Breakdown: IAHSSF’s Threat Assessment Strategies to Mitigating Violence in Healthcare

Threat assessment, risk assessment, and vulnerabilities analysis are the future of proactive security practice in the healthcare environment. Unfortunately, most healthcare organizations do not fully understand the difference between these practices, or how they aid in the prevention of a violence free workplace. Research associated with these tools can be sparse. Where research has been done, it is often hard to digest and hard to scale or practically apply for most healthcare security practitioners. Earlier this month the International Association for Healthcare Security and Safety’s Foundation (IAHSSF) added to the body of research with the release of a paper titled Threat Assessment Strategies to Mitigating Violence in Healthcare. The paper was authored by Sarah J. Henkel, and was vetted by the IAHSSF’s Evidence Based Research Committee.  Here is my breakdown of the work.  

In a word this paper is excellent! This paper represents a well thought out breakdown of threat assessment in healthcare, what works, what doesn’t, and a lot of the misconceptions that plague the industry. I congratulate Henkel on her work, and I consider it a must read for anyone in healthcare security leadership. Let’s take a look at some of the highlights.

The paper sets up the reader for success in trying to present information to help the reader apply threat assessment in the healthcare environment. Henkel starts with an exploration of the present state and the regulatory environment in which hospitals are forced to navigate. One aspect where Henkel nails it is her analysis of the juxtaposition between the rules for protecting employees via regulatory bodies like the Organizational Health and Safety Administration (OSHA) and the rules associated with patient protection via organizations like the Center for Medicare and Medicaid Services (CMS). In this discussion Henkel sums up the conflict well when she points to advocacy work by the Missouri Health Association’s President Herb Kuhn whom she quotes saying: “The disconnect between CMS’ and OSHA’s responsibilities make it more complicated for hospital employees to try to deescalate situations or to manage them without getting penalized (2019).”   

Henkel furthers her breakdown of legal and regulatory issues by looking at various state laws. She also looks at international regulatory issues by looking at laws in Canada and Britain as well as the latest convention by the International Labor Organization which states that workplace violence and harassment constitutes a “human rights violation and threaten equal opportunities” (Henkel, 2019).  

Beyond the current state and regulatory issues associated with violence prevention, Henkel does an excellent job of differentiating a risk assessment and threat assessment for the reader. Her focus, beyond this differentiation, is to educate the reader on threat assessment and the applicability of threat assessment to the healthcare environment. Henkel points to four key components in building a threat assessment process in a healthcare organization; 1) creating a threat assessment team, 2) identifying a threat, 3) investigating the threat, and 4) mitigating and managing the threat (2019). In this analysis, Henkel points to several tools that can be invaluable when adapted to healthcare for any practitioner.

Henkel concludes the paper by identifying threat assessment as an essential component of a comprehensive workplace violence management program, and I absolutely agree. For those who have been in the industry for a while, we are seeing a shift toward more proactive methods like threat assessment. It is a critical shift for our industry, and I am grateful to see work like this being produced. My complements to IAHSSF for sponsoring Henkel’s work, and my sincere thanks to Henkel for all the work she put in to producing this must read. Well done!

If you haven’t read Threat Assessment Strategies to Mitigate Violence in Healthcare, here is a link.

What are your thoughts on threat assessment practices in healthcare? Have you experienced the struggle between OSHA and CMS regulations when trying to work proactively to mitigate violence? Read the paper and let’s discuss. What are your thoughts on Henkel’s work? Let me know in the comments below.


Henkel, S. (2019). Threat Assessment Strategies to Mitigate Violence in Healthcare. Retrieved from”https:/

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