Over the last handful of months, we’ve been requesting that people fill out a survey on signage popping up in healthcare facilities warning people against “violence” and “aggression.” 75 people responded, and we will begin sharing results here.
But first, a bit of history: We initiated this survey because we started seeing signs like the one pictured here popping up in a number of healthcare environments, and our
initial concern was that signs of this nature might actually decrease a sense of safety for many folks, and increase risk of violence in some circumstances. Would these signs, for example, communicate to folks who’ve experienced forced treatment, coercion, and/or abuse in these environments that this is a place where they can expect to be treated poorly and then be at additional risk if they get upset about it?
We did reach out to folks at Cooley Dickinson Hospital (based in Northampton, Massachusetts) to offer feedback and seek an explanation on why they’d chosen to post such a sign. Here’s a snippet of what we heard back from Vice President of Operations and Chief Administrative Operator, Anthony Scibelli:
For someone who was already feeling anxious about a visit to the hospital, I can understand how the sign posted at Cooley Dickinson Hospital’s main entrance could have been provoking and unsettling. … Please know that this would never be our intent. For every patient every day, our goal is to provide exceptional, compassionate and personalized care in a secure and healing environment. Yet at hospitals locally and across the country, creating a safe environment for all is becoming increasingly more difficult. Workers in hospitals and other health care facilities face significant risks of workplace violence. Exposure to workplace violence contributes to subsequent trauma for the staff who experience or witness targeted attacks. In fact, the Joint Commission, a health care accrediting body, the Centers for Medicare and Medicaid, and OSHA, Occupational Safety and Health Administration, are instituting mandatory language that requires hospitals to inform the public that aggressive behavior will not be allowed and that patients and families in our facilities should report such behavior to a staff member.
This sent us on a search for what exactly these bodies are requiring. While this effort is ongoing, we did find the following from the Joint Commission*:
· 2018 Newsletter article (revised in 2021) on Workplace Violence
· 2021 document on new workplace violence standards for 2022
It’s entirely possible that there are even newer standards, and we have reached out to the Joint Commission for comment, but it’s worth noting that we didn’t see any requirements for signage in these particular documents. We also noted that while the Joint Commission does transparently list who had input into the updates, it does not appear that anyone who is speaking from the perspective of a patient or service recipient was included.
Also of note, the 2018 Joint Commission newsletter article lists reasons why workplace violence has become such an issue in healthcare environments. While it’s good to see that they acknowledge the negative impact of understaffing and long wait times on potentially hostile interactions, its nonetheless disappointing to see that they otherwise lay the responsibility for violence against healthcare employees largely at the feet of people in the patient role. “Decompensated mental illness,” “altered states,” and “gang activity,” appear as contributing factors, but use of force and coercion or overall poor treatment and lack of respect from staff do not show up at all.
When considering all these underlying factors and oversights, it should be no surprise that hospitals and other healthcare services make some of the decisions that they do. But let’s see what others thought:
Who responded?* Of the 75 people who responded, 51 identified as speaking from a patient perspective, 30 were speaking from a current or former healthcare employee perspective, and 23 were speaking from the perspective of a family member. (A few others identified most with other community roles such as a housing specialist.) Approximately one third of respondents (26) identified as having experienced forced treatment at some point in their lives. The vast majority were between the ages of 25 and 65 with three responses from people 24 or younger and seven from people over 65. The majority also identified as white or white appearing, with around 10% identifying as black, indigenous, and/or Latine. 60% identified as women, 21% as non-binary, agender, fluid or otherwise gender non-conforming, and 19% as male.
*People were able to check off as many categories as applied to them for the roles question
Do the signs make people feel safer overall?: 2 people indicated that they feel “much safer” because of the presence of the signs, and 7 more said they feel “a little safer.” However, 66 people said they either weren’t impacted at all or felt less safe because of the presence of the signs. By far, the most common response was that the signs left people feeling “much less safe” (30 respondents).
Are the signs likely to reduce the risk that someone will act aggressively? Interestingly, although 2 people responded that they felt “much safer” because of the signs, zero people actually reported feeling that the signs were very likely to reduce violence. 6 people said they thought it might reduce the risk “a little.” Meanwhile, 44 people indicated they thought the signs were likely to increase the risk of violence by “a little” to “a lot.”
What did people say? People left many lengthy and detailed comments. Here are just a few:
“Words spoken or written have the power to inflict harm, fear or hope. Signs that are threatening do nothing to ease discomfort when a person is not feeling well and is hoping for assistance.”
“I think these signs will either be ineffective or will cause more harm. It is irresponsible to create expectations for hospitals to use this signage without having surveyed patients and staff or completed evidenced-based research. I want to see the facts about why these signs are being used.”
“As a healthcare worker, I do not ever want to be harmed or see my colleagues harmed at work. However, signs like this obscure the reality that it is PATIENTS, not workers, who are disproportionately harmed or experience violence while attempting to secure healthcare for themselves. We know also this even more disproportionately affects patients of color, those without sufficient material resources, psychiatric survivors, women, trans and queer identified people, etc. If Cooley (and other healthcare orgs) want to really address the violence in our healthcare system, addressing violence against people looking for healthcare is the first action that must be taken!”
“I, personally, have not seen one of these signs yet. If I did I would automatically think what are they doing to upset so many people that they chose to put a sign like this up. It would most likely make me want to go elsewhere.”
“Staff have a right to be and feel safe – so do we. These signs and practices shut down all “negative” feedback and criticism and formalize the practice of policing our/each others’ emotions and emotional responses in community spaces; this is especially dangerous when done in healthcare settings where we often show up because something is “wrong” (yes routine preventative care and “screenings” for both medical and mental health are officially encouraged but in practice are strongly discouraged by employers, insurance, and capitalism as a whole).”
“Signs like those would make me feel tiny, and unsafe. It would also bring me back to the days in psychiatric hospitals when cruelty was often the norm.”
“It feels to me like the sign is telling me that if I get angry, swear or yell I will be viewed as aggressive and then they can treat me however they deem necessary, even if the anger is due to the facilities lack of human care and concern for me.”
“These signs scare the fuck out of me.”
“I really think the emphasis on “aggressiveness” instead of “violence” is a white supremacist influence that prioritizes comfort/politeness over actual safety for both the provider and patients!”
This is just an initial report back. We will continue compiling results and sharing additional feedback and information learned in the coming months!
EN 
ES