Abstract
Healthcare workplace violence in the U.S. is an epidemic and increases year over year. Regulatory agencies and hospitals develop workplace violence programs, yet they fail to meet expectations of reducing violent incidents. This qualitative case study was intended to determine why hospitals in a healthcare system would have varying security programs. This research leads to an understanding that executives and security program administrators receive minimal to no formal training before being assigned the responsibility to manage the program The case study hypothesis: if management does not receive knowledge or training in the security workplace violence program before or upon hire, then programs are likely to vary within a healthcare system was deemed to be true. In addition, research shows that executive and group coaching to be an effective tool to obtain alignment with key stakeholders toward achieving compliance to the overall program.
Keywords: healthcare systems, hospitals, physical security program, barriers to program effectiveness, group coaching, executive coaching
Introduction
Healthcare is the second-highest industry in the U.S. to experience workplace violence after law enforcement. Researchers report that violence continues to increase over the years (“Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers,” 2016; Schmidt et al., 2019). As such, Occupational Safety and Health Organization (OSHA) developed “Guidelines for Preventing Workplace Violence for Healthcare and Social Workers” that supports the General Duty Clause, Section 5(a)(1) to provide a workplace free of hazards that are likely to cause harm. The Guidelines provide the most effective ways to develop workplace violence prevention programs.
The significance of this qualitative case study is to explore contributing factors that produce variability in healthcare security programs. Furthermore, the study reflects the effectiveness of executive and group coaching methods to develop leader performance to reach the desired outcome (comply with standardized security program). We hypothesize that:
H1: Lack of executive and program leader knowledge of security programs, before or upon hire, will lead to variations of program implementation and compliance within a healthcare system.
H2: Executive and group coaching will enhance the facility performance and compliance of the security program.
The design of this study consists of interviews of executive leaders, including the Associate Administrator and the three members of the physical security team. This paper includes research literature on program effectiveness, executive, and group coaching. After that, I will present the case and interventions initiated, followed by conclusions and future research.
Research
Literature research was conducted in Fielding Graduate University's online library and Google Scholar to better understand program effectiveness, executive, and group coaching and plan the case study design. Keywords utilized to initiate the search included healthcare systems, hospitals, physical security programs, barriers to program effectiveness, group coaching, and executive coaching. I utilized journal articles, peer reviews, and books published after 2000. I filtered the results further by selecting a business, education, and nursing disciplines, resulting in 54 references. Of the remaining articles, I selected five based on their topic or study results around program effectiveness, executive, and group coaching.
Program Effectiveness
Grider et al. (2014) argue executive leadership development programs (ELDP) successfully create highly motivated and engaged emerging leaders. ELDPs increased awareness of organizational goals, values, strategies, and programs. Healthcare facilities consist of highly educated and talented individuals whose jobs are complex and demanding. The more complex the role, likely they are to resist competing priorities for their time or programs that do not bring value to their work (Joo et al., 2012). Olson et al. (2008) examined hospital capability of implementing improvement programs and the relationship between the pattern of program usage and outcomes. Olson et al. argue that hospital capability and program complexity play a vital role in the success of a program. OSHA’s Violence Prevention program argues management’s commitment and worker participation are essential elements to an effective program. The guidelines acknowledge the program's complexity in addressing employee input into design, implementation, and evaluation (“Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers,” 2016). Lastly, the guidelines address the need for continuous communication, feedback, evaluation, and reassessment to ensure program sustainability.
In essence, ELDPs are valuable to organizations as they bring awareness to organization goals, values, strategies, and prioritized complex programs. Complex programs rely on management’s commitment, program priority, and employee participation to achieve compliance. If individuals are unwilling to participate or have other competing factors, programs may be partially adopted or completely fail.
Executive and Group Coaching
The main goal of coaching is to help individuals gain current state awareness, clarify goals, identify actions or objectives that will lead to their goal, and expand their general thinking (Underhill et al., 2007). 92% of leaders reported coaching was beneficial to assist with insight, knowledge, and support (de Haan et al., 2011). More specifically, there is a positive correlation when addressing position transitions, providing helpfulness in general experience, fixing performance problems, and retaining high-performing employees.
Jones et al. (2015) propose a coaching framework utilizing various coaching tools to address the coaching needs of organizations, executives, or emerging leaders. Their meta-analysis study utilizes17 journals that positively affected outcome criteria (skill-based, individual level, effectiveness). Secondly, the paper argues various coaching tools are equally effective due to the coachee’s preference and style.
In brief, coaching brings awareness and expands individuals' general thinking, allowing for change or action. Individuals that participate in coaching experience different needs based on their specific goals. The coachee’s needs should be addressed by utilizing tools that the coachee finds compelling. Lastly, the researchers conclude that coaching effectively produces positive personal and organizational outcome sustainability.
Based on the research, I had a better understanding of how to focus my case study efforts. In the next section, I will explain how I will provide the methods and results of the case study focusing on program effectiveness, executive and group coaching. My research approach included exploring why a hospital program is ineffective and determining how I can assist them in achieving their goal.
Method
Exploratory Information Gathering
In October 2021, a hospital experienced an adverse event related to its security program. As such, the hospital requested an onsite assessment conducted by the systems corporate security team to identify gaps or opportunities for improvement to prevent a similar situation. As part of the corporate physical security team, I participated in an onsite assessment with a hospital in Georgia. During the onsite assessment, several more interviews occurred with leadership and security team members. Discussions were semi-unstructured and focused on five pillars of the program: leadership, policy, education, technology, and assessments. During the interviews, participants and I took personal notes to reflect upon discussions and follow-up on further discussions that required additional detailed discussions. Notes taken were then gathered into category themes, such as leadership, policy, education/ training, assessment, and data collection, then placed into a report.
Executive and Group Coaching
The second phase of this study occurred in November during several online WebEx conversations with myself, facility leadership, and the security administrator. Afterward, I conducted two one-on-one coaching sessions with the Associate Administrator and two group sessions with the Associate Administrator and security administrator. Each conversation lasted approximately 50 to 55 minutes in length, and all participants took notes. The semi-structured sessions utilized the initial report from October as the agenda, which flowed into facility actions taken since the last meeting, followed by focused coaching methods based on the need for clarification, understanding of resistance, or supportive structures to ensure the sustainability of changes. In between the scheduled interviews, participants researched to discover and design program improvements and build upon the next coaching session. One last follow-up discussion lasted 20 minutes, with the Associate Administrator to reflect and receive feedback on the coaching process and its effectiveness.
Results
Exploratory Information Gathering
The qualitative data recorded during the conversations were analyzed and interpreted using sequential narrative/ performative and thematic analytical methods (See Table 1). The findings from the onsite assessment report were shared with the facility and discussed to determine the validity of how the data was interpreted. The Associate Administrator and Security Administrator reviewed the notes. They agreed that the notes taken and submitted were accurate accounts and had no modifications to the document.
As a result of the initial interviews in October, additional investigative literature research was conducted within the healthcare system to identify leadership training programs available to executives. The research was initiated to determine if workplace safety and security were included in any training modules. The review of internal system documents and training modules included five years of historical information. The result of the training literature review found ten leadership training program series developed over the past five years (see Table 2). A review of agenda topics and supportive documentation for the program's courses was initiated for search terms: violence, workplace violence, security. The online search found one result based on these keyword searches. Additional education search was conducted in the online learning system using a catalog search of “violence” and “security.” One additional course for emerging leaders was discovered. A similar search for the same keywords was conducted on the facility website and online learning system for employees. The search discovered eleven different courses.
During a coaching session with the Associate Administrator, we discussed the typical flow of individuals receiving education and training from the time they are hired to 90-days post-hire. The mapping out the education flow brought awareness to a lack of training to executives, security administrators, and employees. I shared the information in the next group session, which utilized the opportunity to identify potential actions to spread awareness of the security program. Some of the actions identified included security topics in the daily unit huddles, staff meetings, executive rounding, and facility newsletters.
Executive and Group Coaching
In this study, the coaching sessions utilize the principle of inter-subjectivity and build group rapport. During the first interview with executives, they stated they were not aware of the overall program or goals of the program. We initiated conversations around where they believe the program was currently, where they wanted it to be, what precisely they believe to be the gaps, and what the contributions led to the gaps. As part of the follow-up coaching discussions, conversations addressed these gaps and issues that contributed to achieving the goals. For example, when the Associate Administrator stated,
“I thought I understood the program until you explained all the components…I have learned so much from talking with you and the group. I didn’t know what to look for or how to interpret the data…I feel we are in a better place now, and we have implemented a lot of things already. We have more to do, but this is a great step forward...When I go to the units and talk with the staff, I ask them about any issues or concerns they have (related to security) and how I can help. I didn’t do that before.”
We inadvertently built a strong bond based on trust and rapport through the back-and-forth dynamic coaching conversations. This dynamic was then transferred to others within the hospital through their engagements. The result of the coaching sessions was deemed successful in raising self-awareness, identifying options for change and action.
Limitations
One case study was conducted within one hospital's more extensive healthcare system. Research conducted occurred between October and November 2021. There were a total of five touchpoints with the facility during two months. Coaching was limited to the hospital Associate Administrator, Security Administrator, and two security team members. I did not measure program sustainability and coaching effectiveness beyond the initial five coaching conversations,
Future Research
Future research should be conducted to ascertain the availability of physical security training to executives and employees and measure training effectiveness and executive and group coaching effectiveness. Healthcare facilities should assess executive onboarding training to ensure adequate training for all areas they are responsible for managing. There is an opportunity for additional research to measure training effectiveness using the program's key performance metrics, such as program assessment and adverse events. Healthcare facilities that do not address program training during onboarding or experience lower program compliance should consider executive and group coaching as an alternative.
Conclusion
Healthcare workplace violence in the U.S. is an epidemic and increases year over year. Regulatory agencies and hospitals develop workplace violence programs, yet they fail to meet expectations of reducing violent incidents. The qualitative case study was intended to determine why hospitals in a healthcare system would have varying security programs. This case study found that (1) hospital executives were not fully aware of the security program; therefore, they could not fully implement the corporate program. (2) Hospital executives and the security Program Administrator are not provided physical security program training before or after hire, and (3) Coaching provided on the program was found beneficial and successful.
To conclude, the first hypothesis, “lack of executive and program leader knowledge of security programs, before or upon hire, will lead to variations of program implementation and compliance within a healthcare system,” was proven accurate. The second hypothesis, “Executive and group coaching will enhance the facility performance and compliance of the security program,” was also found accurate. Additional research should be conducted to determine if this phenomenon is systemic across other healthcare systems. Suppose further research indicates this phenomenon is prevalent, healthcare systems and government agencies should include executive and program leader training in their guidelines or provide executive coaching to support the physical security program implementation and effectiveness.
References
de Haan, E., Culpin, V., & Curd, J. (2011). Executive coaching in practice: What determines helpfulness for clients of coaching? Personnel Review, 40(1), 24–44. https://doi.org/10.1108/00483481111095500
Grider, J. S., Lofgren, R., & Weickel, R. (2014). The Impact of an Executive Leadership Development Program. Physician Leadership Journal, 1(1), 66–69.
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. (2016). OSHA, 60.
Joo, B.-K., Sushko, J., & McLean, G. (2012). Multiple Faces of Coaching: Manager-as-coach, Executive Coaching, and Formal Mentoring - ProQuest. Organization Development, 30(1), 19–38.
Olson, J. R., Belohlav, J. A., Cook, L. S., & Hays, J. M. (2008). Examining Quality Improvement Programs: The Case of Minnesota Hospitals. Health Services Research, 43(5p2), 1787–1806. https://doi.org/10.1111/j.1475-6773.2008.00888.x
Schmidt, M. J., Wessling, E. G., McPhaul, K., London, M., & Lipscomb, J. (2019). Workplace Violence in Health Care: An Overview and Practical Approach for Prevention. Psychiatric Annals, 49(11), 482–486. https://doi.org/10.3928/00485713-20191010-01
Underhill, B. O., McAnally, K., & Koriath, J. J. (2007). Executive Coaching for Results: The Definitive Guide to Developing Organizational Leaders. Berrett-Koehler Publishers, Incorporated. http://ebookcentral.proquest.com/lib/fielding/detail.action?docID=319369
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