Taking steps to prevent violence in health care workplace

A new report by the AMA Council on Science and Public Health responds to increasingly common violence directed at physicians and other health care professionals where they work, looking at the trends in violence, solutions that have been tested and barriers to addressing the problem. The AMA adopted policy to help prevent violent acts in the health care setting.

The U.S. Bureau of Labor Statistics reports that workplace assaults from 2011 to 2013 were 23,540-25,630 annually, with upwards of 70 percent occurring in health care and social service settings. Health care workers are three to four times more likely than other private sector employees to sustain injuries that involve days of work missed.

“Emergency department, mental health and long-term care providers are among the most frequent victims of patient and visitor attacks,” the report said. “A nationwide survey of emergency medicine residents and attending physicians found that 78 percent of respondents had reported at least on workplace violence act in the previous year, and 21 percent had reported more than one type of violent act.”

One of the biggest obstacles to fully understanding the scope of the problem and taking corrective action is the fact that many incidents go unreported.

“Reasons for not reporting can be as simple as health care workers not knowing what constitutes an act of workplace violence or a reporting process that is too cumbersome and time consuming,” the report said. “Other reasons for not reporting include a perception that workplace violence is ‘normal’ or a part of the job, fearing the response they may receive when reporting these events (blaming the victim), and lacking support from leadership to encourage reporting.”

Some hospitals and health systems are taking steps to prevent violence, according to the report. They range from more traditional facility safety to more clinical approaches. Henry Ford Hospital in Detroit, for instance, has installed metal detectors at its entrances to prevent people from bringing weapons into the buildings. In the first six months of screening, the hospital confiscated 33 handguns, 1,324 knives and 97 chemical sprays.

The Veterans Health Administration, meanwhile, flags patient records to help clinicians and others identify patients who may pose a threat to themselves or others. Patients are flagged in tiers, one for those who are high risk for violent or disruptive behavior based on a history of violence and credible threats, and another for patients with other high-risk factors, such as drug-seeking behavior, a history of wandering or spinal cord injuries.

Delegates at the 2016 AMA Annual Meeting adopted policy that calls on all parties to take an active approach to increase the safety of health care workers:

• New policy calls on the Occupational Safety and Health Administration to develop and enforce a standard addressing workplace violence prevention in health care and social service industries.  
• The AMA will encourage Congress to provide additional funding to the National Institute for Occupational Safety and Health to further evaluate programs and policies to prevent violence against health care workers, and asks the National Institute for Occupational Safety and Health to adapt the content of their online continuing education course on workplace violence for nurses into a continuing medical education course for physicians.  
• The AMA is urging all health care facilities to adopt policies to reduce all forms of workplace violence and abuse; develop reporting tools that are easy for workers to find and complete; make prevention training courses available; and include physicians in safety and health committees.  
• Updated policy also encourages physicians to take an active role in their safety by participating in training to prevent and respond to workplace violence threats, report all incidents of workplace violence and promote a culture of safety within their places of work.

“As violent incidents continue to plague hospitals, emergency departments, residential care settings and treatment centers, we must do everything we can to protect the health and well-being of our health care workers,” AMA Board Member William E. Kobler, MD, said in a news release. “We urge the federal government to develop and enforce a federal standard for health care employers to help shield health care workers from workplace violence.”