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Inova Health Creates a SAFE Place for Nurses and Other Frontline Workers

Analysis  |  By Carol Davis  
   November 29, 2021

The health system's specially designed rapid response team has curtailed violence and created a safer workplace for its employees.

When an altercation—verbal or physical—begins at Inova hospitals, it is quickly met with a rapid-response team specially trained to de-escalate and safely contain the fracas.

The Safety Always for Everyone (SAFE) team, Inova's major response effort to de-escalate issues and provide support for team members while also assuring safe care to patients, has resulted in fewer incidents and a staff much more confident in their workplace safety, says Kathy Helak, MSN, BSN, RN, FACHE, CPPS, Inova's assistant vice president for Patient Safety.

Nurses and other frontline healthcare workers are much more likely to be victims of aggravated assault at work than workers in any other industry, says Kaiser Health News. U.S. healthcare workers accounted for 73% of all nonfatal injuries from workplace violence in 2018, federal data shows.

Violent incidents can occur in different ways, Helak says. They range from disrespectful verbal confrontations where an individual—usually a patient—directs profanities, threats, or slurs toward healthcare workers to physical altercations where they hit, kick, punch, or spit on them.

Inova, a five-hospital health system based in northern Virginia, put the SAFE team in place about two years ago, after frontline team members reported that they felt uncomfortable addressing altercations by themselves.

"They didn't necessarily feel that they had the right skills and they needed additional resources," Helak says.

After researching best practices across the country, Inova created a plan.

"We know that having a team of experts that can immediately respond when something does happen with a patient or family member is best, so we immediately pulled together a multidisciplinary team that included nursing expertise, security expertise, colleagues from mental health areas, our communications team, and we worked to really design what we thought would be the best approach to providing this type of intervention," Helak says.

"What was so exciting at the time when we did this was how engaged all those folks were to be able to provide a stronger approach to [give] immediate relief for our frontline team members," she says. "Everybody was motivated to do whatever we needed to do to make sure that our frontline team members felt safe."

Inova developed an around-the-clock SAFE plan, piloted it, accepted feedback, and fine-tuned it based on that feedback. It's now adopted in all the health system's facilities.

Keeping everyone out of harm's way

The SAFE team is comprised of security officers specially trained in how to de-escalate confrontational situations, the nursing supervisor, mental health experts to help de-escalate the situation, physicians, and other team members, as needed, to provide their expertise, Helak says.

When a healthcare worker feels they are in an unsafe situation, they can call a special number that alerts the SAFE team, which responds immediately, she says. The team then uses their skills to de-escalate the situation, get control of it, and keep both the patient and healthcare workers safe so no harm comes to anyone involved, she says.

The intervention doesn't end when the altercation has been resolved, Helak says.

"Following those situations, we often do what we call a debrief, to look at whether there is anything we could learn from this situation so that we could prevent it from occurring next time or if we missed any cues that could have helped us de-escalate the situation before it got out of hand," she says.

Fewer altercations, more comfort

Rapid response has helped the health system's team members feel safe and secure while doing their jobs, particularly since they can be summoned on a moment's notice, Helak says.

Additionally, the number of time that security must be called because of a concerning interaction has been reduced, she says. That's because a patient who encounters the SAFE team is less likely to have behavioral issues for the remainder of their hospital stay, she says.

"It really does allow us to establish the expectations with patients or with their family regarding our desire to provide a very therapeutic environment for the patient to be well taken care of," she says, "but we have expectations in terms of how they need to behave while they're here."

Zero tolerance

Emotions run high in hospitals, making violent outbursts more common than in other settings. But whereas it used to be considered just "part of the job," that is no longer the case, Helak says.

"We here at Inova believe that this is totally inappropriate, and that we are not going to tolerate any of our team members being subjected to any kind of verbal abuse or physical abuse that compromises their ability to feel state and then compromises their ability to be able to take care of their patients," she says.

"Over the last few years, we have really worked very hard at Inova, as part of our commitment to zero tolerance, to encourage our team members, regardless of the type of interaction, to speak up to report it," Helak says. "And we are engaging in improvement efforts to make sure that we have evidence-based approaches to preventing these types of situations from occurring and helping employees feel safe."

“Everybody was motivated to do whatever we needed to do to make sure that our frontline team members felt safe.”

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.


Nurses and other frontline healthcare workers are much more likely to be assaulted at work than workers in any other industry.

Inova created a rapid-response team specially trained to de-escalate and safely contain altercations in its workplaces.

Inova's employees feel safer, and security is summoned much less after the rapid-response team was implemented.

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