How Rural Hospitals Can Strengthen Safe Workplaces

Rural hospitals across America face an increasingly complex challenge: how to protect patients and staff from rising workplace violence while operating within significant financial constraints. These vital community institutions—often the only health care providers for many miles—must balance their fundamental mission of providing care with the urgent need to create safe environments for everyone who walks through their doors.

The statistics paint a stark picture of the security challenges facing health care facilities:

• Health care workers accounted for 73 percent of all nonfatal workplace injuries and illnesses due to violence in 2018, according to the Bureau of Labor Statistics.

• From 2002 to 2013, the rate of serious workplace violence incidents (those requiring days off for an injured worker to recuperate) was more than four times greater in health care than the average for private industry.

• More recent data shows this trend has only intensified, with incidents of violence against health care workers increasing more than 60 percent from 2011 to 2018.

For rural hospitals, these national trends can translate into localized security challenges that may be further compounded by unique operational constraints. These facilities may have lower patient volumes—given that they serve smaller populations and residents sometimes travel to urban facilities to receive their care—which may lead to higher costs on average. This financial reality creates a challenging environment for implementing comprehensive security measures.

When security needs arise, rural hospital administrators face difficult decisions about resource allocation. Every dollar spent on security infrastructure, staffing, or training represents funds that cannot be directed toward clinical equipment, facility maintenance, or patient care programs. This isn't about choosing profits over safety, it's about maximizing the good these hospitals can do for their communities with limited resources.

Despite their many financial constraints, rural hospitals can implement effective security measures through strategic planning and creative resource allocation. Rather than attempting comprehensive security upgrades simultaneously, we can focus on areas with documented higher risk. Emergency departments, behavioral health units, and patient registration areas typically see the highest incidence of aggressive behavior. Prioritizing these areas allows for targeted investment where it's most needed.

Comprehensive de-escalation training represents one of the highest return-on-investment security measures available. Training programs that help staff recognize escalating situations and respond appropriately can prevent many incidents from progressing to violence. These programs typically cost significantly less than physical security infrastructure while providing immediate benefits.

Many security technology providers also offer financing options or phased implementation plans specifically designed for smaller health care facilities. Rather than delaying improvements indefinitely, these arrangements allow hospitals to begin protecting high-risk areas immediately, while spreading costs over more manageable timeframes.

Rural hospitals often have very strong community relationships that can be leveraged for security purposes. Formal partnerships with local law enforcement can provide enhanced security presence during high-risk periods or situations. Some facilities have successfully established shared-cost arrangements for dedicated security coverage during specific shifts or circumstances.

Many rural hospitals can enhance security by further utilizing their current resources as well. Improved lighting, clear sight lines, and strategic furniture placement cost relatively little but can significantly improve situational awareness and deter aggressive behavior. Staff communication systems and panic buttons can often be integrated with existing infrastructure at minimal additional cost.

Rural hospitals aren't without resources for security improvements. Several federal programs specifically support rural health care infrastructure development:

• While the future of funding may not be certain, the Hospital Preparedness Program, administered by the U.S. Department of Health and Human Services, provides funding for emergency preparedness activities, including security enhancements. The maximum total per grant year cannot exceed $350,000 through programs like the Rural Hospital Flexibility Grant Program.

• USDA Community Facilities programs offer another avenue for funding security infrastructure.

These programs recognize that health care facility security serves broader community safety purposes, particularly in areas where rural communities face a variety of challenges and barriers that impact health, such as fewer care providers and medical facilities, greater distances to travel for care, and so on.

Most successful rural hospital security programs, however, share several characteristics:

• They conduct comprehensive risk assessments

  • Understanding specific vulnerabilities allows for targeted interventions rather than generic security measures that may not address actual risks.

• They engage their staff from all levels and disciplines

  • Security measures work best when all staff understand their role in maintaining a safe environment. This includes everyone from clinical staff to maintenance and administration.

• They document all incidents, regardless of size or severity, thoroughly

  • Systematic tracking of security incidents helps identify patterns and evaluate the effectiveness of interventions over time.

• They update their plans regularly and with a focus on improving

  • Security needs evolve, and effective programs include mechanisms for regular assessment and adjustment of security measures.

• They communicate clearly with the whole community

  • Clear communication about security measures helps set appropriate expectations for patients and visitors while maintaining the welcoming atmosphere that is essential to health care delivery.

Rural hospitals cannot eliminate every security risk, nor should they be expected to implement urban or large hospital system-level security measures with a fraction of the resources. However, through strategic planning, creative partnerships, and targeted investments, these facilities can significantly improve safety for patients and staff.

The goal isn't perfection—it's progress. Each security enhancement, training program, or policy improvement represents a step toward safer health care environments in rural America. These efforts deserve recognition and support rather than criticism for not doing enough.

These facilities serve as lifelines for their communities, providing essential care when and where it's needed most. Aiding them in their efforts to create safe environments isn't just about hospital security—it's about preserving access to health care. Every patient who feels safe seeking care, every health care worker who can focus on healing rather than personal safety, represents a victory worth celebrating and supporting.

The path forward requires understanding, partnership, and recognition that rural health care providers are doing their absolute best with the resources available to them. Their commitment to safety runs as deep as their commitment to care. They simply need our help in turning that commitment into comprehensive security programs that serve their communities well.

 By Tom Kitchen, Jr., manager, emergency management, The Hospital and Healthsystem Association of Pennsylvania