Workplace violence (WPV) is increasingly recognised as a serious issue in Canadian workplaces. For example, in Ontario between 2002 and 2016 the number of accepted lost-time workers’ compensation claims (i.e. those requiring time off work) due to assaults increased by almost 60%. In contrast over the same time period all other types of lost-time claims decreased by 42% (Read more here).
Workers in health care experience a disproportionate amount of WPV compared to workers in other sectors. This is likely due to the particular needs of patient populations, the greater likelihood of interacting with the public, and the highly stressful situations that often arise in healthcare settings.
In 2015 the Ministry of Health and Long-Term Care and Ministry of Labour established a Workplace Violence Prevention in Health Care Leadership Table. The goal of this Leadership Table was to “drive a positive shift in organizational workplace violence prevention efforts”. Its interim report, released in 2017, includes a series of recommendations to improve workplace cultures and attitudes towards WPV prevention, and to make health care settings safer.
Understanding whether WPV prevention activities in health care are effective in reducing incidents of WPV relies, in part, upon the collection of accurate information about the number of WPV events that occur.
All hospitals in Ontario have incident reporting systems which would capture WPV incidents. However, the use of hospital reporting systems to understand if WPV events are increasing, decreasing or staying the same over time, assumes that these systems capture most WPV events. It also assumes that there are not differences in reporting practices, or the definitions of WPV events, across hospitals. Unfortunately, we don’t know if this is the case in Ontario.
If WPV reporting in Ontario hospitals is similar to reporting in the U.S., then two recent studies suggest that only a fraction of WPV events end up in hospital reporting systems. One study in seven hospitals in the Mid-west U.S. found that while 68% of respondents who had experienced violence in the last 12 months reported it to someone (e.g. a colleague or supervisor) only 23% reported it to their hospital reporting system. Another study involving six hospitals in Texas and North Carolina focusing only violent events where patients and visitors were involved, observed that 75% of respondents reported violent events to someone, but only 9% reported to the hospital reporting system. Both studies found that the rate of reporting was much higher (36% in the first study and 46% in the second study) if the person was injured during the violence.
Taken together, the results of these studies have important implications for the use of hospital reporting systems to capture all types of WPV within the Ontario Occupational Health and Safety Act, as this includes attempts to exercise physical force, statements or behaviours which are interpreted as threatening, and situations where force is exerted, but no injury results.
Prevention efforts underway in Ontario focus on creating workplaces where WPV is less likely to occur, but also on creating cultures that encourage the reporting of all WPV events – regardless of who the person committing the violence is, and whether it leads to injury or not. Because severity of injury is related to reporting, the capture of overall numbers (or rates) of WPV events in hospital reporting systems is only a first step in an effective surveillance program. This is because on one hand, we want to see reporting for less serious events increase (because this indicates efforts to create a culture of reporting are working); on the other hand, we want to see more serious violent events decrease (because this indicates prevention efforts are working).
As we move forward with efforts to evaluate the impact of WPV prevention efforts we need to create reporting systems across all hospitals that not only comprehensively capture WPV events, but also capture other important factors such as the consequences of WPV, and if action was taken by the hospital as a result of the WPV incident. By doing this, we can better evaluate current prevention efforts, and importantly, better inform future prevention activities to make health care settings safe for workers.