Sometimes when we’re working, someone says something in a way that makes us uncomfortable. Often, we give people the benefit of the doubt, but if we feel threatened, we should not take chances when it comes to our safety. Everyone has the right to come to work and feel 100% safe.

It is our responsibility as leaders to provide you with a safe working environment and methods to address concerns when they arise. For the last 10 months, we have focused on how to stay safe from the virus that causes COVID -19. That is very important, and I hope you are following recommendations both inside and outside our UI Health Care facilities.

I want to highlight some of the available resources if you find yourself in a situation where you feel emotionally or physically threatened. Whether the situation involves a colleague, patient, or visitor, please know we have systems in place to address your concerns.

Following are four situations and instructions for dealing with each.

Unprofessional interaction with a coworker:

• If you experience an unprofessional interaction with a coworker, please attempt to have a professional and productive conversation with that coworker. Wait until emotions are even and meet in a neutral and private location. Addressing conflict is a very productive way to build teams. If your conversation is not productive, if there is a power differential, or if there is a significant reason you two cannot meet, I encourage you to enter a report into the CORS (Co-worker Observation Reporting System). CORS uses a process aimed at delivering feedback in a non-judgmental way. This allows the identified staff member to reflect on their practice and associated interactions with co-workers, as well as the opportunity to self-regulate behaviors. I’ve learned we may not be aware of how we’re perceived or the impact of our words, their delivery, or our actions. Without feedback, none of us can learn. CORS provides a mirror into how we are perceived by others, insight on how that affects our team, and a gauge of the quality and safety of our care. After a CORS report is filed, trained peer messengers will share information with their colleagues to inform them about specific issues and provide the opportunity to improve their communication practices. This is an anonymous process, and information regarding who reported the incident is not shared with the peer messenger or colleague.

Threatening interaction:

• If a workplace experience with an individual leaves you feeling threatened (i.e., he or she is exhibiting the potential for future violence or harm), but the individual is not presently violent, call Safety and Security at 319-356-2658. Safety and Security will work with the Threat Assessment Program to investigate the nature of the threat and respond accordingly. The Assessment and Care team provides an integrated and coordinated process for identifying and responding to students, faculty, staff, patients, and others affiliated with the University of Iowa who may be at risk of harming themselves or others.
• If the person threatening you is a patient or visitor, it’s best to use language to diffuse the situation. We all have empathy and compassion for those who are sick and those who are worried about their loved ones. We may feel they are just “blowing off steam” and that we shouldn’t escalate the situation by taking their words seriously. For example, if a patient or visitor says something like “you’ll regret this,” “if he gets worse, I will be back and you won’t like it,” or “it won’t be good for you if she doesn’t get better,” their words may have been said in the heat of the moment; however, these declarations are actually signals that the person may not be thinking or acting in a logical way. These threats may also be warnings they may follow through with action and harm you or others. For example, I treated a sick patient in the ICU, and her husband was afraid he would lose her and threatened, “If she dies, I will be back with my gun.” We took that seriously and called for help. The Threat Assessment Program was great, both with our team and with the patient and her husband. He did own a weapon and may have never used it, but the Threat Assessment Program protected us. As in many of these situations, the husband regretted his words. By directly addressing this threatening interaction, we discussed boundaries and better methods for expressing his concerns in the future.

Violent interactions with a patient:

• A Code Green violent patient management team is available to respond to potentially violent patient situations. Any staff member may declare a Code Green by dialing 192 if assaultive, combative, or uncontrolled patients pose a threat to themselves, staff members, patients, visitors, or hospital property. When calling the Code Green number, please:
  1. Identify that you need the Code Green team
  2. Identify yourself
  3. Identify the unit, building, and room number where help is needed.

Violent interactions with a visitor, family member, or staff member:

• Contact Safety and Security by dialing 195 or 911 during situations when visitors, family, or staff are being disruptive, hostile, or threatening others. Safety and Security will work with hospital administration and local law enforcement agencies to control these situations.

As I mentioned above, we have resources available for all our staff members. If you’ve experienced a threat or violence, please seek emotional support after this event from any of the following sources:

• The COPE team is comprised of volunteers including chaplains, physicians, social workers, psychiatrists, nurses, therapists, and others and strives to provide emotional support and healing to health care providers who have experienced difficult situations.
• The Employee Assistance Program (EAP) provides integrated services to faculty, staff, and their family members to promote emotional well-being and to increase engagement and productivity among members of our UI community.
• Office of the Ombudsperson is a resource for any member of the university community— including students, faculty, and staff—with a problem or concern. They provide informal conflict resolution, mediation services, and advocacy for fair treatment and fair process.
• Diversity, Equity, and Inclusion @Iowa provides services related to human rights, anti-harassment, violence, anti-retaliation, and discrimination.
• The Office of Diversity, Equity, and Inclusion provides cultural enrichment and acclimation programs for members of the Carver College of Medicine and UI Health Care community.
• Office of the Sexual Misconduct Response Coordinator (OSMRC) coordinates the university’s response to reports of sexual harassment and sexual misconduct.
• Ethics Point should be used to file an anonymous complaint related to a financial crime or misconduct.

Just as you hear at the Eastern Iowa airport: “If you see something, say something,” you should apply this idea at work as well. Know your resources and have a plan to utilize them if the need arises. Your safety matters, as does the safety of your team.

UI Health Care is on a constant quest for improvement, and as an institution we can’t address what we don’t know. We want to hear from you.

I wish you a happy and safe 2021. I am hoping for a year where we all have many opportunities to share our great stories. Thanks for your perseverance, your resiliency, and all you do each and every day.

– Theresa Brennan, MD

References:
UIHC Policies Manual 
Code Green Violent Patient Management Policy EOC-Safety-01.030 
Workplace Violence Policy, EOC-Security-02.007