Crime in healthcare facilities poses a serious threat to patients, providers, support staff, visitors, and first responders. According to the Occupational Safety and Health Administration (OSHA), nearly 75% of the 25,000 workplace assaults reported annually occur in healthcare settings. A 2022 report from the International Association for Healthcare Security & Safety (IAHSS) highlights that violent crime in hospitals rose from 1.4 incidents per 100 beds in 2019 to 2.5 in 2021. Simple assaults surged from 10.9 to 17.7 per 100 beds during the same period.
Much of the violence—over 70% of aggravated and 86% of simple assaults—comes from non-employees targeting healthcare staff. During the COVID-19 pandemic, tensions escalated, leading to off-campus attacks driven by anger over social distancing, vaccination mandates, and visitor restrictions.
Challenges in Crime Response at Healthcare Sites
Healthcare facility layouts and internal procedures are often unfamiliar to local law enforcement, complicating response times and coordination. After an incident, the area becomes a crime scene, potentially halting vital services. Although some hospitals have strong relationships with local law enforcement, this is not yet standard practice.
Encouraging Trends and Professional Insights
Despite rising violence, more healthcare workers are reporting incidents rather than dismissing them as routine. In a 2023 issue of the Domestic Preparedness Journal, security expert Kevin Jones emphasized the value of prevention, preparedness, and strong partnerships with emergency services. This article outlines practical tools and approaches that can help reduce crime in healthcare facilities and improve safety for all.
The Scope of Crime in Healthcare Facilities
Violence is particularly prevalent in emergency departments (EDs), where time-sensitive care intersects with interpersonal conflicts. For example, the Cleveland Clinic confiscated over 30,000 weapons in 2018 using metal detectors in its Ohio region. A 2018 study found that 70% of healthcare workers experienced violence, and nearly 22% feared becoming victims.
Between 2010 and 2020, 39 fatal shootings were reported in Joint Commission-accredited facilities, including:
- 21 staff members (10 by patients, 5 by visitors, 4 by family members, 2 by fellow staff),
- 18 patients (15 by family members, 2 by visitors, 1 by another patient).
Nearly 30% were murder-suicides, many motivated by perceived “mercy killings.”
Violence extends beyond hospitals to outpatient clinics, in-home care, and pharmacies. A review found that 65% of pharmacists experienced workplace violence. Security measures vary significantly—some facilities have in-house security; others rely on local police, often part-time.
Financial and Operational Impact
Beyond physical injuries, workplace violence leads to mental health consequences, absenteeism, and staffing shortages. The “Great Resignation” revealed how burnout and violence are pushing professionals out of healthcare, requiring heavy investments in staff retention and safety programs.
Key Risk Factors for Crime in Healthcare Facilities
According to the Joint Commission and Kevin Jones, common risk factors include:
- Patients with mental health conditions
- Individuals in police custody
- Long wait times and overcrowding
- Gang activity and domestic disputes
- Presence of weapons
- Inadequate de-escalation training
- Understaffed security and care teams
- Poor lighting and visibility
- Limited emergency communication access
- Unrestricted public access
Outpatient and in-home care environments introduce additional challenges due to space limitations and isolation.
Recent Legislative and Standards Updates
Federal Initiatives
In 2023, OSHA began developing a new standard for workplace violence prevention in healthcare and social assistance. The framework may include:
- Comprehensive violence prevention programs
- Hazard assessments and mitigation strategies
- Incident investigations and anti-retaliation policies
- Training and stigma-free approaches for patient care
State Legislation
Several states have introduced stricter penalties for assaults against healthcare workers. Protections vary—some states focus only on emergency or mental health staff. For example, Maryland is the only state that does not require staff to display full names on badges, protecting them from being targeted.
Updated Accreditation Standards
In January 2022, The Joint Commission introduced new workplace violence standards emphasizing:
- Environmental safety monitoring
- Continuous staff training
- Fostering a safety-first culture
Hospitals can refer to the Joint Commission’s Compendium of Resources for implementation support.
Proactive Steps to Reduce Crime in Healthcare Settings
Healthcare facilities can reduce crime and increase resilience by adopting a proactive, top-down safety strategy. Key steps include:
1. Develop a Comprehensive Safety Program
Ensure all staff understand what constitutes an incident and how to report it. Collecting incident data can inform future prevention policies.
2. Create Threat Assessment Protocols
Multidisciplinary teams—security, social work, risk management, and nursing—should collaborate on identifying threats using tools such as:
- Violence Reduction Protocol Treatment Plan
- Brøset Violence Checklist
3. Leverage Technology
Equip staff with:
- Panic buttons
- Mobile apps for emergency check-ins
- Silent alarms and real-time monitoring tools
4. Train for De-escalation
Regular training helps staff manage agitated individuals and minimize the potential for escalation.
5. Optimize Facility Design
Security improvements may include:
- Enhanced lighting and clear sight lines
- Metal detectors or deterrent signage
- Sloped desks to prevent overreach
- Extra exit points for staff safety
6. Strengthen Law Enforcement Partnerships
Conduct regular joint drills with first responders. Share facility layouts and provide access to live surveillance footage. Store go-kits at ED entrances to reduce response time during critical incidents.