Workplace violence is a business risk: CENTEGIX’s Andrea Greco on safety and staffing in health care

Workplace violence has moved from the margins of health system risk registers to the center of the balance sheet.

In its 2026 Healthcare Trends Report, safety-technology firm CENTEGIX argues that violence is now a core driver of staffing instability, regulatory exposure and financial performance, not just a security problem to be managed at the unit level.

The report pulls together national survey data and internal incident logs from the company’s CrisisAlert wearable duress system. Among the findings: 61% of nurses said they plan to leave their jobs within the next 12 months, and healthcare workers remain five times more likely to experience workplace violence than the average U.S. worker.

Duress alerts have spread evenly across all seven days of the week, spike by almost 300% between 8:30 a.m. and 12:15 p.m., and are triggered most often in hallways, exam rooms and nurse stations.

For practices, those trends raise uncomfortable questions: How much violence risk is “baked in” to daily operations? When does a panic button move from “nice to have” to a retention strategy? And what does a realistic return on investment (ROI) look like when safety technology competes with everything else on the capital list?

Medical Economics sat down with Andrea Greco, senior vice president of healthcare safety at CENTEGIX, to unpack the data and learn how practice leaders should respond.

The following transcript was edited for style, brevity and clarity.

The report makes the point that workplace violence is now a major financial and operational risk, not just a security concern. At the same time, 61% of nurses in the report said they plan to leave their job within the next year. From a practice perspective, how should safety planning evolve when violence is treated as a business risk?

To understand that, you have to take a step back and look at the full impact that violence has within a health care organization. When leaders then prioritize and fund safety initiatives because they see that full picture — the impact on employee satisfaction, both their perceived and actual safety, the potential impact to quality of patient care, as well as the financial impact — when they look at all of those things together, I think they realize that the cost of inaction is starting to outweigh the cost of just hoping things get better.

We also think that a shift in mindset is really needed to help gain that clarity and gain that understanding so that, as we talk about strategic solutions, a layered, comprehensive safety strategy — not just a plan on paper, but a strategy that everyone knows how to execute on and within — is really important, versus siloed or standalone solutions that are put in place to just solve one problem at a time.

Last year’s report showed duress alerts peaking on certain days of the week. This year, alerts have leveled out across all seven days, with just slight dips on Sundays and Mondays. What can we take away from that shift?

We were a little surprised to see such a change. But what that shows us is that every day there is risk involved in the healthcare setting when providing care around violence.

When we saw that leveling out, our message really is: plan accordingly. Plan to stay on top of the data, continuously be analytical around what is happening within your organization and know where you need to address things, because it could be any day, any time of the day, that things are happening.

There was a 300% spike in duress alerts between 8:30 a.m. and 12:15 p.m. What is your reaction to that? Are there particular workflows that cluster in that time and leave staff more vulnerable?

There is always a lot happening during the day in a care setting, but during that time period in particular there is a lot going on. When you think about morning rounds, visitors starting to enter the facility, planning for discharge for that day, there is again a lot of activity and a lot of emotions about whether or not you stay or go from the hospital that day.

Lunch happens during that time, as do other shift changes. So there is a lot going on. That change, that interruption of maybe what you were expecting, can really trigger aggressive behavior from patients or family members or the like. There is a lot going on during that timeframe that people have to be a little more flexible around, and sometimes that can be hard to do.

Ninety percent of alerts involved individual staff members needing support, rather than a campus-wide escalation. How can practices structure their internal response — who should be alerted, how fast and through what channels?

What we see as the most effective, particularly in the health care setting, is that that statistic is true across the entire customer base at CENTEGIX wherever we are deployed. The key is maintaining it being immediate. The alert is immediately delivered to those who need to respond to offer aid, and it remains a discreet notification element.

We find that that really goes hand in hand with de-escalation training and other tools and resources that are provided to health care workers to maintain a calm working environment and also protect themselves. So again, it is being immediate and discreet.

When we look at the responders that come, it can go everywhere from a unit leader or leaders who are on that floor in that facility to security staff and then all the way to local law enforcement. If there is a standalone clinic, as an example, that does not have other leadership or security on site at the time and their first line of defense is local law enforcement, we can support that.

What we really focus on — and what organizations should do — is understand what is happening within their four walls, what resources they have available to them, and then customize and align our alert delivery to the right responders for that organization and that specific location itself. It can be really unique. While we have best practices, we meet every organization where they are and make sure that we do deliver that quick aid as soon as possible.

Nearly half of duress alerts in the report are tied to aggressive or physically threatening behavior. What kinds of situations are most often escalating in routine care settings?

We see that encounters often happen not only in patient rooms but in hallways — so away from that patient care setting itself — between staff and patients and family members as well.

We also unfortunately see, as tensions grow, that there are altercations between staff themselves. We have seen that from both COVID-19 and beyond. The tension and the air in care settings is a bit different. Expectations are different. The allowance for behavior is different. So again, we see that happening in a variety of different relationships and in all different places.

Behavioral incidents are most commonly triggered in hallways, exam rooms and at nurses stations. Is there a way practices can redesign or better protect those areas?

When you think about minimizing isolation, it is obvious, but it can be difficult to accomplish when you think about how care settings are constructed. That is really why the accelerated response that we enable when support is needed is critical, and we focus on that as one of our most crucial elements.

It is also important to think about how we initiate alerts through our system. That is why that exact location information is really important, so that if someone is alone or is in an isolated area, you know exactly where they are without having to have eyes on them first. You can go directly there.

How do privacy concerns, particularly about safety tools relying on real-time location systems (RTLS), affect adoption?

Health care workers are trained professionals. They do not want to be tracked. We have seen a lot of that feedback from our own users. Nursing unions across the country have also vocalized this strongly.

You do not want to be in a situation where a solution is provided to aid a worker, but they do not want to wear it because they do not want to be tracked. They are unsure if that will be used in a punitive way against them in some other manner.

When you stay focused on safety being the forefront of your solution — and for us, that means we are only tracking the badge and the badge wearer when an alert is initiated and when that help is needed — you can see the rise in adoption and appreciation of the tool investment itself. It is seen truly as a solution designed to provide a safer culture within the organization and a speedy response when help is needed, rather than being something that is seen as punitive and tied to other items that are not centered on safety and keeping them safe in their work environment.

According to the report, preventing even a small amount of turnover can save health care organizations a significant amount of money. What numbers should practices look at to determine whether investment in safety technology or other violence-prevention strategies are worth it?

We spent quite a bit of time in 2025 trying to quantify that for our customers and for ourselves so that we understood the value that our solution delivers. We have a new ROI calculator and report where we examine just that.

We look at average costs per incident by estimating the work-loss costs, labor costs for backup staffing that is sometimes needed, repair of damaged infrastructure if that is the case, and certainly retention and recruitment costs. When there is an incident, we also look at workers’ compensation claims and other medical expenses.

We really looked at all these different elements that have a true cost that can be identified to help organizations take a look at the real dollars-and-cents costs of less or no action taken around protecting and keeping their staff safe. We put that into a calculator.

We have looked at what it normally takes to replace a nurse, as an example. It is over $60,000 to replace one single nurse, and as you look at specialties and physicians, that number exponentially grows. We looked at average workers’ comp claims and things like that to help guide organizations to do that calculation themselves and see what that impact really is.

We also consider turnover rate and those costs associated with not just retaining people but all the training and all the time spent on recurring elements that have to happen to get someone up to speed to provide quality care within an organization. In some organizations, there is also an element of taking a hard look at insurance costs. There might be some ability to impact their insurance costs when they are able to reduce the number of incidents that happen.

There are a lot of different levers to pull when you stay focused on safety of the employees, safety of your patients and the quality of care, and then look at that financial impact. It can really be eye-opening.

We have talked through several parts of the report. Is there anything in the data you think practices might be missing?

If I had to leave us with three themes as we think about 2026, I would say this:

First, organizations need to have a workforce-centric approach. Safety initiatives really need to be aligned with their core business goals, like retention and profitability. Make sure it is also a solution that is going to be adopted. We talked about the less attractive RTLS options. An investment is only as good as it is used and the value that is actually delivered.

Second is the demand for ROI. We talked about our creation of an ROI calculator and report for prospects and existing customers. Safety investments really need to demonstrate measurable improvements in financial performance and highlight the cost of inaction to help drive some urgency around decisions and increased policies, procedures and investments in safety within the organization.

Third is accountability. We have seen a lot of really high-profile incidents in the last year. There is pending legislation at the state level and at the federal level, things like the SAVE Act (H.R. 3178/S. 1600) — which makes assaulting hospital staff a federal crime — and, at the state level, Illinois is considering SB 1435 — which would require hospitals to provide wearable duress buttons attached to employee ID badges. They are driving greater accountability for workplace safety and not just having a “check the box” plan on paper, but helping hold organizations and communities accountable to take action and to have positive plans in place that are effective and real. Those are exciting things to see move the trend.

Each year we talk about the consistency of the level of violence happening. We really want to be part of making a proactive change to lessen that, but when it does happen, to be there so that help is on its way as quickly as possible. Hopefully those insights help too.