Lessons to apply in Canadian healthcare settings to reduce violence
Paediatric hospitals are facing a growing wave of workplace violence driven by emotionally charged care, rising public incivility and post‑pandemic system strain – and safety leaders say the incidents are often under‑reported and poorly understood. “Care is emotional, and yet at times very unpredictable,” moderator and senior clinical advisor at Canopy, Jeannie Venella told participants in a recent Canopy Works webinar on safety in paediatric care, noting that parents commonly describe themselves as “terrified and helpless” when their children are ill.
Citing 2022 Prescani data, she added that paediatrics was ranked as the third riskiest environment to practise in, behind adult behavioural health and adult emergency departments.
Under‑reporting in paediatrics
For Melissa Jones, director of workplace violence prevention at Children’s Health in Texas, one of the starkest issues in paediatric settings is how rarely incidents are recorded. “Oftentimes our staff are experiencing workplace violence, but they don’t report it because it’s a kid. They’re just a child. They didn’t mean it,” she said, contrasting a one‑year‑old swatting during an IV start with an eight‑year‑old kicking out of anger and frustration.
Jones is working to shift that culture: “It’s not a punitive measure to report the workplace violence. But as a director of workplace violence prevention, I can’t fix what I don’t know.”
She stressed that leaders rely on incident data to identify patterns by day, time and location, and to drive “heat maps and data analysis and gap analysis” that inform resourcing and training decisions.
Layered responses: security, systems and resiliency
At Children’s Hospital Colorado, senior vice president and chief patient experience and access officer Suzy Jaeger described how pandemic‑era service cuts at adult hospitals and a severe RSV surge increased volumes and acuity across a vast catchment area. The result, she said, was “a perfect storm around how our team feels about their safety and security and the issues that they encounter each and every day.”
In response, the organisation rebuilt its security model, introduced a visitor management programme, installed weapons detection at key entrances and reduced 24/7 access. Staff also received personal duress devices through Canopy’s platform, which Jaeger said are highly valued by frontline workers.
Beyond physical security, Colorado invested in resiliency: moral distress rounds, resiliency rounds, access to on‑site psychological support, creative arts therapy for staff and tools within the electronic health record to guide de‑escalation in a consistent way. One “de‑escalation navigator” in the EHR has generated about 3,500 documented incidents over three years, with roughly 65 per cent rated low acuity – a sign, Jaeger said, that staff are intervening earlier and preventing more serious events. During the same period, patient complaints and grievances fell by nearly 20 per cent.
Proactive behavioural health support
Children’s Hospital Los Angeles (CHLA) has focused on proactive behavioural health supports in a setting where patients with acute mental health and safety needs are dispersed across medical units. Behavioural Health Manager Meghan Drastal leads a multidisciplinary rounding team – including psychology, psychiatry, child life and social work – that visits units three times a week to identify risks and support staff.
“We’re really working on transitioning the culture of being reactive to being proactive,” Drastal said. One recent innovation is a behavioural health “code cart” stocked with PPE and tools such as bite‑resistant gloves, face shields, ligature‑removal devices and a lockbox for patient belongings, giving teams rapid access to safety equipment when a situation escalates.
CHLA pairs these tools with hot debriefs after critical incidents and a behavioural crisis response team – security, supervisors, social work and charge nurses – that aims to ensure staff “don’t feel alone” during violent episodes. Personal duress badges are widely used, with roughly 30 activations per month and typical security response times under 30 seconds.
Planning, metrics and the role of technology
Panelists underscored that technology is only one layer in a comprehensive workplace violence strategy. Jones recommended a formal workplace violence management plan with short‑term (six‑month), one‑year and three‑ to five‑year goals, aligned with a multidisciplinary committee that includes frontline staff from across departments such as nursing, environmental services and food services.
She also pointed to earlier experience with personal panic buttons in an adult system, where average security response times fell from about 55 seconds to 32 seconds – “20 seconds responding to a violent event can make the difference between severe injury, no injury,” she said.
For Jaeger, sustaining reporting is central to any programme. Drawing on a long‑running patient safety initiative called “Target Zero,” she argued that a just culture and transparent feedback loops are essential: “The only way we’re going to get better is if you report something when you see it and you give us details so that we can understand when and why and where it happened and then we can employ tactics to be able to eliminate that from happening again.”
Implications for Canadian health and safety leaders
While the examples came from U.S. children’s hospitals, the pressures they describe – dual duty to child and family, behavioural health complexity, burnout and staffing shortages – mirror conditions in Canadian paediatric and acute‑care settings. For health and safety professionals in Canada, the panel’s core messages are familiar but urgent: define workplace violence clearly in paediatrics, insist on reporting, invest in layered controls that range from visitor management and weapons detection to de‑escalation training and wellness, and hard‑wire early‑warning processes into everyday clinical workflows.
As Venella concluded, when paediatric care teams feel safer, they can stay present with the child and deliver the best care possible – without omissions driven by fear or fatigue.
