The Joint Commission REPORTS HERE that "once considered safe havens, health care institutions today are confronting steadily increasing rates of crime, including violent crimes such as assault, rape and homicide. As criminal activity spills over from the streets onto the campuses and through the doors, providing for the safety and security of all patients, visitors and staff within the walls of a health care institution, as well as on the grounds, requires increasing vigilant attention and action by safety and security personnel as well as all health care staff and providers."

"While there are many different types of crimes and instances of violence that take place in the health care setting, this Sentinel Event Alert specifically addresses assault, rape or homicide of patients and visitors perpetrated by staff, visitors, other patients, and intruders to the institution."

"The Joint Commission’s Sentinel Event Database includes a category of assault, rape and homicide (combined) with 256 reports since 1995 – numbers that are believed to be significantly below the actual number of incidents due to the belief that there is significant under-reporting of violent crimes in health care institutions."

"It is noteworthy that the assault, rape and homicide category of sentinel events is consistently among the top 10 types of sentinel events reported to The Joint Commission. Since 2004, the Sentinel Event Database indicates significant increases in reports of assault, rape and homicide, with the greatest number of reports in the last three years:  36 incidents in 2007, 41 in 2008 and 33 in 2009."

The Joint Commission notes that "the following contributing causal factors were identified most frequently over the last five years:

• Leadership, noted in 62 percent of the events, most notably problems in the areas of policy and procedure development and implementation. 
• Human resources-related factors, noted in 60 percent of the events, such as the increased need for staff education and competency assessment processes.
• Assessment, noted in 58 percent of the events, particularly in the areas of flawed patient observation protocols, inadequate assessment tools, and lack of psychiatric assessment.
• Communication failures, noted in 53 percent of the events, both among staff and with patients and family.
• Physical environment, noted in 36 percent of the events, in terms of deficiencies in general safety of the environment and security procedures and practices.
• Problems in care planning, information management and patient education were other causal factors identified less frequently."

The article goes on to report on the reasons that hospitals and other large health care institutions are becoming ever riskier places and cite such examples as continual public access, high stress environments, highly charge emotional situations and the like.  But, while securing against the perpetuation of violence against staff by members of the public the Joint Commission article notes:  "While controlling access to the facility is imperative and ongoing surveillance of the grounds is a necessity, administrators must be alert to the potential for violence to patients by health care staff members. The stressful environment together with failure to recognize and respond to warning signs...can elevate the risk of a staff member becoming violent towards a patient. Though it is a less common scenario, health care workers who deliberately harm patients by either assaulting them or administering unprescribed medications or treatments, present a considerable threat to institutions, even when the patient is unable to identify the responsible person."

The Joint Commission points out that this makes the role of the human resource departments ever more important.  But the Commission notes "Since criminal background checks are costly, at a minimum, organizations may want to conduct criminal background checks on job candidates who are to be placed in high risk areas, such as the ED, obstetrics, pediatrics, nursery, home care and senior care settings."  The Joint Commission reports on suggested actions to improve safety in the institutional health care setting.

"Founded in 1951, The Joint Commission seeks to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Joint Commission evaluates and accredits more than 17,000 health care organizations and programs in the United States. An independent, not-for-profit organization, The Joint Commission is the nation's oldest and largest standards-setting and accrediting body in health care. To earn and maintain The Joint Commission’s Gold Seal of Approval™, an organization must undergo an on-site survey by a Joint Commission survey team at least every three years. (Laboratories must be surveyed every two years.)"

The Joint Commission provides accreditation services for hospitals, home care organizations,medical equipment services, hospice services, nursing homes, long term care facilities, behavioral health care organizations, addiction services, ambulatory care providers, and independent clinical laboratories, and more.

"Joint Commission standards address the organization’s level of performance in key functional areas, such as patient rights, patient treatment, medication safety and infection control. The standards focus on setting expectations for an organization’s actual performance and for assessing its ability to provide safe, high quality care. Standards set forth performance expectations for activities that affect the safety and quality of patient care. If an organization does the right things and does them well, there is a strong likelihood that its patients will experience good outcomes. The Joint Commission develops its standards in consultation with health care experts, providers, measurement experts, purchasers, and consumers."

Joint Commission Resources is a global, knowledge-based organization that provides innovative solutions designed to help health care organizations improve patient safety and quality. An affiliate of The Joint Commission, JCR is the official publisher and educator of The Joint Commission. JCR provides expertise on the many issues organizations face in a challenging health care environment through a variety of product and services including: education programs, publications and multimedia products, its Continuous Service Readiness program, comprehensive health care consulting and custom education, and accreditation and consulting for organizations abroad. The Joint Commission and JCR maintain strict policies that prohibit The Joint Commission from sharing any confidential information about accredited organizations with JCR. The fact that an organization has obtained services from JCR is kept completely separate from Joint Commission accreditation decisions.