Why is there so much violence in healthcare?

              If you are not aware of the enormity of the violence problem in healthcare, then you must be living under a rock. The reports pouring in from various organizations continue to show the rise in violence against healthcare workers. Forbes.com recently published an article by Heidi Kurtner identifying healthcare as the most dangerous profession in America due to workplace violence (2019). The Bureau of Labor Statistics (BLS) has shown a steady trend in the increase of intentional injuries by another person in healthcare (see the graph below). Of note, the BLS numbers only show those injuries that result in days away from work, and does not relate the reality of daily abuse that either doesn’t involve physical injury or goes completely unreported.

While nurses take the brunt of these assaults, this epidemic affects all aspects of the healthcare industry. The American Journal of Managed Care recently published an article on the rising epidemic of violence noting that 47% of Emergency Department physicians have reported a personal physical attack (2019). Additionally, we see violence affecting all types on ancillary services that provide care to patients everyday across the healthcare sector. But, with all this knowledge, and the burgeoning focus on the epidemic, the question remains why healthcare?

I think the answer is more obvious than most people want to admit, and far more difficult to address than we want to believe. I believe there is a deep-rooted cultural problem with acceptance of violence within the healthcare industry. Specifically, I believe that we have for decades accepted violence as part of the job, and this refusal to acknowledge, much less address the problem, has built the foundation for the epidemic of violence we are faced with today. Everyday healthcare providers accept assault as part of their job, and that is the real tragedy of violence in healthcare.

Research has shown that underreporting of assaults in healthcare is a significant barrier to violence prevention (Arnets, A., Hamblin, L., Ager, J. Luborsky, M., Upfal, M., Russell, J., & Essenmacher, L., 2015). Some research has shown the rate of underreporting to be as high as 88% (CHPSO, 2017). I would challenge you to ask yourself, in what other profession can you ask for a service to be provided, and in the middle of that service assault the provider without consequence? In healthcare you can do that with near impunity, and in fact you probably won’t even be reported to internal hospital leadership, much less local law enforcement.

Many might say that patients may not know what they are doing, but I would also argue that the criminal nature of the offense is often irrelevant. Assaultive behavior that involves willful intent is far easier to deal with. However, we primarily see disease progression and altered mental status as key drivers for violence in healthcare. So, the argument is legitimate that the attacker does not know what they are doing. But… does that absolve the organization from protecting their workers? By no means. But the organization cannot implement strategies for violence prevention if their internal reporting mechanisms tell them there is no problem.

The fundamental truth is this, violence can be prevented. But, organizations have to recognize there is a problem in order to muster the resources needed to solve the problem. Many healthcare organizations have been slow to action because their employees tell them, through their reporting, that there is no problem. Until we all embrace reporting incidents of violence as the foundation of violence prevention efforts, then healthcare will always be one of the most dangerous jobs in America.

What are your thoughts on violence in healthcare? Do you see the connection between reporting and solutions? Join the conversation in the comments below. Like, share and follow to support the Proactive Security Blog.

References:

Arnets, A., Hamblin, L., Ager, J. Luborsky, M., Upfal, M., Russell, J., & Essenmacher, L. (2015). Underreporting of Workplace Violence Comparison of Self-Report and Actual Documentation of Hospital Incidents. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006066/#.

CHPSO. (2017). Violence in Healthcare. Retrieved from https://www.chpso.org/post/violence-healthcare.

Kurtner, H. L. (2019). Healthcare Remains America’s Most Dangerous Profession Due To Workplace Violence. Retrieved from https://www-forbes-com.cdn.ampproject.org/c/s/www.forbes.com /sites/ heidilynnekurter/2019/11/24/healthcare-remains-americas-most-dangerous-profession–due-to-workplace-violence-yet-hr-1309-bill-doesnt-stand-a-chance/amp/.

Stephens, W. (2019). Violence Against Healthcare Workers: A Rising Epidemic. American Journal of Managed Care. Retrieved from https://www.ajmc.com/focus-of-the-week/violence-against-healthcare-workers-a-rising-epidemic. {A

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