In 2019, MedStar Health rolled out a Workplace Violence Prevention training program for all associates. This training reinforced MedStar Health leadership’s commitment to the highest standards of quality and safety embodied within a high-reliability organization. MedStar Health’s Workplace Violence Prevention program was designed to train associates on techniques and procedures in de-escalating potentially harmful or violent situations. The initial program included the following elements:
Mandatory annual training for all associates on emergency preparedness and workplace violence awareness and prevention
A systemwide active shooter training
A half-day, in-person de-escalation training to provide all “front-facing” associates (e.g., staff in clinical settings) with the confidence and skills to respond to potentially dangerous escalating behavior situations
A full day of in-person training for associates considered at high risk for workplace violence (e.g., Emergency Medicine staff) that includes advanced physical skills training and de-escalation techniques taught by a MedStar Health training partner
At the start of the COVID-19 pandemic, the MedStar Health executive team commissioned MedStar Health SiTEL to update and redesign the Workplace Violence Prevention training program. The team was asked to create multi-modal educational options to replace the large in-person classroom style of the original training that was no longer feasible due to COVID safety concerns. In advance of the redesign, MedStar Health SiTEL hosted focus groups to gather feedback on the original training. Participants identified verbal de-escalation as a key component in preventing violence and requested incorporating additional tools and techniques within the updated training modules.
The MedStar Health SiTEL team, in collaboration with MedStar Health’s Quality and Safety, Compliance, System Security, Risk Management, and Emergency Management teams, completed an updated version of the Workplace Violence Prevention training program in April 2022 within a compressed 10-week design and implementation timeframe. The new program introduces a novel Recognize, Accept, and Plan (RAP) systemwide communication method that’s designed to be easy to remember and quick to implement to help associates rapidly de-escalate workplace aggression or violent behavior. The program incorporated updates to safety protocols brought on by the pandemic, including an increased emphasis on the importance of non-verbal communication while wearing personal protection equipment (PPE).
The module, accessed through MedStar Health’s SiTEL Learning Management System (SiTELMS) platform, was updated to provide tools and techniques to diffuse potentially volatile situations before they reach the point of physical aggression or violence. Scenarios include nurse/patient, associate/associate, and outpatient situations that demonstrate the correct and incorrect ways to use verbal and nonverbal communication to de-escalate potentially violent situations encountered in a variety of healthcare settings. For example, one scenario involves a patient services assistant using the RAP method to de-escalate a tense situation where an ambulatory patient, experiencing pain and a long wait time, becomes aggressive toward staff.
To support ongoing education and awareness of the training, MedStar Health SiTEL created a facilitator guide incorporating a variety of interdisciplinary inpatient, outpatient, and call center scenarios that can be completed as unit-based tabletop simulations. The comprehensive guide includes pre-brief information, training scenarios, and debriefing tools to assist entity facilitators with a goal of minimizing impact on associates’ time and internal training resources. After receiving strong, positive evaluation results during the program’s pilot at MedStar Harbor Hospital, the full training program was rolled out across the entire MedStar Health system.
Since the redesigned training’s rollout in April 2022, all MedStar Health associates were required to complete the online version of the training module via SiTELMS. As of February 2023, more than 4,800 associates have taken the full-day version of the training.
To date, the Workplace Violence Prevention De-Escalation RAP Tabletop Scenario Training significantly increased associates’ (perceived) ability to de-escalate an aggressive situation based on post-training evaluations. The vast majority of associates who completed the training stated they were more confident in their ability to meet the demands of an escalating situation. In fact, 85% of the learners favorably rated their ability to de-escalate a potentially dangerous situation, compared with only 60% before the training. Associates were also more positive about the effectiveness of techniques they learned in dealing with escalating situations post-training. We are grateful for this progress in such an essential and challenging training area and have embedded Workplace Violence Prevention learning in our annual mandatory education program to strive for continued improvement and positive impact. We also regularly enhance and expand the training content, scope, and classes, developing updated scenarios and incorporating the latest aligned policies in the process.
This case study is one of the latest leading examples of how the MedStar Health SiTEL team creates and delivers dynamic and interactive training for MedStar Health associates. The team develops hundreds of learning modules annually that are used within the MedStar Health system and beyond. As part of the MedStar Institute for Innovation, the MedStar Health SiTEL team experiments with tools such as virtual reality programs to push forward innovation in health education and to create a more hands-on experience for trainees.
MedStar Health SiTEL led an update to our Workplace Violence Prevention training program to ensure the highest levels of safety for MedStar Health associates and patients. The update responded to shifting in-person safety protocols stemming from the COVID-19 pandemic and incorporated additional de-escalation needs identified by staff.
TeamMedStar Health Simulation Training and Education Lab (SiTEL); MedStar Health Quality and Safety; Compliance; System Security; Emergency Management; Risk Management