The Rise of Workplace Violence: Addressing Healthcare’s Biggest Threat


Workplace Violence (WPV) is one of the greatest threats to US healthcare today. Throughout my career, I have witnessed the changing landscape of workplace violence,
its escalating nature, and its harmful impact on the provision of services, the associated costs, and individuals affected.

We face the harsh reality that WPV is a complex and growing problem. US healthcare systems face enormous pressure from rising patient demand and the difficulty in recruiting and retaining staff, which is caused, in part, by workplace violence. It is widely acknowledged that incidents are grossly under-reported. Thus, the accurate scale of the problem is not fully understood. Far more must be done to understand WPV, its impact, and how to address it to keep healthcare workers safe.

Industry collaboration is the key to innovation and transformational change – with cooperation occurring across healthcare systems, industry associations, institutions, and representative bodies, alongside suppliers and technology companies. There is enormous value in mutual support and information exchange.

Although this paper focuses on security and safety issues across the US healthcare system, the discussion will provide insight, new perspectives, and inspiration for national and international audiences. It supports the mission of the IAHSS to collaborate across the international healthcare security community, including the National Association for Healthcare Security (NAHS) in the UK.

Lastly, this paper will interest a multi-disciplinary audience in healthcare—including healthcare executives, police leaders, and security practitioners, as well as clinical and non-clinical staff involved in workplace violence prevention and mitigation programs. It contributes to existing literature, highlighting interventions and strategies that have yet to be fully explored.

I am deeply indebted to the healthcare and security professionals that have contributed to this paper. Thank you for sharing your personal experiences and insights, and for your passionate belief that we all need to come together and act to address healthcare’s greatest threat. I would also like to thank the membership of the IAHSS for being such an important voice on the issue, my research partner Sally Donohoe for all of her efforts, and Sam Houston State University for publishing this paper.

Executive summary

This paper discusses the scale and impact of workplace violence in US healthcare and explores current best practices and innovations in preventing and mitigating violence.

Section 1 sets the scene by explaining workplace violence’s scale, nature, and impact in the sector. According to the US Bureau Of Labor Statistics (USBLS), 73 percent of nonfatal workplace injuries and illnesses with days away from work due to violence in the US occur in a healthcare setting (USBLS, 2018). Despite a widespread issue with the under-reporting of violence, incident rates are also on the rise.

One of the barriers to tackling workplace violence is a misunderstanding of its nature. Sensationalist media stories about external perpetrators, such as active shootings and terrorist attacks, frame the public perception. However, the vast majority of violence is actually generated by patients – a fact not always understood by hospital leadership. Focusing on patient-generated violence through a clinically led approach is critical to achieving meaningful change.

The impact of workplace violence cannot be overstated in building the business case for investment in prevention programs. Workplace violence does not just impact the affected staff members – it disrupts caregiving and treatment; it harms patient care and damages a hospital’s or healthcare system’s reputation.

Workplace violence also has a financial impact, particularly in the area of nurse attrition, recruitment, and training. According to the American Hospital Association (AHA), proactive and reactive violence response activities cost US hospitals and health systems $2.7 billion in 2016. This includes $280 million for violence preparedness and prevention, $852 million for victims’ unreimbursed medical care, $1.1 billion for security and training costs, and an additional $429 million for medical care, staffing, indemnity, and other costs as a result of violence against hospital employees (Van Den Bos et al., 2017).

Additionally, the fear of violence adds to the harm of actual violence. Anxiety and stress are a major threat to healthcare provision as drivers of reduced performance, higher absenteeism rates, long-term sickness, and resignations.

Section 2 demonstrates why there is cause for optimism in combating workplace violence. The launch of updated standards from The Joint Commission (TJC) in 2022 has defined new requirements for hospitals and healthcare system executives and provides a solid framework for building an effective workplace violence prevention program.

Key TJC themes are leadership accountability and creating multi-disciplinary teams to lead on workplace violence, rather than leaving the responsibility solely to security teams. We also look at proven best practices recommended by TJC, namely Threat Assessment Teams (TATs) and Behavioral Emergency Response Teams (BERTs).

Then, we examine strategies and interventions that healthcare organizations are deploying successfully to tackle workplace violence. These include better collection and use of data, the delivery of targeted training programs, and adopting a community-based approach to hospital security.

Section 3 shifts the focus to the biggest challenges the healthcare sector faces in tackling violence and suggests solutions where they exist. You will see that a lack of leadership buy-in is a crucial blocker to progress. Security teams need to boost C-suite understanding of key issues while putting forward a solid business case for investment. A further challenge is the failure to adopt a clinically led approach to assessing and managing new patients who may exhibit violent behavior. This section also highlights the problem of underreporting of workplace violence – you cannot truly develop an effective violence mitigation plan if you do not have an accurate picture of its prevalence.

One of the most daunting challenges in security is the protection of staff across the entirety of the hospital setting to ensure safety everywhere, not just in hospital buildings, parking areas, and office buildings, but also in the community where home health is administered.

Finally, we address the tendency for knee-jerk reactions and quick fixes in response to previous violent incidents. Implementing standalone measures has not proven effective when compared to collaborative systems and solutions. The recommendation is to create a long-term plan for phased technology investment, which leverages the existing technologies that hospitals have already installed.

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