Violence in the hospital setting occurs in many forms. It’s important that institutions have the resources in place not only to address mass casualty events but also to address individual episodes of violence.

At the Cleveland Clinic, Ashley Withrow is one of those resources. She joined the hospital system's police department in 2014 as its only victim advocate thanks to a state grant provided by the Victims of Crime Act of 1984.

Withrow’s efforts revolve around workplace violence and encompass patients, visitors and Cleveland Clinic staff. She offers guidance, resource referrals and emotional support on issues related to domestic violence, sexual assault, stalking harassment and anything that can be reported to the police as part of the health care system’s Victim Advocacy Program.

A majority of referrals come from the system's police department, but Withrow also works closely on the inpatient side with emergency medicine departments and care management teams across the Cleveland Clinic to provide crisis intervention while patients are receiving care.

Many of these cases involve domestic violence, she says, and Withrow can help victims pursue criminal charges and guide them through the legal system. Positions such as Withrow’s are a necessity considering that about 50 percent of all workplace assaults occur in a health care setting, according to the Bureau of Labor Statistics.

The victim advocate role allows Withrow to make relatively small changes that can aid victims and prevent them from experiencing these assaults. In one instance, Withrow adjusted a parking space assignment for a member of Cleveland Clinic’s staff who was experiencing stalking at work. She has arranged police escorts for victims traveling around the health system and has worked with managers to schedule different break times to make victims less vulnerable, she says.

“The workplace is one of the few things that people can’t change as they’re seeking safety,” says Withrow. “A lot of people can move or change phone numbers or email addresses, but a lot of us can’t up and leave our jobs, because we need our income, so work can become a vulnerable place.”

There’s been a steady increase in the number of victims she's served each year, according to Withrow, suggesting that the demand for aid is there. She's hoping state funding will come through for her program so she can eventually hire a second victim advocate.

The victim advocate role is merely one part of the efforts Cleveland Clinic has undertaken to address workplace violence. The Code Violet Committee at its Fairview Hospital, of which Withrow is a member, performs risk assessments throughout the system to identify areas vulnerable to violence, among many other undertakings. And a violence steering committee incorporating individuals from across the system began meeting in May with the goal of sharing best practices throughout the organization and standardizing them across all Cleveland Clinic locations.

These efforts appear to be working. An employee engagement survey conducted a few months ago showed that staff scores for safety have improved, according to Mary Beth Thoburn, director of critical care and emergency services at Fairview, in Cleveland.

One thing is certain: Hospitals must adequately consider violence in all its forms and take the necessary steps to address the problem, and that starts at the top, says Deborah Small, chief nursing officer and vice president of patient care services at Fairview. “You have to have leadership that acknowledges [that] workplace violence occurs [but] that it’s not an expected part of the job role.” 

“So often you will hear someone say, ‘You work in an emergency room, you know you’re going to see that [violence].’ … It’s something that we have to, as leaders, address and put in resources to help prevent and also help support the care if something does happen,” Small says.