From My New Book

Healthcare Insights: Better Care Better Business

You are up at 5 a.m. to begin working the early morning shift at the local community hospital. A half-hour later, nurses and two doctors in the emergency room are confronting a patient with a disease for which they never bargained nor are trained to manage. It is being documented in the scientific literature as an epidemic of violence spreading throughout health-care systems worldwide.


Workers are largely left to fend for themselves. Administrators offer little planning and training to prevent violence against medical staff, and the judicial system, including police departments, are not much more help. Violence in medical facilities is viewed as an occupational hazard.

Researchers claim the numbers of incidents are largely underreported but on the increase in emergency rooms. Violence includes severe verbal abuse, physical threats, and assaults. Nearly two decades ago, 57 percent of medical staff responding to a survey had been physically assaulted, and 48 percent of them suffered impaired job performance after an attack. More than half will eventually leave working in the emergency room, fearing future attacks.

One of the grave deficits in developing a cogent prevention safety plan is the lack of regularly collected data in a uniform manner. There is not a common definition of violence and violent acts. For instance, are thefts, vandalism, and burglaries considered acts of violence? Are incidents in hospital parking lots of equal weight to violence in emergency rooms? Are there correlations between size of facility, patient traffic, socioeconomic status of populations, numbers of hospitals beds, and more? Are incidents reported to the police, and are their data coordinated with data collection from the facilities?

Independent study agencies concerned with health-care safety conclude the numbers of assaults, rapes, and homicides in hospitals rose between 2007 and 2010. A more sophisticated “Healthcare Crime Survey” by the International Healthcare Security and Safety Foundation reported in 2014 that the numbers of assaults, rapes, and sexual assaults in hospitals continued to rise since 2010 by 37 percent in three years. Gun violence is on the increase too, but it is rarer than other types of violence.

The Israel Medical Association claims workplace violence is among the highest for medical personnel. More than half the incidents occur in hospitals and one-third in community medical facilities. Patients account for 51 percent of assaults on medical personnel and visitors 49 percent. In Israel, violence is related by research data to long wait times in emergency rooms and dissatisfaction with care patients receive. The authoritative status of doctors as the chiefs of the medical care system and the public perception of doctors as leaders make them particular targets of assaults. The effects of violence experienced by nurses has Israeli doctors suffering from guilt, anger, fear, dejection, disappointment, and post-traumatic syndromes.

China’s Ministry of Health reports the numbers of violent incidents against medical personnel increased from 10,000 in 2005 to more than 17,000 in 2010. A 2012 editorial in The Lancet describes the violence in China’s medical facilities as a crisis.

The US government recognizes violence is spreading throughout the health-care system. In response, the Centers for Disease Control and Prevention is awarding grants to outsourcing agencies for workplace-violence-prevention programs in the medical setting. These outsourcers ought to be funded to put prevention programs in place nationally and have mobile teams available across the country for follow-up after incidents occur.

Uniform data-collection techniques and statistics are also a high priority. Commonly agreed-upon definitions of terms are most important, setting the parameters of what constitutes violence. Second, data collection methods and procedures must be uniform. These data must be in tandem with police departments, the Department of Justice, and the Bureau of Labor Statistics’ Census of Fatal Occupational Injuries that collects data of workplace homicides. The Bureau’s Survey of Occupational Injuries and Illnesses collects data on nonfatal workplace injuries involving days away from work. Data collected from the Consumer Product Safety Commissions’ National Electronic Injury Surveillance System and related programs collect data on workers treated in emergency rooms for nonfatal assaults. Another federal agency collects and publishes data linking public and private initiatives regarding workplace violence.

At the very least, every medical facility must have a prevention program in place with procedures that ensure the safety of staff and patients. There must be snap-back emergency procedures when violence breaks out. Finally, every institution needs a project management office to collect uniform data and determine a plan for their use in stopping the epidemic of violence in the health-care system.