Report recommends statewide de-escalation training, better reporting to curb workplace violence in Vermont hospitals

Vermont Program for Quality in Health Care (VPQHC) presented a report to the House Healthcare committee March 13 that found wide variation among Vermont hospitals in workplace-violence prevention programs and recommended statewide, standardized de-escalation training and improved incident reporting.

The report, prepared under Act 24 and based on research conducted in 2023, used a statewide hospital assessment, five focus groups and a literature review to compare Vermont hospitals’ practices to best practices. "Workplace violence is a serious problem in health care in Vermont and nationally," VPQHC Executive Director Hilary Wolfley told the committee.

The nonprofit described several strengths — including hospitals’ stated commitment to staff safety and post-incident support — and several common challenges: inconsistent de-escalation training, gaps in standardized reporting and data collection, and variation in environmental safety standards across facilities. VPQHC recommended implementing a comprehensive training program with trauma-responsive care at its core, enhancing incident reporting systems, investing in staff safety infrastructure, setting a minimum set of safety standards, and supporting a learning network for hospitals.

VPQHC Quality Improvement Specialist Morgan Bedard, who administers the statewide patient-safety program for the Department of Health on behalf of VPQHC, described the report’s qualitative findings and methods and shared lived-experience context. "I've been looked in the eye by a patient's family member who told me that they would return the following day with a gun," Bedard said, underscoring the report’s focus on frontline staff safety.

Presenters told the committee the research was done in 2023 and that the report includes a copy of the assessment instrument and focus-group questions; they recommended reassessing periodically and suggested an annual assessment to track trends and measure progress. VPQHC also noted organizational context: the group was established by the legislature in 1988 as a nonprofit, nonregulatory peer-review entity, employs roughly 14–15 staff, and runs about 17 ongoing quality-improvement initiatives. VPQHC also serves as the fiscal sponsor for the Vermont Consultation and Psychiatry Access Program.

Committee members asked whether a pending bill, H.259, addressed the report’s concerns. "The bill, as introduced does have regular — I think it's annual — analysis included in it as part of the requirement," said Mari (House Healthcare committee member), who said she was preparing the record of action and would consult the bill sponsor and nurse coalition for further history. Committee member comments noted the report’s research date (Jan. 15, 2024) and the recommendation that legislators and hospitals re-evaluate current alignment between the bill language and the report’s findings.

VPQHC asked the committee to consider state-supported, standardized de-escalation training and sustained funding so hospitals would not be forced to choose training over other priorities. The presenters emphasized that best practices exist and that policy resources and continuous quality-improvement efforts could help standardize prevention programs across the state.

No formal committee vote or directive was recorded during the presentation. Presenters said they would provide the full report and assessment materials to the committee and were open to returning for further discussion.