Workplace Violence in Healthcare

Widespread violence against physicians and other healthcare professionals continues to rise. Workers in healthcare settings have significant exposures to violence that can result in fatal & life-changing injuries. Exposure can come from patients or residents, family members, facility visitors, and from healthcare workers. These serious events can result in significant physical injuries, temporary or permanent disability, psychological trauma or even death. Workplace violence situations also have a negative impact on organizational culture as they adversely impact worker morale and increase work stress and staff turnover. There are a variety of direct and indirect risk factors impacting the healthcare industry. It is important to evaluate all aspects of the workplace violence program systematically. Regular review is necessary to identify deficiencies and opportunities for improvement. The core elements are interrelated, and each is necessary to the success of the overall system.

Workplace violence in the healthcare setting is not a new problem, however it is a growing issue of concern. The Joint Commission has issued Sentinel Alerts from as far back as 2008. According to the US Bureau of Labor Statistics, health care and social service workers were five times more likely to experience workplace violence than all other workers, comprising 73 percent of all nonfatal workplace injuries and illnesses requiring days away from work.

Preparation is key in mitigating risk. Many healthcare advocacy organizations have been proactive in assisting with educational efforts on how to build safe measures involving workplace violence. The American Society for Health Care Risk Management’s “Workplace Violence Toolkit”is a great example of such efforts.                     

Developing a clear plan to identify, report and respond to threats and violent incidents is an essential step in the preparation process.

  •  Workplace violence plans should include procedures to identify and evaluate risk factors for workplace violence, correct hazards, prepare for workplace violence emergencies, and respond to and investigate violent incidents. Additional information on developing workplace violence plans can be obtained from OSHA.
  • Consider implementing a Patient Behavioral Agreement upon initial intake and annually thereafter. The agreement defines expectations and consequences of non-compliance. While certain patient behaviors may warrant immediate termination (violence, threats, destruction of property), other actions may be correctible, thus preserving the physician-patient relationship.  The sample form Notice of Inappropriate Behavior may assist you in rehabilitating patients who engage in inappropriate behavior, but their actions do not warrant immediate termination. *If an incident report is completed, do not file the incident report in the medical record.
  • Ensuring dangerous activities never get started at all is the best way to prevent them from escalating to someone being harmed. Physical security measures are often simple and cost-effective methods for minimizing and preventing potential workplace threats. Installing door locks, door jammers, bulletproof transaction windows, blind corner mirrors and “panic” alarms are several relatively straightforward security-enhancing options. More sophisticated systems that incorporate biometric security sensors and camera systems may be the best option for large practice settings and hospitals.
  • The American Academy of Family Physicians (AAFP) has developed a comprehensive Preventing Violence in Health Care Toolkit that touches on issues such as intimate partner violence, bullying, and gun violence prevention.
  • View the Violence in the Office Practice Setting: Preparation and Responseseminar by signing into the secure services portal.

After a plan has been developed, the next step is to properly deploy it. This can be accomplished through routine staff training, instruction and review of policies and procedures.

  •  For new employees, training should begin during the onboarding process. All staff members should receive training on an annual basis, and more frequent sessions may be necessary for high-risk settings. Visiting providers and contract professionals should receive the same training as regular employees. Diligent training efforts allow staff members to develop skills and practice procedures that keep both them and patients safe during a workplace violence event.
  • Another tool to consider in your education and training regimen is mock drills. Mock drills help simulate the stress and confusion of an actual workplace violence event and afford staff the opportunity to gain confidence in applying workplace violence strategies. Contact local law enforcement about their availability to assist you in developing mock drill training programs.

Organizational response and evaluation are critical elements of an effective violence prevention plan. An effective policy outlines the immediate steps leading to the provision of first aid and emergency services to injured workers, patients, visitors, and families.

  • Organizational policies should encourage the reporting of workplace violence. OSHA defines workplace violence as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs in the worksite. We encourage you to monitor existing or pending legislative action and reporting requirements at both state and federal levels.
  • Post incident responses include reporting and notification utilizing the chain of command structure within the organization and outside authorities as appropriate. Violent incidents often have a long-term impact on employees, who may feel distressed and insecure for months after an incident.
  • Provide staff with the opportunity to debrief and offer additional services.  
  • Encourage staff to fill out an incident report and train your work force how to document objectively. Analyze incident reports and patient complaints and communicate to staff additional follow-up will occur. Communication is an important element of keeping staff informed and planning future training.
  • Covered employers are required to prepare and maintain OSHA logs to document serious work-related injuries and illnesses. All documentation such as workers’ compensation reports and associated medical records should remain confidential and be maintained separately.
  • Program evaluation and ongoing monitoring allows the organization to assess its workplace violence prevention and mitigation strategies. This may include a standard way of reporting violence, a thorough and ongoing review and investigation of reports, the identification of trends and injuries, and measuring improvement.