Keeping Your Communities, Employees Safe from Gun Violence

Meghan Walsh, MD, MPH, FACP, shares how Hennepin Healthcare addresses the effects of community violence both inside and outside the organization's walls.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Podcast. Audio of the full interview can be found here and below. This is also part two of a three-part series on gun violence prevention in healthcare. Part one can be found here.

Meghan Walsh, MD, MPH, FACP, serves as the chief academic officer for Hennepin Healthcare, a Level I adult trauma center, Level I pediatric trauma center, and acute care hospital in the heart of Minneapolis.

Walsh joined Hennepin in 2001 where she started as an intern, then made the climb to the C-suite in 2012, where she has been the longest-serving C-suite executive for the health system.

Over the past two decades, Walsh has witnessed a lot of change and challenges, and with that, solutions and innovations were created to benefit the community, both inside and outside the walls of the organization.

One of the challenges is the increase in gun violence and its lasting effects. According to data from the Minneapolis Police Department, AP News reported that in Minneapolis in 2021, more than 600 people had been treated for gunshot wounds in the city's hospitals.

In the latest HealthLeaders Podcast episode, Walsh spoke about the gun violence epidemic and how Hennepin is addressing community violence both inside and outside the organization's walls, and she offers leadership insights.

This transcript has been edited for clarity and brevity.

HL: How is gun violence considered an epidemic?

Walsh: Firearm injury is a major public health issue, and frankly, we should think about it like we think about cancer or heart disease. When you think about a public health crisis or any sort of issue, you think about what particular disease leads to premature death. And firearm injuries do. It also causes long-term physical and emotional disability for patients, for their families, for their communities, and for the medical team who takes care of [them].

There are also significant direct emergency and medical expenses and bigger overarching economic costs to society. It falls perfectly within the public health crisis definition, and we have to think carefully about leveraging the same measures we use in all of these other system-wide diseases and crises.

HL: How has the gun violence epidemic impacted the Hennepin Healthcare workforce and students? What have you experienced?

Walsh: We see the impact of gun violence on our patients now more than ever. The highest increases in firearm homicide rates are seen among young black males and people living in high poverty areas. These groups experience an unequal burden of firearm homicide compared to white, wealthy Americans, and in 2020 it got even worse.

Firearm violence is inextricably tied to race, inequity, poverty, poor housing, limited access to healthy food, educational opportunities, and also a lack of safe places to work, live, play, walk, and socialize. Hennepin, in the heart of Minneapolis, is surrounded by a lot of these inequities and disparities in our community.

We've done a lot to try to mitigate the impact of these challenges internally. For instance, we've done more with psychological first aid for care teams. That includes doctors, nurses, social workers, chaplains, and the whole care team that is impacted by patients who are suffering such grave harm and impact.

We debrief these cases as a team in real time. That's important for resilience, for teaming, for the ability to come back to work the next day. We have more mental health resources for all our employees here at Hennepin and especially our faculty physicians, residents, and students.

[New interns] are set up with a therapy visit as a baseline. They can choose to opt out, but the idea is if we can normalize mental health support, if we can make it easy, if we can help people try it out when they aren't in distress, they'll know how to get help when they are.

All of this is part of the bigger circle of prevention, support, and partnering with our healthcare teams and our community, all in service to trying to decrease the impact that gun violence has on everyone.

HL: What other steps have the health system taken to prepare for on-site gun-related violence?

Walsh: All 7,000 of our employees receive active shooter training; this was introduced in the last five years.

We have a security team [that] is performing constant risk assessment in our clinics and our hospital. Our security team are considered valuable members of our care teams. They're part of orientation, they come into the room and team with doctors and nurses for de-escalation of patients who are ill and are at risk of harming themselves or others. We see them more as care providers than we do as security.

As the chief academic officer, I also have a role in preparing for gun-related violence here at Hennepin. For over six years, we have utilized our simulation center to provide de-escalation simulation training for every new resident that comes to Hennepin. They learn verbal de-escalation, they understand risk assessment and how to escalate concerns. We debrief about how hard this is, and what to do, and who to call for help. We build teaming, we collaborate, and that is how we can build a community that takes care of one another at Hennepin.

There are also system changes you make. COVID forced us to decrease access into our hospitals for infection prevention reasons. We have continued to streamline access for visitors, for patients, for other workers, who come in and out of this organization, and [we] route them through a few portals of entry so that we can better ensure the safety of our employees here.

HL: What is the health system doing to help address gun safety and gun violence in the community?

Walsh: We have an amazing hospital-based violence prevention program called Next Step. It connects survivors of violent injury with services, in hopes of disrupting the cycle of violence. The program has enrolled more and more patients in the last few years, and it practices through a trauma-informed approach.

We have a critical role to plan for gun violence prevention education … In Minnesota, we don't have red flag laws, so our skill-building focuses on trust building with patients and their families. These are skills that have to be taught. Residents have to learn how to ask about this stuff, and if a risk assessment is performed, and a patient is checking any of the boxes for increased risk, they need to know how to intervene and what actions they can take.

[Additionally,] our surgery program is spearheading a lot of research on gun violence and publishing in the area.

HL: What advice do you have for leaders in healthcare that are trying to address the gun violence epidemic?

Walsh: The first step is focusing on the safety of your employees. This is a hard job even on its best day, and we are seeing patients in distress on a regular basis. Do your employees know the safety protocols at your institution? Do they feel safe? Your employees are also your community, so the light they shed on concerns is likely reflecting what your community's concerns are, and [that] will probably help you start to see opportunities for doing more locally.

The second step is building out a strong system for assessing risk factors. To assess for these in our patients, [we look for] adverse childhood events and social determinants that raise the risk of experiencing violence across all sectors of the system. How do we systemize this regardless of your specialty, whether you are a patient seeing a dermatologist or a trauma surgeon?

The third step is [having] all health systems learn from the community on how to prevent gun violence. The people in these impacted communities possess knowledge and experiences that make them uniquely qualified. They can reimagine safety and remedy the cycles of trauma and violence in their communities better than we can. So how do we shift power and resources to community-led safety practices? [How do we create] policies and violence prevention efforts that go outside of the walls of the hospital, that will benefit our community and our health systems in the long run?

A lot of hospitals are scrambling to figure out how to build this type of lens in their own health system. There are great programs out there. You do not need to reinvent the wheel. One site I love is called The BulletPoints Project. This is an amazing online resource for clinicians and medical educators. It offers a curated collection of content for firearm injury prevention.

HL: How would you define your leadership style?

Walsh: I love the principle of fair process as a leader, and I employ it as a teacher and as a leader in the organization. The underpinnings of fair process are three key principles:

1. Engage. Involve individuals in decisions that affect them. That doesn't necessarily mean they get their way. Listen to the points of view, and genuinely seek their opinion and insight as you're looking to make a decision.

2. Explanation. Explain the reasoning behind the decision to everyone; why am I making this policy change or this next step decision as a leader? Oftentimes leaders forget the "why." They forget to explain with clarity why the decision is the decision they made. That often can decrease a lot of the resistance that can occur with change.

3. Expectation clarity. Make sure everybody understands the decision you're making and what's expected of them moving forward.

If you do these three things as a leader, you'll get a lot of support, and you can effectively manage the change. I try to embody those principles in every decision I make and with nearly all of the teaching points I make as well.

HL: What advice do you have for women and others in healthcare who aspire to serve in the C suite?

Walsh: Find a mentor, someone who really sees your career trajectory and helps guide you getting there. Find an ally, someone who can align with you in your goal across particular issues. Find a confidant, someone that will never leave the role of supporting you, even when you're on opposite sides of an issue. Find a network of champions, a group of people that believe in you and are there in support of you.

Those four roles: mentor, ally, confidant, and champion, are often not the same person. Build that community around you.

I got this job because I had a male boss who truly believed in me, even when I wasn't sure I could do this job. He sponsored me and he supported me, but he also championed me publicly to other leaders. It's important to find that for your own journey, and it's important to be that for others who are just starting theirs.

Related: Northwell Health CEO Addresses Gun Violence Prevention