Safety: Create a Safe Environment

Prevent, identify and mitigate workplace violence at your surgery center.

ASC leaders are facing unprecedented challenges. Many of you are juggling conflicting priorities, such as meeting regulatory requirements, increasing revenue and reducing costs, all while addressing operational issues like filling staffing needs, procuring supplies and ensuring the safe delivery of high-quality care. These tasks are inherently difficult, and the changes anticipated in 2025 threaten to exacerbate these challenges.

While that extensive list is enough to keep any leader occupied, addressing these priorities may create blind spots in certain key areas. It often feels like the daily fires to be put out and endless minor emergencies are the norm. However, it’s crucial not to get so caught up in the day-to-day that you forget to prepare for real emergencies. There is no substitute for preparing for the unexpected types of events you think will never happen at your facility. Throughout my career, I have experienced many near misses, good catches and just plain luck. I’ll never forget the lessons I learned, including the importance of establishing protocols for emergencies and performing practice drills for events such as surgical fires, cardiac arrest, malignant hyperthermia and various patient-related emergencies. I also created protocols for impaired providers and staff, provided regular education and conducted mock drills regularly. Given all of that, I felt confident about our ability to respond to emergencies.

However, I learned the hard way that patient-related emergencies were not the only threats to safety and security in the center. A few close calls involving angry patients and family members, domestic disputes involving patients and an angry patient gaining access to a restricted area prompted a review of our safety and security plan.

Develop an emergency plan

Our plan included engineered controls that limited access to restricted areas and promoted a safe environment, but a review of actual practices revealed security breaches. Despite our good intentions to increase efficiency and convenience, we had created avoidable vulnerabilities.

The building was secure with restricted access to patient care areas, administrative offices and staff lounges. However, the universal construction code of “1234*” was still being used to access restricted areas throughout the building, even after several years of operation. Our environment had other security breaches, such as leaving external doors propped open for PRN staff, vendors and providers, and leaving the loading dock door open for deliveries.

As an ASC leader, you are responsible for creating a safe environment for patients, staff and visitors. While medical emergencies constitute most emergency events, threats of violence against your providers, staff and facility should be in your emergency plan. Regulatory and accrediting agencies emphasize this, and their urgency about it is rising. For example, in July 2025, The Joint Commission will implement requirements that include defining workplace violence, as well as developing worksite analysis processes, leadership oversight, policies and procedures, reporting systems, post-incident strategies, and training and education. Here are a few steps to assess vulnerabilities and develop strategies to prevent and mitigate workplace violence.

Identify potential hazards

• Review incident reports and analyze past incidents of workplace violence to identify patterns and common factors. Conduct surveys and interview staff and providers about their experiences and perceptions of safety.

• Evaluate the physical environment by assessing your facility’s layout.

Develop mitigation strategies

• Develop and implement a program to prevent workplace violence, including measures to secure access to facilities and monitor potential threats.

• Create or update workplace violence prevention policies. Implement ongoing training for all staff.

• Implement a process for reporting potential and real risks of workplace violence.

• Have a robust communication plan with tools to communicate emergencies and facilitate responses. Train staff on the “Run, Hide, Fight” strategy.

• Create a process to immediately update security access. Remove any staff, providers or contractors who are no longer associated with the center.

• Conduct drills specific to workplace violence and active shooters. Evaluate effectiveness, identify gaps and implement strategies based on findings.

Monitor and review

• Conduct periodic reviews of the program.

• Work with your existing security team or local law enforcement to perform audits, planning, emergency drills, debriefing and ongoing education.

By integrating these steps, ASC leaders can ensure a safer environment for patients and staff. For more information on emergency drills recommended for ASCs, visit aorn.us/asc-emergency-drills. OSM