Keeping patients, visitors, staff, and facilities safe and secure is a critical responsibility for every healthcare organization, and more than 90 percent of hospitals say they have systems, programs, or protocols in place for managing staff safety and health. But in comparison to other industries, healthcare settings face a much greater risk when it comes to one specific threat: workplace violence.
Statistics reveal the magnitude of the problem:
- Healthcare workers have a 20 percent (6.5 per 1,000) overall higher rate of workplace violence (as measured over a 16-year span) than all other workers (5.1 per 1,000).
- About 75 percent of the nearly 25,000 workplace assaults reported annually occur in healthcare or social-service settings. And assaults make up nearly 11 percent of serious workplace injuries in healthcare, compared with only 3 percent in the private sector.
- Violence-related injuries are four times more likely to cause healthcare workers to take time off from work than other types of injuries.
- 27 out of the 100 fatalities in healthcare and social-service settings that occurred in 2013 were due to assaults and violent acts.
Even more alarming is the fact that workplace violence in healthcare organizations is often underreported – suggesting that actual rates may be much higher.
“About 75 percent of the nearly 25,000 workplace assaults reported annually occur in healthcare or social-service settings.”
Increasing regulatory attention also makes the issue a priority: in April 2018, California became the first state to require all healthcare facilities to maintain a comprehensive plan to prevent workplace violence. And the Joint Commission – the healthcare accreditation organization – followed by publishing the Sentinel Event Alert, recommending hospitals take more action to boost safety and reduce workplace violence risk.
Because of the complexity and frequency of workplace violence in the healthcare field, risk managers must fully understand the specific reasons that can fuel these threats so they can more effectively address the challenge. Here are a few of the most significant exposures.
Unique exposures in the healthcare industry
The healthcare industry has many unique factors that make it more vulnerable to workplace violence. Hospitals, for example, generally offer unrestricted public access, so they automatically have higher levels of risk than typical office environments. Workplace violence risk factors vary by setting, but common issues that affect many healthcare facilities include:
- Stressful work conditions and high worker turnover, leading to disgruntled employees and making security more difficult with an influx of new faces and ID badges to monitor.
- Working in neighborhoods with high crime rates.
- Presence of weapons among visitors – or even patients.
- Working with patients in pain, in unfamiliar surroundings, or who have a history of violence, may be under the influence of drugs, or who are mentally unstable.
- Medical equipment and building design that can block vision or escape routes in cases of emergency.
- Inadequate lighting in hallways or exterior areas.
- Understaffing or working alone, especially during meal times, visiting hours, and overnight.
- Inadequate security staff.
- Long wait times and overcrowded waiting areas, leading to unhappy patients or visitors.
Long wait times and overcrowded waiting areas, leading to unhappy patients or visitors.
The challenge of adding new services in healthcare
Healthcare is also evolving in ways that expand risk and increase the challenge of keeping everyone safe.
“Hospitals have changed their personalities, so to speak,” says Jeff Duncan, SVP and Chief Underwriting Officer, Healthcare Practice, Liberty Mutual Insurance. “If you’re engaging in more patient-centric wellness work or population health, you will interact with patients in their homes, the community, and other less-controlled environments. It’s important both to draw ground rules on where interaction can take place and to anticipate the types of aggression incidents that could occur in each. Hoping for the best is not a strategy.”
“Hospitals generally offer unrestricted public access, so they automatically have a higher level of risk than a typical office environment.”
Many large-scale, multi-hospital systems continue to expand access to include comprehensive networks of care that range from long-term care facilities and outpatient clinics to mental health centers and home-health agencies. Engaging and protecting this broader spectrum of healthcare staff means ensuring their perspectives and needs are incorporated into all violence-prevention efforts.
For example, workers conducting home care visits are at particular risk. Because they provide care inside the patient’s home, the environment is essentially uncontrolled. Shockingly, 61 percent of home-care workers report on-the-job violence annually, and unique concerns include the presence of weapons and drugs, family violence, robbery, and car theft.
Costly impacts of workplace violence
The negative fallout from violent workplace incidents can spread throughout the organization – and even the community. Not only is financial loss for the institution significant in cases of worker injury or death, but also in reputation and in the emotions of the staff working there.
But the ramifications can be even greater than negative PR and employee morale. When it comes to workplace violence, medical facilities are increasingly held responsible under premises liability, where plaintiffs can win civil awards because of hazardous conditions and failure to prevent violence. There are also far-reaching implications for healthcare organizations regarding workers compensation, general liability, and property exposures.
To mitigate risk, preparation is key
Preventing workplace violence must be both a concerted institutional effort and an ongoing process – not a one-and-done. To get started, here are some recommendations by The Joint Commission for institutions to follow:
- Clearly define workplace violence (including verbal abuse), develop systems to allow for reporting, and encourage staff to report incidents across the organization.
- Track incidents from multiple sources and analyze trends of incidents.
- Provide resources for victims of violence, including emotional support and post-trauma care.
- Analyze incidents that occur to see if there were other contributing factors, and help identify if there are patterns that easily call for early intervention.
- Train staff in deescalating tactics and self-defense techniques, including alarms, security support, safe rooms, and emergency communication processes.
- Look for opportunities to continuously improve prevention and reporting efforts to reduce workplace violence incidents.
Starting a workplace violence prevention program can feel daunting, but you don’t have to go it alone. In fact, OSHA recommends seeking “the advice of independent reviewers, such as safety and health professionals, law enforcement or security specialists, and insurance safety auditors.” Pulling in such outside resources during your worksite risk analysis can help ensure that you are following industry best practices and aren’t missing something critical in your planning
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