Scott Gee (Host): Welcome to AHA Associates Bringing Value, a podcast from the American Hospital Association. In this series of podcasts, we speak with AHA Associate Business Program partners check in on their efforts and learn how they support AHA hospital and health system members.

Today's topic is interpersonal and domestic violence, a discussion of the deadliest events impacting the healthcare environment. When I came to the American Hospital Association, I had no idea that frontline healthcare workers were the second most often assaulted profession behind law enforcement. Even coming from law enforcement background as I did, that statistic was shocking to me.

Recently, we've also seen some horrific acts of violence toward the sector as a whole, starting with the senseless murder of Brian Thompson last December, and as recently as last week when a Pennsylvania man was arrested for violent threats against the hospital's CEO. The physical threats to the healthcare sector are escalating constantly. The AHA has been working closely with the FBI's Behavioral Analysis Unit One, and we developed guides for hospitals to use in detecting and mitigating potential threats. For more information on that, please visit AHA's Hospitals Against Violence website. I am Scott Gee, Deputy National Advisor for Cybersecurity and Risk at the American Hospital Association.

Today, I'm joined by Jason Grellner, Vice President and Head of Healthcare at Evolv Technology. And we look forward to working with good firms like Evolv as we help mitigate hospital violence going forward. Welcome to the podcast, Jason.

Jason J. Grellner: Hey, thanks for having me this morning. It's great to be here.

Host: Jason, before we jump right in, can you share with our members about your expertise, your professional journey, and what experiences brought you to Evolv?

Jason J. Grellner: Yeah. I started out in law enforcement much like you. I spent 27 years, 22 of those years in narcotics work working with some of the greatest agents the nation had to offer from DEA, FBI, ICE, you name it. I had a great career there and, after retirement, left and went to work for Mercy Healthcare based out of St. Louis, Missouri, at that point was a 42-hospital healthcare system with 43,000 coworkers spread across seven states. I was happy to be at a Catholic healthcare organization, had a great career there. We were an early adopter of violence mitigation hardware, the Evolv Express. And I had the opportunity, after a few years, to actually join Evolv and work to help make healthcare safety and security prominent across the world, really. We're working not only in the United States, but in Eastern Europe as well as Western Europe and Canada.

Host: That's great. So, addressing the safety and security of doctors, nurses, staff, patients, and visitors to hospitals is a top priority for AHA members. Can you give us an overview of how domestic and interpersonal violence shows up in various healthcare settings, especially in ways that leadership and staff might overlook?

Jason J. Grellner: Certainly. You know, even going back to my own law enforcement career, a lot of times, we would be called to hospitals to interview the victims of interpersonal domestic violence. And then, as I worked in the healthcare space, first managing and supervising public safety officers in healthcare, and then later having the entire system under my control, we could really see not only where domestic violence was interacting with our patients. But also, with our own staff or members of our staff who are victims of interpersonal domestic violence. And you got to remember, Scott, in healthcare, you're working with highly educated individuals, right? You've got men and women who have spent years, perfecting their craft in spending years in medical schools and nursing schools, and highly educated. But they do fall victim to the same traps of interpersonal domestic violence that anyone can fall victim of.

And what we find is that that domestic and interpersonal violence doesn't just affect them in their personal life away from work. It follows them to work. And it led me to start looking at Mercy some of the most horrendous events that we had had. We looked at acts of violence that had caused death or serious bodily harm, and we tracked almost all of those back to domestic violence incidents, incidents where the victim was a member of our own team at our own hospitals who had done the right thing, many of them were in the middle of divorce proceedings. They had gotten orders of protection, full orders of protection. But what they had failed to do, and they had failed to report those to us, whether it was because they didn't feel that it would help or whether they didn't feel that they wanted their personal life on display for everybody at work, they really had not given us the opportunity to help them protect themselves at work. And it ultimately led to a lot of them's death.

Host: Yeah. And that's tragic, Jason. The hospital staff really needs to make sure that any threats that come to their attention do get shared with hospital security folks.

Jason J. Grellner: Yeah. Over the last year, I've really made that a point that we wanted to get across to everybody in healthcare is that, look, 27% of women are going to experience a form of domestic or interpersonal violence in their lifetime. That's almost one in four, right? The nursing industry is heavily laden with females.

And so, when you look at your staffing model and the number of females that you have in your staff, and you figure that one in four, one in 4.5 of those are going to be a victim of interpersonal domestic violence. You really need to work with your HR staff. We need to bring this out of the shadows, right?

Host: Absolutely.

Jason J. Grellner: This is not something to be ashamed of. The victim is the victim. They're not putting themselves out there to be victims, right? The perpetrator is the problem here. And we need to put the spotlight on making sure that we're doing everything we possibly can to help the victim. And that includes taking safety measures, allowing them to park in specialized parking, making sure that our security staff is aware of the predicament they find themselves in. Understanding who the suspect is, and doing intelligence gathering on that individual to make sure if they show up on the property. We're aware of it through ALPR or facial identification and recognition, everything that we can do to make sure that our personnel feels safe when they come to work each day.

You know, that's the biggest part of violence in healthcare is we want our healthcare workers centered on the patient. And doing everything they can to make sure that the patient is receiving the best care possible. They can't do that if they're worried about their own personal safety. And for a victim of domestic violence, that is constantly in the back of their mind.

And so, anything that we can do to, again, get this out of the shadows, draw the curtain back on this and say, "We understand. We know what to do if you're the victim of domestic violence." Not only if you're a patient, but if you're a team member of ours, a coworker of ours, we want to help. We're not judging you, right?

Host: Right. Absolutely. But the key is sharing that information, making people aware of the potential for violence.

Jason J. Grellner: Certainly. And understanding that there's already been violence, right? They wouldn't be a victim of violence if there wasn't already violence in their lives. And again, that violent actor is not acting rationally. And so, that violence can fall into door. I can remember what one of my own incidents at a small hospital that I worked at, where I was walking, one of our nurses out to her vehicle after work one afternoon, and he was waiting on the line with a large Bowie knife. And I don't know what his intentions were. I know how upset he was to see me walking her to her car. But I immediately put her in a car, put myself between he and her, and was on the phone with 911 and our dispatch center to get more help out to the parking lot. He was violating a court order. So, rationality doesn't play into it when there are emotions involved. And that emotional guttural response that he was having to her interactions with the courts and the court's interactions with him were spilling over onto our parking lot. That's the other thing that we find, is that these interpersonal, domestic violence situations may not occur directly inside the facility. A large percent of them are actually occurring on the parking lots and parking garages and green spaces of our hospital systems. And so, that's something that we don't normally take into account, right? We look at everything inside the threshold, and we really need to extend that out to the area of the parking areas.

Host: Absolutely. So Jason, in one of your blogs, you mentioned having a training program that focuses on things like deescalation skills, incident reporting and, most importantly, probably recognizing warning signs. Can you give our listeners some of the signs of behaviors that frontline staff and administrators should be trained to recognize?

Jason J. Grellner: Yeah. A lot of times, you'll find that the victim will confide in a friend, a close personal friend at work. And so, at least one person will know and that friend usually doesn't want to destroy that confidence, so they don't want to tell anybody else what's going on. And everything is just in secrecy. And then, something happens, something dynamic happens, and then it's like, "Well, I knew about it, but she really didn't want me to tell anybody." And I thought I was doing the right thing. And that's all part of that embarrassment, right? That's all part of that hidden secrecy of this disease really, that is affecting healthcare.

It's bringing patients to us through the ED. It's bringing people to us, again, through our own coworkers. And so, we have to break that code of silence. And so, first and foremost is knowing that if somebody's "confiding in you," they want the information to get out. They want help.

Host: They want help.

Jason J. Grellner: Exactly, Scott. And so, by continuing that secrecy, you're not giving them the help that they want, right? And so, we need to get that help and we need to get that help out. And we do that again through our HR, through our public safety, and making sure that we have policy and process in place. People who are withdrawn and sullen can be the victims of domestic violence and having issues. We need to interact with those people and dig it deeper into what's going on with them, "We care about you, you seem to be off," and ask the hard questions, check-ins, on those individuals before something occurs and something happens. And then, deescalation, like you said, deescalation, verbal deescalation isn't just for use with those that are visiting our healthcare systems in our locations. It's for use with our own coworkers. They can also be extremely upset, angry, anxious, have a lot of anxiety, because of the physical and mental torment that they're going through in their own personal lives. And again, not many people can be two different people in their life, right? They can be one person at home and one person at work. Those of us who have managed people throughout our lifetime understand that what happens at home does not stay at home. And so, we need to be cognizant of that.

And the other thing is this, if you are a victim or have been a victim, it's very easy for you to spot other victims, right? You understand what they're going through. You see the same things in them that you saw in yourself. And so if you see those things, it's see something, say something. Talk to those individuals. Look, we're a place of healing. Healthcare is a place of healing. And we need to be a place of healing for domestic and interpersonal violence.

Host: Yeah, that's fantastic. So Jason, we talk a lot about staff members, team members, healthcare workers, and they are by far our most precious resource. As you said, they have to be focused on patient care and not worried about the other things going on in their life. When violence does show up in healthcare settings, how is this violence affecting frontline healthcare workers?

Jason J. Grellner: Yeah, you know, I say that, in the past, there was violence in healthcare, because of the human condition, right? As children, we were taught that if an animal is struck in the roadway as a child, don't go near it, right? Don't try to help it. The animal's in pain, it's in fear, it's in anxiety, right?

And if you go near it, it may lash out from those emotions and defend itself and bite you. So, always go get a parent, guardian and have them deal with the animal. Well, it was the same way in healthcare, right? When we would bring somebody into the emergency room, that's not a place of happiness, right?

When I was dating my wife, I didn't say, "Hey honey, it's Friday night. Let's go hang out at the ED," right? We'll go down to the cafeteria, we'll get some delicious hospital food. And then, we'll hang out in the ED, because it's such a fun place to be. People coming into the ED are in pain, they have fear and they're in anxiety. So, the same as that animal. And so, when we're treating that person in the emergency department, they can sometimes lash out from those feelings, right? So, we were used to that. In fact, it's where the old analogy came from, "It's just part of the job," right?

But what we have seen from just before COVID to now is ideological, anger; and people who are acting out from ideology. They believe they know more than the doctor. They've looked it up on Google. "Masks work." No, they don't. "Getting an inoculation works." No, it doesn't. The same fights that we see played out on the television each night are being played out in our EDs across America.

And so, that kind of anger and misunderstanding is not something that we're used to in healthcare. And the fact that people aren't willing to discuss issues, they want to argue issues, and that arguing and that fear and anxiety, then lead to physical altercations. That's something that we're not used to dealing with. We're not used to people saying that you are evil, you're not here to help, you're here to hurt us. You just want to be part of the industrial healthcare revolution. And you want people in the hospital all the time, because it just makes money for your CEOs. And denials are just there to make more money for the CEOs as we saw in what the devastating effects in December with UHC.

And so, what we've never had to deal with is this sort of anger and resentment and ideology that bubbles over, as you just said last week, an individual from Virginia who was going to go down to Tampa, and guillotine the CEO of the hospital over not who he was, but what he represented, right? And that ideology representation anger, and those sorts of things are what we've never dealt with before and why we have to up our game, right, in our security layering.

Host: Yeah. So finally, Jason, could you share with our listeners any proactive steps that hospital leaders can take to protect hospitals and staff? We're talking protocols, technologies, ways to identify and mitigate these risks before they arise to violence?

Jason J. Grellner: Yeah, certainly. I talk about this all the time, and it's really taking the boundaries of your healthcare ecosystem to the very edge, right? And that starts with technology at where people are entering your campus. That can include facial recognition, software writing on your VMS system. It can include automatic license plate readers so that you know when bad actors are entering your campus that are there to just do damage. They're there to rob, steal, and do things that they would normally do anywhere else in the community. And now, they're going to do them on your property so that you can identify people who are involved in domestic violence and interpersonal violence because, by court order, they're not allowed to come near or harass the victim who's now on your staff, right?

Host: And just their presence is a violation of the law.

Jason J. Grellner: Exactly.

Host: Absolutely.

Jason J. Grellner: And look, they have a right to healthcare also, right? But at least you know they're on the campus. And you can identify them, you can segment them, you can get them to care, and you can keep the victim and the suspect apart from each other. And if they're there for a non-healthcare reason, you can get them off of your campus as soon as possible, right? Access control. We did a great job during COVID, Scott, of really controlling access to our healthcare campuses.

And a byproduct of that was some of the lowest crime rates we've ever seen on healthcare campuses. We did a great job of understanding who was on our campus, closing down doorways and portals of entry, and really forcing people to come through where we knew we could see them, talk to them and identify them. That's a practice we need to continue. We need to make sure that if it's a staff-only entrance, it's a staff-only entrance, and do we really need 17 public entrances to the campus or can we do with 10 or seven, right? And then, how do we man those and who's greeting? How do we train those greeters? Even if they're not a part of our security team, they can be the eyes and ears of our security team.

And then, as you have said, utilizing cameras and other AI opportunities that are out there that we didn't have before, things like sound intelligence, where we can hear the word help, we can hear agitation in voice, which is one of the predictors of physical violence is people getting agitated and raising their voice. There's all sorts of different AI capabilities out there. We're now seeing autonomous drones coming in to be available that can fly around our campuses and not only help us with security, but monitor their temperature of our cooling towers to make sure that our maintenance is being taken care of. And so, there's a lot of opportunities out there now to invest in technology that can help us keep our campuses safe and run more efficiently.

Host: Jason, thank you very much for joining us today and sharing your takeaways with AHA members. For our listeners, if you'd like to learn more about Evolv Technology and the AHA Associates Program, please visit sponsor.aha.org. Or if you'd like to learn more about AHA cybersecurity programs, please visit aha.org/cybersecurity. Also, as always, special thanks to our frontline healthcare heroes for what you do every day to defend our networks, take care of our patients, and serve our communities. This has been AHA Associates Bringing Value, brought to you by the American Hospital Association. Thanks for listening, and stay safe everyone.