SAN DIEGO — We all know the devastating effect that violence can have on our communities, but less widely known is its impact on hospitals.

A new report commissioned by the American Hospital Association attempts to quantify that impact, and the tally is staggering: $2.7 billion spent last year alone related to community violence. That includes some $1.1 billion spent on security and training in order to prevent violence within the hospital, along with $852 million in unreimbursed care for victims of violence. Another $429 million, meanwhile, went toward medical care, staffing, indemnity and other costs tied to violence inflicted on hospital employees, as well as $280 million on preparedness and prevention including emergency preparedness training, community-based prevention programs and staff training for violence-related trauma, according to the report.

“Keeping people healthy is at the heart of health care, and violence runs counter to that,” AHA President and CEO Rick Pollack said in a statement. “It's our hope that quantifying the resources hospitals and health systems commit illustrates the enormity of this issue as a public health problem while giving hospitals the chance to highlight their efforts to keep their communities and workplaces safer.”

The AHA released the report July 28 as part of a panel at the 25th annual Leadership Summit and in conjunction with its yearlong Hospitals Against Violence initiative, launched last year as a way to bring hospitals together to address violence in the many forms it takes.

Panelists highlighted the complexity of the problem as they reviewed the many facets of violence, including how hospitals are addressing human trafficking, treating violence as a public health issue and helping to prevent assaults from occurring within the hospital.

Thomas Simon — associate director for science, Division of Violence Prevention, with the Centers for Disease Control and Prevention’s National Center for Injury Control — believes hospitals are ideally situated to work toward ending violence in their communities.

“Hospitals are really in a unique position. ... You’ve got great infrastructure, you’ve got stability. Oftentimes in communities, the hospital is really the only organization you can say that about. You bring great credibility to the table,” Simon said Friday at the summit. “So, there’s a real opportunity for hospitals to get involved.”  

Simon detailed the CDC’s four-step model for treating violence as a public health issue, which he encouraged hospitals to adopt:

  1. Defining and monitoring the problem by gathering data on violence, such as the number of deaths or injuries caused by violent acts.
  2. Identifying risk and protective factors that might put individuals at an elevated risk for being involved in a violent incident as well as factors that might reduce that risk.
  3. Developing and testing prevention strategies based on those data and factors.
  4. Assuring widespread adoption of those strategies once they have proven to be effective.

Simon cited the “Cardiff Model” for violence prevention as one example of those steps being used in the real world to prevent such incidents. The model, first developed by a professor and surgeon at Cardiff University in Wales, involves sharing data from violence victims (weapon used, date and time of incident, location, etc.) with police and local authorities in order to prevent further attacks from occurring. That effort has led to a 42 percent reduction in hospital admissions and violence recorded by the police and 50 percent fewer victims of violence showing up in local emergency departments, according to the university.

Looking to bring similar success to the U.S., the CDC has been working with both Grady Memorial Hospital and the Dekalb County Police Department to adapt Cardiff in the Atlanta area. Those efforts involved hiring a violence prevention coordinator at the hospital, placing a violence injury screening in the electronic health record system and training about 150 nurses on the model.

Simon said that early staff surveys have shown that employees are taking to the program. Some 95 percent of nurses said they are committed to the model, he noted. “I think one of the reasons for this is that they really agreed with the idea that Grady Hospital had a role to play in community violence prevention, that they had an ethical and moral responsibility to help address what was happening beyond the hospital’s walls.”

A year and a half into the pilot, the CDC is seeking ways to further expand use of the model in other cities and hospitals. It’s also exploring other ways to make the community safer around Grady Memorial, including the development of a community garden.

Simon was joined on the panel by Holly Gibbs, director of Dignity Health’s Human Trafficking Response Program, and Sonya Greck, senior vice president of behavioral health, community benefits and safety net services at Mission Health. Gibbs, herself a survivor of human trafficking, shared how the San Francisco-based system is working to address this pervasive issue. You can read more about that in this H&HN blog. Greck, meanwhile, discussed her Ashville, N.C.-based organization’s systematic approach to cutting down on assaults in the hospital. You can read more about those efforts in this piece from June’s magazine.

The Hospitals Against Violence initiative got started last year after the AHA board asked the association to look more closely at the issue following the Pulse nightclub attack in Orlando, Fla., panel moderator and AHA board member James Leonard, M.D., said Friday. A little more than a year after that incident, Leonard has been heartened to learn more about the work that hospitals are already undertaking.

“As we engaged all of you around the country, it’s been really staggering how violence and what’s going on in our communities and many of the projects across the entire nation go way beyond anything that’s very narrowly defined, and that’s what I am so excited about as this panel was pulled together,” said Leonard, who is president and CEO of the Carle Foundation.