Healthcare Industry Violence: Causes, Impact and Prevention

• Chris Calderone, Senior Thought Leadership Manager

Workplace violence in the healthcare industry can have far-reaching consequences. The negative effects of violence, whether emotional or physical, extend beyond the individuals directly involved and can influence patient care and satisfaction, as well as safety, quality and staff turnover.

With violence against healthcare workers on the rise, healthcare organizations and their leaders face the critical task of addressing this pressing occupational safety issue. Understanding the different types of aggression, its prevalence, and the underlying causes and risk factors is crucial for implementing effective workplace violence prevention strategies.

By creating a culture of safety, providing comprehensive training, conducting risk assessments, and implementing security measures, hospitals and health systems can work towards minimizing violence in healthcare and protecting hospital workers and patients.

Table of contents

1. Understanding violence in healthcare
2. Causes and risk factors for healthcare violence
3. Impact of violence against healthcare workers
4. Prevention of violence in healthcare
5. Risk assessment and security measures
6. Reporting and investigating violence

Understanding violence in the healthcare industry

81% of U.S. adults surveyed said there is a staffing issue in hospitals today.

Hospital Safety and Staffing Consumer Survey Report 2023

Workplace violence has long been a concern across all industries and business sectors, but it is especially concerning for many healthcare organizations and their leaders. The priority that healthcare organizations place on addressing and preventing workplace violence is understandable given the steady increase in violence against health care workers over the past several years.

Defining violence in the healthcare industry

The Joint Commission defines healthcare workplace violence as “an act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors”.

Types of healthcare violence

There are different types of healthcare workplace violence that can range from threats and verbal abuse to physical assaults and even homicide. Examples of healthcare workplace violence include:

• Physical assault (slapped, punched, pinched, scratched or kicked)
• Objects thrown at an employee
• Spitting and biting
• Verbal abuse and threats
• Other forms of intimidation including bullying

The prevalence of violence in healthcare settings

In a survey conducted by ECRI, a nonprofit patient safety organization, respondents reported that violence against clinicians was the second most important issue for healthcare leaders, second only to concerns about pediatric mental health.

Violence against workers is five times more likely to occur in a hospital or other healthcare setting than in non-healthcare workplace settings according to a report released by the U.S. Bureau of Labor Statistics.

Data from the U.S. Bureau of Labor Statistics from 2018 shows that just over 10 in 10,000 health workers have encountered violence in the workplace as compared 2.1 in 10,000 workers across all other industries.

Simply put, hospitals and health systems have become dangerous places for health care workers.

💡 Read more: Patient Safety in Hospitals: Best Practices & Strategies

Causes and risk factors for healthcare violence

39% of U.S. adults surveyed say they are likely to avoid the hospital due to concerns about violence

Hospital Safety and Staffing Consumer Survey Report 2023

There are several risk factors that are often associated with incidents of violent behavior directed towards healthcare workers. Risk factors associated with healthcare workplace violence can be explored from the individual level and from the system-level.

Individual risk factors for violence in healthcare institutions:

• Staffing shortages (and over-burdened nurses and other caregivers)
• Inexperienced or anxious staff
• Poor coping mechanisms among staff
• Lack of training
• Lack or of robust staff safety protocols and procedures
• Staff and clinician burnout

System-level or environmental risk factors for emotional and physical violence in healthcare:

• Overcrowded areas
• Long waiting hours
• Inflexible visiting hours
• Lack of information/poor communication
• Language and culture differences
• Frustrated patients and family members

The impact of violence against healthcare workers

Healthcare workplace violence can impact and involve more than just healthcare workers. Violence can also be directed towards others including vendors, visitors and even other patients.

Healthcare workplace violence and other threatening disruptive behavior can take a physical and an emotional toll on healthcare workers. From a physical perspective, healthcare workers can miss work due to treatment and recovery associated with violent incidents that result in actual bodily harm.

The emotional or psychological toll can be problematic as well, which is why preventing workplace violence is an important priority. Some common issues associated with the emotional harm include:

• Demoralization
• Depression
• Loss of self-esteem
• traumatic stress disorders
• Difficulty concentrating
• Heightened anxiety

💡 Read more: The GHX 5 Part Framework for Vendor Credentialing Compliance

Healthcare violence prevention

Hospitals and health systems need to have robust protocols, policies, and procedures in place that can help to prevent and minimize violence in healthcare by creating a culture of safety in the workplace.

The Occupational Health and Safety Administration’s Guidelines for Preventing Violence for Healthcare Workers provides many practical tips and techniques that can help organizations implement a workplace violence prevention program.

Training and Education

Training and education initiatives can help health care organizations establish a culture of safety that focuses on prevention. A critical element of an effective training program includes teaching staff how to properly recognize behavioral warning signs of violence in individuals.

Another important element of an effective training program includes teaching and developing essential communication skills that can be used to manage and prevent workplace violence in healthcare facilities.

Risk assessment and security measures

Risk assessments and proactive healthcare security measures are also important considerations for healthcare organizations. Risk assessment tools can provide healthcare organizations with a standard set of tools that can be used to assess and evaluate potential threats.

A few examples of effective safety measures include the use of de-escalation teams – these are teams comprised of specially trained staff that can be mobilized to respond quickly to incidents and threats. The Centers for Disease Control and Prevention (CDC) has a few good examples of Violence Risk Assessment Tools.

Healthcare industry safety measures against violence

There are several proactive security measures that healthcare organization can implement to enhance the physical workplace safety of their facilities, including:

• Decreasing the number of public entrances
• Restricting public access
• Introducing security teams that check identification for all visitors
• Expanded use of security cameras and live video monitoring
• Increase presence and visibility of uniformed security staff
• Use of metal detectors in high-risk areas such as emergency departments

Using technology solutions such as a kiosk (like the Vendormate Kiosk) to manage vendor and visitor check-ins can help ensure safety by providing heightened visibility around vendors and visitors coming into the facility. When placed at access points, they help improve the visitor check-in process, and can even be enabled with “watch lists”.

Reporting and investigation

Reporting and investigating incidents of violence is an important element of an overall violence prevention strategy. Healthcare workers need to know that all reported acts and incidents will be taken seriously, and each one will be thoroughly investigated by the appropriate healthcare leader or safety and security team.

In addition to timely follow-up and investigation of incidents, healthcare leaders need to ensure that the privacy of all workers that report incidents of violence will be protected.

Healthcare organizations can reduce the severity and frequency of workplace violence incidents by understanding risk factors; implementing training and communication programs; conducting risk assessments; expanding physical security measures; and by controlling vendor and visitor access.

Emotional and physical violence against health care workers poses significant challenges to health systems in the United States. The prevalence of violence against healthcare workers is alarming, and it is crucial for healthcare organizations and their leaders to address and prevent healthcare violence. By understanding the causes and risk factors associated with healthcare violence, organizations can implement effective strategies to protect their staff and patients. 

By implementing robust protocols, providing ongoing training, conducting risk assessments, and enhancing security measures, hospitals and health systems can create safer environments for their workers and ultimately improve patient care and satisfaction. Addressing and preventing healthcare workplace violence is not only an ethical responsibility but also crucial for maintaining a sustainable and resilient healthcare system. 

Common FAQs about healthcare violence

What are the causes of violence in the healthcare industry?  

Overcrowded areas, long waiting hours, inflexible visiting hours, lack of information/poor communication, language and cultural differences, patient and family frustration are factors in healthcare violence.  

How does violence impact healthcare professionals and patients?  

Violence in the healthcare industry results in demoralization, depression and anxiety, loss of self-esteem, traumatic stress disorders, difficulty concentrating, delayed care as well as staff and patient dissatisfaction.  

What can be done to prevent healthcare workplace violence?  

Decreasing the number of public entrances and restricting public access, staff training, risk assessments and security measures to identify and monitor visitors as well as increased presence and visibility of uniformed security staff can help prevent healthcare violence.  

What safety measures can healthcare professionals take to protect themselves from workplace violence?  

Healthcare professionals can benefit from learning de-escalation techniques, participating in training programs and rapidly reporting ALL forms of workplace violence including non-physical incidents. 

Disclaimer: The contributor of this piece is solely responsible for its content and accuracy, and the views expressed do not necessarily reflect the opinion of GHX.

Sources

1. GHX Study: Half of Americans Avoid Seeking Care in Hospitals Due to Staffing Shortages and Virus-Exposure Concerns. Hospital Safety and Staffing Consumer Survey Report 2023.
2. The Joint Commission. "Workplace Violence Prevention."
3. ECRI. "Top 10 Patient Safety Concerns 2023."
4. U.S. Bureau of Labor Statistics. "Workplace Violence in Healthcare 2018." 
5. Occupational Health and Safety Administration (OSHA). Guidelines for Preventing Violence for Healthcare Workers.
6. CDC. "Violence Risk Assessment Tools." Violence Prevention for Healthcare Workers.

Chris Calderone

Senior Thought Leadership Manager