um, anyone who works in healthcare, uh, on the, on the patient care side of things, would, would tell you that it's pervasive, it's escalating. Um, it's a problem that's not going away. Again, caregivers are five times more likely to experience violence in any other industry. That's a stat that, you know, is said a lot, but I don't think you can say it enough. I don't think people realize the amount of violence that occurs. I mean, that's including law enforcement officers and correctional officers who you would anticipate would have a lot of, of violence committed around them. Um, but we're seeing five times more than what they're seeing. Um, and as shocking as that statistic is, um, we know that for a variety of reasons, that number's greatly underreported.

Speaker C: Wow.

Speaker A: So as I speak to healthcare, uh, workers, practitioners, both in the US and abroad, um, they're very concerned about their safety. Rightly so. Um, I've seen firsthand how it's driving caregivers out of the industry. Um, you know, there's a stat I think I saw a couple years ago that said around 180,000 caregivers leave the industry each and every year due to concerns about their safety. Uh, it causes burnout, it causes distraction, it erodes patient safety and patient outcomes. At the end of the day, um, I think it's. It's something that, again, we really need to focus on. Uh, there is a downstream effect that I think that people don't really consider, and that is that, um, everybody's going to need medical care at some point in their life. And if we don't address this problem, uh, the level of care that we get is not going to be the level of care that we want.

Speaker C: Yeah, yeah, absolutely. And you hit on a couple of things there that I'd love to pick up on in a little bit more Detail. Um, the first, to me that's again, fascinating from kind of looking outside in, um, is that this goes so much further than just the immediate harm to staff or to others involved. And you've said that it affects the quality of care, the financial performance. Give us a little bit more context. As you sit at that executive table with your peers, how are you educating them? What are you talking about in terms of those effects? And can you give us a little more detail on that?

Speaker A: Yeah, of course. Um, you know, I think that, as I've said, there's a number of downstream effects, uh, some of which we've kind of touched on. Um, so really what I try to educate people on is that, you know, first there's this fear of patient generated violence that caregivers have. Um, you know, I was asked recently by someone, uh, on LinkedIn to stop using the term patient generated violence. Um, they feel it's prejudicial. I, I disagree. Um, I think that, uh, patient generated violence addresses the unique source of the violence. It provides a level of context. Um, it speaks to the legal and clinical nuances of violence that are perpetrated by patients. Um, and it allows us as security professionals to know what specific issues we're dealing with, uh, and how are we going to address those issues to better protect caregivers, patients, visitors and facilities. Um, so to answer your question, I think that fear and violence can lead to what's called defensive medicine, where caregivers limit their interactions with patients. They, uh, don't prescribe needed medical care and they don't, you know, take the best care of the patient because they're afraid of that patient. Um, there can also be medical errors that are committed if they're distracted, if they're more focused on their safety than they are and what they should be doing. We could have, you know, the wrong medications could be, could be given. To me, it's just caregivers can become emotionally detached or burned out whenever they're, they're faced with this sort of thing on a daily basis. Um, and again, like I said, there's. We see this mass exodus of caregivers who are leaving the industry, uh, to seek opportunities where there's less violence. I think financial performance, which to me is secondary to the harm to caregivers, uh, and patient outcomes. We see higher recruiting, uh, costs, um, higher retention costs for hospitals, reputation damage, uh, um, these are all costs that are passed along to the patient. At the end of the day, if we have to bring in, uh, additional resources, whether that be contract labor, um, Add security mechanisms to reduce incidents of workplace violence. Those costs get passed along to the patients at some point. I think there's also higher insurance and legal costs. There can be potential OSHA penalties, uh, malpractice suits or lawsuits from caregivers when they feel that they're, uh, not being protected. So I think there's this huge financial cost that people aren't really thinking about. Uh, I think everybody believes that healthcare, um, is very expensive and it is. Um, but I think that, you know, when you really dig into the numbers, you see the margins are very thin for healthcare organizations. There's not a lot of money that's made at the end of the day. Um, and we do this because we want to help people. We do this because, you know, it's a calling, I think, um, and if we don't address these things again, I think there's just so many things that occur and brand damages that I talk about with to organizations all the time is you don't want your organization to be that organization that people look at go, I would go there, but it, I don't feel safe when I'm there. You don't want your caregivers leaving because they don't feel safe. So I think there's a lot of things that we can focus on. Uh, when we look at this as why do we need to address this issue?

Speaker C: It is just so fundamental. Um, and it kind of goes along, I think, with one other thing that you mentioned as well. And um, I like the way that I'm probably going to get this wrong, but I really like the way that you said this, that the, the violence that we're seeing is not just a healthcare system problem, but it's a community problem. Um, so I'm curious, what do you wish the public understood that maybe they're not privy to or that you wish was out there in more detail?

Speaker A: You know, I talk about this anytime I go in and talk about workplace violence. And what I would say is I wish the public understood that taking their frustrations out, uh, either verbally or physically, it takes a heavy toll on caregivers. So for me it's important that we not see patient generated violence as a healthcare issue. Uh, this is a community issue and one that will eventually impact everyone in the community that needs medical care, including their children, their loved ones. Uh, so I think really to assure that our communities have access to quality, affordable health care, we've really got to start prioritizing the, uh, protection of caregivers. Uh, failure to address this issue. I think is going to have a detrimental and long lasting effect on health care and patient outcomes. So I would just told them I understand that long wait times can be frustrating, um, but it's kind of, it's a, it's a cycle that, that occurs when we have more violence, we see more caregivers leave the industry, we see higher cost, we see um, diminished patient outcomes, um, which causes more people to become frustrated, which causes more workplace violence. So if we could really kind of uh, change the perception that uh, patients have and understand that we're doing everything we possibly can to provide them with that, that high level of care that they need. Um, it's just we need to really work together, I think, to solve this problem.

Speaker C: Yeah, absolutely. And it's interesting to me because some of the statistics that you've given us here again are pretty compelling. I mean $18 billion spent in this space, but only 3 billion from a prevention perspective. Hundreds of thousands of caregivers that are leaving the field and sometimes it's a direct, ah, result of concerns around their safety. But um, it also sounds like, you know, maybe from your perspective that the industry as a whole isn't doing enough in terms of that investment on the front end and investment in the problem and so on. So why do you think right now there's that disconnect between the outcomes that we're seeing and, and maybe the motivation of health systems that aren't as well versed in this, um, to make some of those investments on the front end of it.

Speaker A: You know, I think that probably it comes down to is it's a different risk appetite that organizations have and they think that there's little chance of this happening, um, to the degree that I need to, to um, to make these significant investments. Because sometimes security investments can be, can be very costly. Um, but I also think that it's something again that, that really needs to be done, that you really have to, to think about again, that, that $15 billion that's being spent post event, right? To me there, there's a way that you could, you can quantify that to say that we're actually going to be saving money if we make these investments on the front end. Uh, we are, we're better protecting our caregivers, we're better protecting our brand. We're not seeing, seeing our caregivers leave to go to an organization where they feel better protected, which is going to allow them to again, focus on providing quality care to our patients. Um, I think you could make the argument that HCAP scores can go up at that point because if they're, the staff is focused on providing that quality care, they're not worried about their safety. They're doing everything they can for better patient outcomes. And that translates to me, to patients that are, they're getting the outcomes that they want, that they are happy with the care they're receiving. And so I think, um, it's really just reframing how people think about this issue. And I get at the end of the day that, you know, healthcare organizations are there to provide healthcare and a lot of the investments they make, again, we don't make a huge amount of money at the end of the day. Right. And a lot of that money's got to go to providing care. It's got to go to the MRI machines, it's got to go to um, all the things that go in providing that care. So security is typically not the primary focus, uh, of where we spend our money. But I think that we've seen a huge shift over the years, over the last few years, uh, since COVID to where more money is going to security initiatives, which, you know, some people would say that's great to me, I would rather we not have this issue, um, of violence and that that money was going towards better care, better quality equipment, uh, to provide that care. But um, we need to spend that money at this point in order to protect our caregivers so that they can still be there to provide the care. So it's, it's kind of a, it's a difficult situation to solve and I think that's why no one has really figured out exactly what we've got to do because there's a very fine line of balance that has to be maintained. I think at the end of the day, again, it comes down to everybody working together to try to solve this problem and even the community plays a role in that.

Speaker C: So help us understand, obviously you're a leader in this space with your health system in your day to day, you have a consultancy around this space as well. Um, so obviously you've given tremendous amounts of thought to the investments and strategies that might actually make caregivers feel genuinely safer and genuinely supported. Help us understand, as you look, as you look at your own health system and then your clients, what are some of those investments and strategies that do seem to be working?

Speaker A: I think orchestrated safety efforts with strong policies are where you got to start. The, uh, use of technology can make m caregivers uh, feel better protected. That's a, uh, force multiplier, um, that you can't Overlook, uh, some of the things that I like and I'm very excited to see that we're doing here at FMOL health would be, um, uh, lightweight, wearable duress alarms that allow our caregivers to discreetly contact security if there's a problem. Um, and around the policy piece of that is making sure that they understand that don't wait until there's a problem to call security if it looks like a problem is starting. Uh, we would rather you contact us early and us get there and be able to help solve that problem before it becomes physically violent. I think that designing facilities with safety of mind, um, having clear sight lines throughout the facility, um, you know, access control for sensitive areas, making sure you've got adequate lighting, uh, using SEPT principles when you're, you're designing these facilities. I think again policies that clearly state that physical or verbal abuse will not be tolerated and what those penalties would be. Um, I think a big thing is non punitive reporting that encourages nurses to uh, to report incidents of violence without fear of blame. Um, some of the groups that I speak to when I talk to nursing leadership groups, they talk about um, not reporting incidents of violence for fear of being blamed for. Why did you cause this issue? And so I think making sure that they feel that they can report these incidents without judgment is uh, critically important. Um, I think de escalation mastery, not training, uh, we train people to do these things and then it's like a box is being checked. But really focusing on that de escalation piece, um, I've seen some people talk about non escalation, uh, figuring out ways to prevent things from escalating in the first place, which uh, to me sounds fantastic. I think that's not as easy as it could be. So I think the really focusing on the de escalation piece and teaching people how to do that at a very high level, um, I think psychological and peer support groups are important. Um, making sure that caregivers feel supported after violent incidents, um, are all things that um, organizations should really be focusing on.

Speaker C: It's really interesting. I mean, so not unlike a lot of problems that we see in healthcare and other uh, industries. It's kind of people process and technology. And you've described obviously some technology. We'll get a little bit deeper into some of those things in a minute. But I'm fascinated about uh, kind of the way that you've described that because it is technology, it's people in terms of working with other executives in your peer group, like leaders in nursing. Um, and it's also process around policies, procedures, things like that. So I, uh, mean, it's. Whenever we talk about something like that, it really feels as though that becomes a commitment from a culture or an executive perspective to make strides in a particular area. Would you say that that's, I guess, accurate in this space? And talk to us a little bit more about how this kind of topic hits the executive level. Um, and again, among your peers, as you guys are sitting in the boardroom or the conference rooms, what other pieces and parts of the organization are you going to, to, uh, to make progress in this space?

Speaker A: Well, I think again, it's, is again, the, the biggest issue that we have in healthcare. I don't think anyone who's talking about healthcare is not talking about workplace violence and ways to mitigate it. So I think when we all get together, um, again, we all have a role to play in this. And I think that partnerships, uh, are, are incredibly important. I try not to, in my role, I try not to just dictate how things should work because, uh, I can come up with an idea and I can say this is going to solve our problem. Um, but the caregivers who are the ones who have to follow through on this, it may not work well for them. And so I think when we're all in the same room and we're talking about these issues, I think collaboration and talking about. Here's what I would like to see. Um, I have a goal in mind. I want to see, you know, workplace violence eliminated, ah, if possible, and then having the other people who are at the table say, well, here's the part I can play, here's how I can make that happen. And then we all work together and we come up with the best plan that makes, you know, the progress that we want to see. Um, but actually works for the people who have to live within the confines of whatever policy or procedure that we define. Um, so, uh, it's a, it's a partnership. And again, um, I think everybody's got that important role to play, and I think everybody has the same goal at the end of the day is to solve this. Um, you know, I try to. Any, any security initiative or technology that I come up with, I always try to partner with nursing. That's uh, typically like 80% of your, uh, of your staff are going to be nurses. And so if you can get, um, buy in from your nurses, I think that they typically have a very, a very large voice that can help amplify what you're trying to say. Um, and when you go to the administration, you go, here's a security initiative that we want. It's going to cost X amount of dollars. Um, nursing has, you know, is there at the table with us and they're saying, yes, we think this is going to work. I think you have a much better chance of success whenever you get all the different caregivers, you know, whether it be physicians or nurses involved in the, in the solution. And you all say, this is what we think is the best idea moving forward. Um, security, um, is typically, you know, a cost center. And again, we don't always get the things that we want because there are, there are priorities that, uh, we may be unaware of. It may be again, equipment purchases or other things that we're trying to do in order to continue to provide care in the community. But if you can get everybody there to say, yeah, we think this is going to have the desired effect, I think you have a much better chance of success.

Speaker C: Yeah, that makes perfect sense. And I want to go back to the technology angle on this. So. And you mentioned a couple of things that the wearable distress alarms is a fascinating technology to me. Um, I know you've also talked about concealed, um, weapons detection. Um, you've looked at AI, camera analytics, and then we have this whole, um, cascade of machine learning, data analytics, AI and so on coming into play in terms of predicting and preventing, um, violence before it happens. Um, can you give us some more context? What's new in security technology and what's coming that we should all be aware of?

Speaker A: Uh, I love the duress alarms as you, uh, as you talked about. I love concealed, um, weapons detection. I think that, um, a lot of these technologies are really around reducing anxiety of our caregivers. If they feel that weapons are not being permitted into the facility. That's one less concern that they've got. If they have a way to discreetly notify security and whenever they feel threatened. Um, I think that's another thing that helps reduce that level of anxiety they've got and allows them to focus on providing that quality of care. Um, I think that some of the things that you're seeing, um, as in every other industry, every other vertical in the world, AI is ah, huge. Um, it's used in, uh, the concealed weapons detection, um, as it's looking and learning how, uh, to be better at detecting weapons. Um, I think that's only going to become more pronounced over the years, um, making security technology more effective and more capable. Um, I like cameras that use AI to look for visual cues such as Grow behaviors that are associated with aggression. Whether it be the person is, you know, starting to pace or they're, they're making a fist, um, it can look for these things and go, hey, there's a problem, potential problem there. Notify security. Security can come over, intervene, de, escalate before the situation escalates. Uh, so I like that. I like, uh, some of the audio detection that, uh, you can add to camera systems now that look for, um, raised voices, sounds of glass breaking, or you can program in keywords, um, that alert security before a physical altercation even begins. Um, I like predictive, uh, modeling that analyzes past behaviors and looks for and identifies potential issues that may allow us to, uh, proactively manage them. I know that some of the predictive modeling things, uh, sometimes are controversial, but again, um, and the security side of things, we're always looking for ways that we can better prevent things from happening, better protect caregivers. And so to me, um, if we know there's a potential problem from a patient who's exhibited aggression, um, in the past, if we can figure out a way to prevent that person from becoming agitated again, if we can, um, know what cues set them off, what we were able to do to de escalate that person, to me, that's a win at the end of the day because we want them to get the care that they need. We want the caregiver to be safe, we want the patient to be safe. Um, so anything that we can do, within reason, of course, um, are things that I think, uh, we should be trying.

Speaker C: When you're evaluating technology or policies, procedures, strategies, so on and so forth, I mean, I think of healthcare and there's just such diversity in terms of the different types of environments that you have to solution for. You've got, you know, very public and accessible eds. You know, you have obviously nursing floors, you have the physician offices. A health system like yours has a lot of different kind of touch points, and a lot of them are kind of soft, if you will. So when you, when you think about this world and you think about the technologies, processes, policy, so on and so forth, are you looking for solutions that can fit a number of these different environments? Are you looking at the individual environments themselves and solutioning on a smaller scale? Talk to me a little bit about how you think about the world. When you're dealing with such a significant organization with all these different touch points.

Speaker A: I think you really got to look at it from both angles because sometimes, um, you know, you've got a facility that's Very unique and the services they offer and the layout that it has and the staff that are there. Um, so sometimes you're going to have something that is a, um, designed specifically for that facility to make sure that you meet the needs again at the end of the day, what, what we want. I can sit and think this is a great solution, but it may not meet the needs of the caregivers at the um, at that facility. So um, I typically try to think of things from a system standpoint that I would like. If I can find a technology that solves a number of problems and can be applied across the system. Um, that to me just makes more sense than having, you know, disparate standalone systems. Right. But again there are times when we do need to have something. We may have a behavioral health facility that has again a very specific um, uh, patient. We have uh, different ways that we handle, we receive patients there. It's not as open as say our EDs or our other clinics and things. So we may need to do things a little differently there. But again, at the end of the day everything that we're doing is designed on keeping caregivers and patients safe. Um, so if we need to add something that is unique to that facility, to me that's a no brainer. That's what we're going to do because that's what's going to work absolutely best in that particular situation.

Speaker C: Really fascinating. And I know we're almost out of time here, but just to kind of close it out. Anything else that you'd like to share with the community that you're excited about, anything that you're working on, anything at all in terms of last thoughts here today, Eric?

Speaker A: Yeah, I would say, um, you know I, as we've talked about, I recently started working as the chief security officer for Fmol uh Health in Baton Rouge. It is a uh, an incredibly unique environment here in that um, we are making significant investments to better protect caregivers and patients. Um, I, I can't say enough about what we're doing here. I mean it's, it's, it is, it's the exception, not the rule where we are just making these, these huge investments. We've uh, we've started a K9 program which I believe is going to be the first in the state of Louisiana where it's a security canine program. We got a grant through our foundation to fund uh, this program. We are in the early stages of building a um, large state of the art security training center where we're going to be able to train all of our security officers to a very high level. Uh, we've added tasers and body worn cameras. Um, we're adding more concealed weapons detection systems. Uh, we are looking at analytics uh, for our cameras again that can identify those signs of agitation or people handling weapons or reading license plates. Um, it has just been a fantastic experience. We were just, we're doing all these things which uh, you know, for a lot of healthcare systems this would be a multi year process and we're um, just very concerned about the safety of our caregivers and our, and our patients. And so we are just, we're moving at lightning speed to get a lot of these things done. So these are all things that uh, you know I've talked to other healthcare systems and, and things that they've been doing or things that I've done over the last decade that I've seen a real um, change or shift in workplace violence numbers and getting those numbers uh, down just been, has been fantastic. And um, I'm looking forward to doing whatever we can here to again move the number on uh, move the dialogue. Workplace violence.

Speaker C: It's pretty incredible the work that you've been able to do in such a short amount of time. Um, and I thank you uh, for your leadership on this topic, um, and for showing the rest of us a path forward on it. Eric, uh, it's been a real pleasure to have you on and thank you so much for joining us and thank you for the work you're doing and

Speaker A: thank you for the opportunity to talk about it and um, you know, I'm glad that we have this sort of platform here where we can share information. I think that's very important. Again, a lot of the ideas that I've come up with are ideas that other people have come up with and I've seen on a podcast or I've talked to at a conference and things. So I think um, this is a huge issue for everyone and any opportunity we have to share this sort of information and help other people improve their programs is important.

Speaker C: Absolutely. Again, appreciate your time Eric and thank you also to our listeners. If you enjoyed the conversation today, please like share and subscribe to help us keep growing the show. And if you'd like to learn a little bit more about Taylor Healthcare and the digital healthcare experience, you can go to taylor.com digital healthcare that's our show for today. And uh, until next time, this is Chris Civitarise. Wishing you health and good cheer. Take care.

Speaker B: To learn more about Taylor healthcare, please visit taylor.com digital healthcare this podcast is for educational purposes only and is provided with the understanding that it does not constitute medical, legal or financial advice or services. The Digital Healthcare Experience is produced by Naomi Schwimmer Podcast music by Nicholas Bach. Subscribe now and stay on the forefront of the digital healthcare revolution.

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