This is Laura Dedo with Becker's Healthcare Podcast.
I'm thrilled today to be joined by Dr. Jason Stra,
regional Medical Director of Safety and Security at Atrium Health,
wake Forest Baptist. Dr. Stra, it's a pleasure to have you on the podcast today.
Oh, the honor's mine.
Now, I know we have a lot to talk about.
There's so much happening in healthcare right now, and it seems like things are,
are moving rapidly there. There's something new to think about every single day.
But before we type into my questions,
can you tell me a little bit more about yourself and your background?
Oh, sure. Uh, happy to. I'm, uh,
board certified in emergency medicine as well as emergency medical Services.
Uh, after residency,
I spent the first a decade of my practice in a small but busy rural
hospital in mount area, North Carolina. Um,
it's the town that Hollywood knows as Andy Griffiths Mayberry. Um,
from there I transitioned to become part of the academic faculty at
Wake Forest School of Medicine at Atrium Health Lake Forest Baptist.
And that was in 2013. Um, I started out and I really,
really enjoyed, uh, teaching,
being able to provide e m s medical direction and,
and do some clinical research that, that really focused on
identifying and eliminating rural disparities, uh, in healthcare, uh,
using some, some mixed methods in implementation science. All of this,
uh, changed though, uh,
last July when one of my colleagues was, uh,
physically assaulted in the ED by one of her patients.
Uh, it was a, it was a pretty, uh, severe assault, um, and it,
it really impacted her as well as the rest of our faculty.
And in response, our,
our group met with our health systems leadership to discuss this incident
as well as the violence that, that we have faced for years and years.
Uh, from there, leadership stepped up in a really big way and they appointed me,
uh, to my current role as the medical director for safety and security.
So I spent the past 10 months learning and engaging in this
multifaceted international problem. And it's, it's been,
uh, a real, uh, experience.
It's been eyeopening and, um, unfortunately, uh,
my colleague, uh, is still out and,
and I don't anticipate her ever being able to come back to the ED and take care
of patients. So I am certainly driven to,
to try to prevent these kind of incidents in the future.
That's so fascinating to hear,
and really thank you so much for sharing that story because I think it really,
really resonates on how your career trajectory can make a, a sharp turn,
um, unexpectedly, and certainly you stepping up to the plate and,
and filling that need of being able to really focus on making sure that there is
safety for your colleagues, for physicians,
for nurses and other clinical workers at the hospital, and really, you know,
focusing energy there is so important and critical.
I know it seems like the incidences of workplace violence for healthcare leaders
have been ticking up over the last few years for several reasons,
and certainly it's something that's very important.
So I'm just so thankful that you were able to have that opportunity,
and it seems like the health system is very supportive of you engaging in,
in some efforts to make the organization safer overall.
Yeah. Thanks, Laura. I, I appreciate those kind words and,
and you're certainly right. Um,
we have experienced an exponential growth in, uh,
the number of incidents of violence within healthcare, uh, since, um,
the beginning of covid.
Absolutely.
So I'm sure some of that colors your response to my first question here and
looking at what are some of the opportunities that you're seeing in healthcare
right now, as well as the headwinds that you have your eye on. You know,
what has been working well for you and what do you anticipate coming in the
future?
That's a great question and, and I, I guess I'll answer that with, um,
we have an opportunity for real culture change. Uh, when,
when our, our top leadership met with us, they,
they made some pretty valuable statements. Our, our CEO, Dr.
Freal, said that we must lower our tolerance for abuse.
And our regional cmo, Dr. Andrea Fernandez, said,
we can no longer take a whack-a-mole approach to
violent acts. We need to, uh, take a,
take a holistic, uh, evidence-based, uh,
scientific approach to improving our safety. And,
you know, because we have taken that approach,
the headwinds at Atrium Health, wake Forest Baptist have really changed.
And we have, we have shifted, uh, the, uh, impression,
the thought process, uh, and the approach, uh, that,
that our teammates have that now the,
the safety of healthcare workers is equally important
to the safety of patients. And, and that's, that sounds,
um, like it should always have been that way, but it really hasn't.
As healthcare providers, we, we have always yielded to the patient,
and we've, we've come to realize that, that we can't,
can no longer survive with that mindset, and we need to,
to truly realize the zero tolerance policy
that we have. And, and we're finally focused on that, making that a reality.
So we, we have zero tolerance for, uh,
aggression assaults, both verbal and physical and, and,
and try to prevent every preventable one. But if,
if an incident is unpreventable,
we need to make sure that we engage with, uh,
the teammates and engage with the patient and protect them, uh,
from another assault, protect the patient, and also help the,
the healthcare worker, our teammate to,
to recover from any kind of verbal or physical assault.
That really makes a lot of sense.
And I appreciate you taking us behind the scenes within how your organization is
growing and developing, um, these policies. From your perspective,
what have you done differently since this incident occurred? Um,
that that really is making a difference,
what it has worked well and what happens when there is, um,
an incident that, or,
or is the potential for an incident or somebody identifies some of the risk
factors that could lead to a, a violent incident? Um, how do you,
what, what comes next? What's the protocol.
Again? A a great question, Laura.
The challenge with workplace violence is how many sites this
problem has. In the early stages of, of my new role, we,
we work to, uh, identify, uh, different initiatives,
different problems with solutions that needed to be addressed. And,
uh, our initial list had over 80 different, uh,
things that we needed to, to learn about and, and come up with, with solutions.
So it's, it's exciting that there's, there's that many opportunities,
but also the importance of triaging, right?
The importance of putting priority on some and not others. And,
and fortunately we've been able to come up with, uh,
several solutions that are low or no cost,
and our teammates are really, uh, engaged.
They are yearning for the ability to feel safer and to,
to keep not only their patients safe, but also, uh, one another safe.
So the list is, is very, very long. Um, but we've had,
we've had great success because of,
of the teamwork that we have at Atrium Health Wake Forest Baptist.
That's great to hear. Now,
I'm wondering for organizations out there that are looking to strengthen their,
uh, workplace violence policies, looking to become a more safe place to work,
what is an investment that's worth making?
Especially right now when I know a lot of hospitals and health systems are
facing financial hardships. What is really important for them to step up and do,
um, to add the most value, po value possible to the health system.
That, uh, unfortunately doesn't have a cookie cutter answer? Uh, the,
the points where violence can enter into your healthcare system,
uh, varies from place to place. And in,
in my travels to multiple different healthcare systems, uh,
that's what we learned. The, the,
the way to generally answer that question that I,
I think is effective is to simply invest in,
in safety and to engage with this problem,
to acknowledge that it exists, to acknowledge that,
that it's become, uh, exponentially worse and,
and the, the return on investment for engaging in safety and leadership,
acknowledging that it occurs at the patient's bedside is,
is really beneficial for the overall feeling
that, um, all our teammates have and, and knowing that if,
if something were to happen, uh, even, even the threat of something happening,
that that leadership knows about it and leadership cares and their safety
matters to our, our leaders. That, and, and they, I mean, the patients,
uh, treating providers, the,
the patients' nurses right there at the bedside. So I would,
I would invest in, um,
taking the time and engaging in this problem and
assessing what the actual needs are for your healthcare
system.
That's such a great point and so valuable to understand on the ground level
where, uh,
the biggest risks are in where there might need to be extra support and
investment, um, you know, of either resources, time, energy,
or financial investments. Um, that makes a lot of sense. Now,
I'm wondering too, before we wrap up our conversation,
where do you see some of the best opportunities for growth in the future? Uh,
what, what are you optimistic about or,
or where do you see healthcare and especially safety headed?
Yeah, that's a, that's another great question. Uh, Laura, I, I,
I really think the future is bright. Um, it's,
it's it's time for us to, to really integrate a lot of the,
um, technology that we have, uh, inside of, of,
of our hospitals already and double down on, on some things, um,
like natural language processing and machine learning, uh,
to be able to improve the accuracy of reporting of
incidents.
We found that the number of incidents that are reported
in the reporting software that we have, the incident, uh,
software that we have is, is much less than, than what happens in reality.
And through natural language processing and machine learning,
we've been able to,
to look through the electronic medical record and identify additional
incidents of both verbal and physical assault that didn't make it into the
incident reporting software, but did make it into, uh, the, the medical record.
We've also seen that, um,
looking at some, some real time location system,
uh, hardware and software allows us to,
um, take technology and assist our,
the rest of our team to come to the aid of one of our teammates that, that,
that may need help. So, um, this,
this technology, this tool is, is able to, um,
have a simple button push that can be used to access help either before
or, uh, during an incident and a,
in an easy wearable type technology. Uh, and,
and we've seen at our facilities that, that,
that really just having that tool on their badge
allows them to feel, uh, so much safer. So if a,
if an incident were to occur, um, they,
they feel like they're connected directly to, uh, security and,
and that message does go to our security dispatch and they're able to, uh,
dispatch officers, uh, immediately to,
to know exactly where that teammate is without any information other than a
button push coming from, from our teammate. That being said,
we've also looked towards some, some simple technology.
Uh, in addition to having, uh, the advanced, uh,
badges that have the real time location systems, we also have, uh,
personal alarm screamers that, uh, you may have seen, um, that,
that when, when activated create a, a very high frequency, loud,
uh, alarm. And, and that also helps the, uh,
teammates around the incident to know that that help is needed and to be able to
locate where that incident is happening.
So these are just a couple of examples of, of what we've, uh,
looked to inside of information technology. Uh, we've also, uh,
looked at, uh, sitter logs and,
and how those sitter logs may be able to predict, uh, incidents,
uh,
use of screening tools that can be built into the electronic health record and,
and different, uh,
QR code driven surveys to be able to again,
improve the reporting that we see in our,
our facilities, just to make it easier for our, for our healthcare workers,
our teammates, to be able to report when,
when there are incidents of either verbal or physical, um,
assault.
That's great to hear. It seems like that would really make a big difference, um,
for the workers in,
in your teammates who are on the ground level every single day.
And I know during the pandemic there was a lot of different things happening
that potentially could have, um, increased some of these incidences,
some of the distrust in healthcare as well. Other, uh, challenges,
are there any trends that you're seeing overall that, um, are, are,
are bringing some of those, uh, that trust back into healthcare?
Is it still really, um, very much, you know,
a factor in how people are coming into the ED and in coming into the hospital in
general?
It certainly still is a factor, but, but what we've,
what we've seen is the importance of, of being consistent in,
in our approach, having clear, uh, boundaries that, that, uh,
cannot be crossed. There's, there's zero tolerance for
inappropriate aggressive behavior and to, to just kindly
and matter of fact, um, state that, that that is behavior that,
that we won't tolerate inside of our facilities, um, and engaging, uh,
when, when there's problems, um, the, the human tendency, uh,
for for many when, when there's, uh,
incidents of aggression is to walk away,
step out and not address the underlying, underlying problem.
And, and what we're finding that in,
in the world that we live in, uh, the, the,
a lot of aggression comes from miscommunication and a feeling that
the, the, the person isn't cared for. That, that, that the,
the, the issues that somebody's having, the,
that lack of comfort that somebody's having, uh, doesn't matter to other people.
So we found that by being honest, by engaging, being kind, being consistent,
um, and trying to assess, uh, why a patient is becoming, uh,
verbally or physically aggressive, we've been able to deescalate, uh,
a large number of,
of incidents that that previously developed into assault. But,
but here, um, with, with some very simple, uh, initiatives,
we've been able to prevent a large number of, of these assaults that.
Absolutely. I really appreciate that.
And that's good to hear that you've been able to, uh,
prevent some of those along the way. Dr. Stra,
thank you so much for joining us on the podcast today.
This has been such an interesting and fascinating conversation,
so informative and I know helpful for all those listening today.
I really appreciate your time and look forward to connecting with you again
soon.
Thanks, Laura.