Emergency Action Planning for Violent Incidents in Dental Facilities

Who's going to make the decision whether we stay and hide or whether we run? Where are we going to go? Where's the designated place? So you literally practice it. And my best analogy is you practice it just like you would practice for a medical emergency. Welcome to the Phil Klein Dental Podcast. As dental professionals and practice owners, we have a lot to think about and manage in order to keep everything running smoothly at the office. But there's one thing that is probably not top of mind, and that's workplace violence. The odds of a violent incident unfolding in our practice is relatively low. But if it happens, the question is, are you prepared? So we invited our guest, Mary Govoni, to talk to us about workplace violence in the dental setting and what we can do as dental professionals to best protect our team members and patients. How do we identify the risks, de-escalate a potential violent interaction with a patient or former employee, and ultimately decide, in the case of a deadly threat, whether to run, hide, or fight? Mary is an internationally recognized speaker, author, and coach, focusing on infection prevention and control, OSHA and HIPAA compliance. ergonomics, and workplace violence. She's a certified dental assistant and registered dental hygienist with 50 plus years of experience in the dental profession. Mary Govoni will be joining us in a second, but first, thanks to GC America, we're now able to incorporate all the advantages of glass ionomer into a beautifully aesthetic, strong, long-lasting restoration. That's a great reason to try GC Fuji Automix LC. You'll love the convenient automix delivery system and ergonomic dispenser. which allows precise placement into the preparation. And GC Fuji Automix LC is bioactive, allowing for a high rechargeable fluoride release, which is ideal for high caries risk patients. And because it forms a chemical bond to tooth structure, even in the presence of saliva, there's no need for etchant and adhesive bonding. This saves steps and is ideal for challenging patients where access and isolation are difficult. And the small filler particles in the material allow for superb polishability and excellent aesthetics. So when you're thinking glass ionomer for your clinical cases, think GC America, a world leader in dental materials. To learn more, visit gc.dental. Mary, it's a pleasure to have you on the show. Thank you for having me. I appreciate it. So not that long ago, we probably would have... even thought about doing a podcast on workplace violence, especially the kind of violence that has happened in dental offices in the past year or so. Obviously, we heard about the one in San Diego where a young dentist who was only at a dental school for a couple of years was tragically killed by one of his own patients in his treatment room. Other staff members were also shot but survived. There was a patient that we talked about. offline i'm a woman dentist who was stabbed she probably lost her eye and may never practice again and that was from a patient in the chair i believe that pulled a knife out and became very violent so you know we're definitely dealing with a scenario where it's something to be concerned about i wouldn't say you know worried to the point where you're stressed because it's not that common but it's always good to be prepared so today we're going to be talking about emergency action planning for the possibility of a violent incident in a dental facility. In a previous podcast, we discussed the need for an emergency plan. How would a dental practice go about compiling an emergency plan for this kind of situation? My recommendation would be to utilize the tools that OSHA has available on its website and we will provide a link to the e-tool that OSHA has. literally asks a series of questions about how many employees you have and where is your practice setting rural or in a large city, all the characteristics. And you fill in information and do some descriptions. It's not just clicking boxes and it spits out a plan for you. You have to do some descriptions, but that will ensure that you have the things. that OSHA wants you to have. And so I think this is best done perhaps as a group type of activity that we have a discussion in perhaps a team meeting about, you know, what would we know or how would we know if there's an active shooter alert in our area, for example. Do you have a network? in your city or county that alerts people. It may be the same one that's used to alert for bad weather. But if there is an active shooting or some shelter in place order that's been issued by a law enforcement agency, how would you know that? Would you get it on your cell phone? Some of the systems actually dial into all the businesses. That's a really, really important thing to start there. use the e-tool, get it documented, and then make sure everybody knows what that plan says so that you can practice what it says. And once you have a plan in place that describes specifically the configuration of where you work and what's around you and so forth, what are your recommendations regarding how to practice what's in this plan? What I have seen some practices do very successfully is carve out maybe an hour of patient time and they invite either patients or family members people that they know to impersonate patients and they come in and then they're just going about their normal activities or simulating that and then all of a sudden somebody says okay we now have an active shooter alert what do we do and immediately everybody has their role that they need to fulfill, who's in charge of patients, who's in charge of employees, who's going to make the decision whether we stay and hide or whether we run. Where are we going to go? Where's the designated place? So you literally practice it. And my best analogy is you practice it just like you would practice for a medical emergency. We have a patient down in the treatment room. They are not breathing. What are we going to do? Who's going to call 911? Who's going to get oxygen? Who's going to get the medical emergency kit? Same type of thing. What are the steps we need to follow? So Mary, there are variables in this kind of situation where the actual threat is taking place. Is it in the front of the office? Is it in the treatment room? Is it a patient? Is it a disgruntled employee? So how might the response differ considering these different variables? It differs slightly in who might be the first. person to respond. So, for example, if the threat came from outside and it came in the front door, then it's going to be the business team members who are going to be sort of at the front lines, if you will. If it happens in the clinical area, then there needs to be obviously a hierarchy of how do we address, how do we contain this? If it's a patient that does get out of control, what We need to learn some tools about how to de-escalate, not panic, stay calm, talk very calmly to that person. Somebody may be trying to disarm them. But these are things that professional self-defense trainers need to be accessed to teach you how to do those types of things. that isn't necessarily instinctual for all of us. It could even be two employees who get physical with each other. And I have actually seen that happen in a practice that I consulted in a number of years ago that two dental assistants literally got into a hair pulling, punching fight in the office. So we need to, again, try to de-escalate it, try to contain it. And then we evaluate, do we run, do we hide, or do we fight back? So workplace violence is defined as any act of violence or threat that occurs in a place of employment. And that could be physical force or psychological trauma. So there could be someone, for instance, that knows an employee. Let's say it's an estranged husband. They come into the practice and they are... verbally abusive, you know, screaming and yelling things and just derogatory things in front of the patients, in front of the other staff, but no physical activity has happened. There's no interaction physically. What is the best way to proceed? How do you diffuse that when you see someone almost out of control, they haven't lifted their fist yet and done anything physical, but it looks like it could lead to that. It could continue to accelerate into something more violent. What's the best way to handle that to nip it in the bud as fast as you can? The best way but the most difficult way is number one stay calm because if you rise to the level of agitation of that person Then they're maybe going to notch it up another level. So it just keeps escalating. So we need to stay calm try to de-escalate Know that This person probably isn't going to be thinking logically. So trying to use logic on them is maybe not going to be so effective, but just staying calm, listening to them. What is it that they want? What is it that they need right now? And also trying to isolate them, as you said, away from the other patients, away from other employees. Let's go. into the break room and let's sit down and talk about this just calmly low tones no sudden movements just trying to de-escalate so hopefully it kind of brings their emotional level down a little bit and once their emotional level comes down a little then they can be slightly more logical but If this is someone who you know that there is a restraining order against, do not hesitate to call the police. Let them know what's happening. Ask them to come perhaps to the private entrance to the building or to the office and have them come without lights and sirens because that, again, may agitate that person. And again, it's up to the people in the office to decide which way they want to go with this. And they have to, on the fly, determine or evaluate what level of how excited is this person to the point where it could move into more of a violent situation. You don't want to go into the break room with that person if you feel that way, because that person could go ballistic. And now you're a victim because you're old. Yeah. So you have to be it's your your points are very well taken, but it's really. Something you just have to feel for it at the time and say, maybe we could defuse this by trying to talk this person down. But if they're acting in a really illogical and just in a way that's just uncontrollable, I think calling the police straight up is the right way to go. I agree. I think so. And you also have to really someone, maybe not the person who is being personally threatened, but someone else really make some observations. What are their pupils pinpointed? That could be a sign that maybe there's some influence of drugs, illicit or otherwise. Are they really agitated, moving a lot? Are they sweating profusely? Those kinds of. really stress reactions. And I wouldn't leave anyone alone with that person. There should be more than one person. And when I said before about getting them into the break room, that wouldn't be a one-on-one situation. That would be at least two other people escorting them somewhere where they're away from the patient. So if they did get violent. there could be less damage that happens. We'll be getting right back to our discussion. We're going to be talking about the four different types of workplace violence. But first, when it comes to patient dental chairs, why choose between sitting or standing when you can have both? Experience the perfect blend of ergonomics and intelligence with the new Forrest 6400 chair from Dental Ease. As the highest rising chair in the industry, the 6400 offers unparalleled treatment flexibility, allowing more dentists to practice without pain. Your patients are less likely to interrupt your treatment as they relax in the soothing warmth of adjustable heat and massage, in the comfort of plush, ultra-leather cushions and optional neck and knee pillows. And with Aris Intel, the new standard in smart technology, you'll gain insights into practice efficiency, revenue, and maintenance, all from the only chair that monitors data at no extra charge. For more information, contact your local DSX rep or visit dentalese.com. And again, there's four different types or four different categories that are normally referred to when we're talking about workplace violence. One is Someone who has no legitimate business at the work site, which is the least common. And then moving down the line to the more common would be violence directed at employees by the patients or visitors. The next one would be violence against an employee by a present or former employee. And then the most common one would be violence by a person with a personal relationship to an employee. And that's the one I want to ask you about, Mary. Is it the responsibility of an employee if they're having this kind of very rough relationship or they have an estranged boyfriend or husband or wife or girlfriend? Is that something they should be telling the office about? Because that's an uncomfortable discussion. And like you said, we've talked offline about this. It's not something that... like to talk to other people about because they may be embarrassed about it and so forth but is it really the responsibility in these cases even if there's no restraining order it hasn't gone that far for the office to be aware that if this person comes in we have to be careful I believe that it is the responsibility of that person to tell at least one other person because If that person came into the workplace, then now it's not a one-on-one situation anymore. It involves everyone in the office and patients. And we need to keep not only employees safe, but patients safe as well. So as healthcare professionals, we do have an obligation to tell. We don't necessarily have to give all the details. Just simply saying, I have a concern. This person has threatened me. This person has been following me and it's making me uncomfortable. I just want you to know so that if they do come in and they're threatening, this is what's going on. something that we haven't really touched on is taking people's threats seriously. A lot of times things are set in anger or they're set out of stress, but many times people will follow up on what those threats are. That's an excellent point, Mary, and I think people that are involved in these kinds of rough relationships where they want to Vengeantly go after their estranged wife or husband or whatever the relationship is They know they can catch them at the workplace because they know that they're there The office may be small. There's nowhere for them to go So they've got them cornered so to speak. Do you agree? I totally agree and I think there's also a little bit of perhaps that revenge or humiliation factor. Not only am I going to hurt you, but I'm going to hurt your reputation. I'm going to discredit you in front of your employer. I'm not just mad. I'm going to get even with you. So absolutely. Again, I think it's worth mentioning, Mary, to our audience that it's highly unlikely based on statistics. that there will be a violent crime taking place in your dental practice. It's not likely. The odds are against that. However, being prepared for such an incident could be the difference between life and death. So we have to be prepared. And we talked about having an emergency plan. What other things, or what would you say would be the priority thing to do in a practice, starting as soon as possible, to best prepare for different kinds of workplace violence? The number one thing I would recommend is get some training, whether it's having somebody come into your practice or you watch some videos. And we've talked offline about the great videos that are available from the FBI and from the Department of Homeland Security. We'll put in links for those video training programs just so you have an awareness. What are the verbal cues or? body language characteristics that we need to look for um in somebody who might be violent taking threats seriously letting people know if a patient threatens someone in the practice then whoever was threatened needs to let the doctor know, the practice administrator know. Everybody needs to know. And we need to perhaps make a note in that patient's file. And you quote exactly what they said. And maybe they didn't mean it, but maybe they did. And right now, as you said, it's a very sad thing that we have to worry about this. But we do have to, in the times that we're in right now, think proactively be prepared take threats seriously unusual behavior you know sometimes we kind of laugh about it oh yeah they're just you know it's that person they're just kind of quirky we need to we need to learn what signs are there to look for and and as you have said and i totally agree we hope that we never encounter this in a practice but better to understand what to do, what to look for, and be prepared in case it does. Yeah, all good points. And I think the dental practice owner should make a point to tell the staff that whatever training we get for office safety in this realm of workplace violence applies to your personal life. When you go to Walmart, when you walk to your car and you return to your car in a parking lot and your car is kind of isolated, you get into an elevator. These things apply to the employee's life everywhere, not just in the dental practice. So by having this training and doing it enthusiastically is a benefit to the patient and their family and their friends with every aspect of their life that they live. So true. Thank you very much, Mary. We really appreciate your insight. You've covered some really important points, and we hope that dental offices that listen to this in front of them and that there is a risk but risks can be managed and mitigating the possibility of something terrible happening by having a good plan in place is well worth it and having good training all well worth it thank you so much Mary, for your time thank you