AUSTIN, Texas — Risk managers need to work with senior leaders at health care systems to create prevention strategies that can reduce incidences of violence against medical providers.

Several dynamics can lead to violence in hospitals and other medical facilities, including substance abuse, stress from dealing with medical bills and problems with navigating a complex health care system, said Diane Doherty, New York-based vice president of Ace Medical Risk, a division of Ace USA.

Ms. Doherty said all medical groups need to acknowledge that violence can occur in their organizations and should work to craft up-to-date violence prevention programs that take a medical system's unique vulnerabilities into account. This includes encouraging employees to report acts of violence in health care facilities and getting buy-in from senior managers to take a zero-tolerance approach to violent acts in the workplace.

“Preventing workplace violence is everyone's responsibility,” Ms. Doherty said. “It takes a multidisciplinary team approach, and the risk manager plays an important role in leading and guiding that team.”

Ms. Doherty made her comments in a session on violence in hospitals during the American Society for Healthcare Risk Management's annual conference, held Oct. 27-30 in Austin, Texas.

Richard D. Sem, president of Lake Geneva, Wis.-based Sem Security Management, offered advice for health care systems that are looking to prevent violence in their workplaces. Mr. Sem, who provides security consulting for health care organizations, said he has seen an increase in “rude and aggressive” behavior at hospitals.

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Mr. Sem said that risk managers should develop close relationships with internal security managers, as well as police or sheriff's departments in their communities.

“You need to have that liaison with your local law enforcement agencies,” Mr. Sem said. “They need to know you, they need to know your plans, they need to tour your facility, they need to have layouts, (and) they need to know what you're going to do in case of violence and what their relationship is. They can be a great resource.”

Mr. Sem recommended limiting the number of entrance points in hospitals, and recommended having people greet visitors as they enter facilities. By establishing contact with people entering the hospital, Mr. Sem said staff can make an early assessment of whether a person might pose a threat of violence.

“I think the most powerful five words in security are "How can I help you?'” Mr. Sem said. “They're not a threatening question, (and) most ... people coming in will appreciate the question. But it's a good way of assessing what people might be up to.”

Mr. Sem also recommended providing security training for all employees in medical facilities.

“Your staff needs to have responsibility,” he said. “Often when I talk to nurses and physicians, they'll say, "It's not our job, it's security's job.' Well, it is their job really. It's part of their role.”

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In another ASHRM conference session, a joint study by Aon Risk Solutions and ASHRM showed that medical malpractice claim frequency is expected to remain flat in the next year, while the cost of med mal claims has seen the smallest increase in more than a decade.

The study projected no increase in hospital professional liability claim frequency for 2014. Meanwhile, med mal claim severity, including defense costs, is growing by 2.5% annually, which is the lowest rate of severity growth in the report's 14-year history.

“This risk appears to be fairly under control and fairly stable,” said Erik Johnson, Raleigh, N.C.-based health care practice leader for Aon Risk Solutions' actuarial and analytics practice, in a presentation at the ASHRM conference.

The report estimated that med mal claims in 2014 will represent 60 cents in costs for every $100 of hospital revenue, or $135 per average hospital admission. Hospitals have been reducing med mal costs in part by improving patient safety and self-insuring to cover malpractice claims, the study said.

Aon and Dublin-based insurer and reinsurer Beazley P.L.C. also performed an analysis of high-severity med mal claims with costs of more than $2 million.

Valentina Minetti, London-based underwriter and pricing actuary for Beazley's health care specialty lines, told ASHRM conference attendees that Washington, Philadelphia, and Cook County, Ill., had the highest frequency of high-severity med mal claims.

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However, she noted that states with tort reform laws, such as California and Maryland, have seen a recent increase in med mal claim severity that is steeper than the national trend.

Beazley claims managers “are seeing record verdicts in states that are not necessarily the usual suspects,” Ms. Minetti said. “States like Wyoming, Maine, Virginia and Colorado have all had state-record verdicts in the last 12 to 24 months.”

About 3,000 people attended this year's ASHRM conference. Next year's conference is set to be held Oct. 26-29 in Anaheim, Calif.