By: Barb Collins

“Code White… Code White… Code White.” 

In hospitals, these words signal that violence, or the threat of violence, is unfolding somewhere within the organization. These events are being recognized as occurring more frequently, and they are not limited to one type of interaction. Healthcare teams are seeing more situations involving everyone, including patient-to-patient, patient-to-staff, family or visitor-to-staff, and staff-to-staff incidents. This should alarm all of us. 

At Humber River Health, Code White incidents occur multiple times a day, and hospitals throughout the Greater Toronto Area are experiencing a similar trend. Behind every code is a person whose sense of safety has been disrupted while providing, receiving, or supporting care. 

Let me be clear: violence in healthcare is unacceptable. It is not part of the job. It is not something our teams should simply learn to live with, and it is not something patients, families, or visitors should face while in a care environment. This is not a challenge we can solve through resilience alone. 

Even more concerning, hospitals are also experiencing Code Silvers, which are among the most serious security alerts an organization can issue. A Code Silver indicates that someone has brought a weapon into a healthcare environment. These are spaces we work tremendously hard to keep safe, compassionate, and respectful. The presence of weapons in these spaces is completely unacceptable. 

Workplace violence is a serious and growing safety concern across healthcare, with consequences that extend well beyond the moment of an incident. It affects morale, well-being, recruitment and retention, patient flow, wait times, and the overall care experience. Most importantly, it can disrupt the safe, timely, and compassionate care that patients and families rely on. Our teams are trained to respond calmly, quickly, and effectively when risks arise, however, preparedness should never be mistaken for acceptance.  

At Humber River Health, we have made the clear decision not to stand by and allow violence to become an accepted reality of healthcare. Across the system, we need to turn down the temperature by working earlier and more closely with patients, families, visitors, and each other to prevent conflict from escalating. That is why we have implemented a new Workplace Violence Escalation Framework that provides a practical, organization-wide pathway to identify concerning behaviours early, assess risk, de-escalate wherever possible, notify the right supports when needed, and respond consistently. 

Prevention is the foundation of the framework. It focuses on understanding the factors driving fear, frustration, or conflict and using respectful de-escalation strategies wherever it is safe to do so. The framework recognizes that violence can take many forms and when prevention efforts are not enough, it provides a clear process for notification, documentation, coordinated follow-up, and reasonable, proportionate action to help maintain safety for everyone in the hospital. 

Supported by our new Workplace Violence Clinical Practice Leader, who is responsible for education and local troubleshooting with individual teams and program areas, the framework is being reinforced through training and hands-on support across the organization. A new Workplace Violence Committee is helping develop and coordinate resources, shared materials, and practical tools so they are easy to access and available at all times. Our Professional Practice team is also supporting workshops using case studies and scenarios to show how situations can evolve and when progressive escalation may be needed. 

Through Nursing Skills Days and drop-in sessions with leaders, we are helping teams build confidence in de-escalation, limit setting, and knowing when to escalate. Education is also extending beyond nursing to other frontline teams, with offerings for corporate teams as well. Additional Social Workers are available to provide support, while Patient Flow Managers and evening Clinical Practice Leaders help maintain coverage after hours. Together, these supports make the framework more visible, practical, and transparent. 

Creating a safe workplace and care environment is one of our most important responsibilities as healthcare leaders. Our people deserve more than recognition for the challenges they face, and patients and families deserve care that is not delayed, disrupted, or diminished by violence. For this work to succeed, everyone has a role to play in maintaining a safe, respectful environment where care can be delivered and received with dignity. 

For patients and families, our goal is to provide the best care possible, often during some of the most difficult and vulnerable moments in a person’s life. We understand that coming to the hospital can be stressful, frightening, and emotional, and we meet people in moments of pain, uncertainty, and fear. We are committed to responding with compassion, professionalism, and respect but compassion does not mean accepting violence. Violence, threats, or aggression make it harder to deliver timely care, create delays and increase wait times, and affect everyone in the hospital. 

Our staff, physicians, volunteers, and healthcare teams come to work each day to care for others. Protecting their safety and well-being is essential to protecting the quality, continuity, and experience of care for patients and families. 

This focused work is a commitment to preventing, recognizing, and responding to violence because safeguarding the people who make care possible is ultimately about safeguarding the care our community depends on.