Taking Action to Prevent Workplace Violence in Health Care

Added on Jun 20, 2018

Emily Halu, RN, MSN, Press Ganey Consultant

This is Part 2 of a two-part series on violence in the health care workplace. Part 1 provided insights into some of the causes of workplace violence and where health care leaders can begin on their safety journey.

safety firstAs an experienced acute care nurse, I know firsthand how easily care visits can escalate into dangerous situations. We see patients and family members at their most vulnerable, which means we often deal with aggressive or violent behavior in addition to the everyday stress of our roles. But we should not have to.

It is time for us as health care leaders to align our actions around building a culture and environment that best protects our workforces.

From our experience in health care workforce safety, we know that culture influences the actions and behaviors that contribute to safety events, including preventable injuries due to violence. To protect our workforces from preventable harm, we must create a safety culture that is founded on fairness and mutual respect, nurtures continuous improvement and supports the use of universal skills to reduce the risk of errors.

To create a safety culture, we as health care leaders must do the following:

1. Commit to Zero Harm, including a policy of zero tolerance for verbal threats or violence of any kind. 2. Align our actions and those of our staff with the strategic goals of reducing injuries and fostering effective teamwork by adopting universal skills in everyday practice.3. Use storytelling, messaging and visual media in the work environment to promote the organizational commitment to Zero Harm.


However, a safety culture alone will not end violence in health care. We must continuously build on it, cultivating key additional components such as hazard-specific identification, analysis and prevention, along with local learning. 

Hazard-Specific Prevention

To prevent violence to health care workers from patients and visitors, organizational leaders must first recognize and acknowledge the risk of violent acts in the workplace, analyze the work environment to identify and remove potential hazards and prepare staff to respond appropriately. To this end, executive leaders, directors and managers should

  • Perform environmental assessments during rounding to detect any engineering controls—such as line of sight, areas to take shelter, and storage for items that could be thrown or used as a weapon—that are ineffective or need to be modified;
  • Convene focus groups of front-line workers from different professions, departments and regions to evaluate engineering and administrative controls, such as written operating procedures, work practices and safety and health rules;
  • Prioritize risks by severity and develop action plans to make modifications to those controls;
  • Develop a team to sustain these gains and receive feedback from front-line staff as well as leaders; and
  • Provide de-escalation and self-defense training.

Local Learning and Continuous Improvement

In their book Managing the Unexpected: Sustained Performance in a Complex World, Karl E. Weick and Kathleen M. Sutcliffe introduced the principle of deference to expertise, which exemplifies the ability of a High Reliability Organization (HRO) to anticipate and cope with the unexpected. This principle refers to the best practice of deferring to specific individuals who possess expertise or situational knowledge that most closely addresses the problem or concern at hand. To engage these front-line experts in identifying and resolving pain points that may pose a risk to them or their patients and to increase awareness of specific patients, families or visitors that may be disruptive or dangerous, HROs practice a technique known as local learning.

Leaders can engage their front lines in local learning to prevent workforce violence by doing the following:

  • Demonstrating a commitment to the safety ideal of “see something, say something”
  • Performing an apparent or root cause analysis of any injury—whether it was due to violence or not—to drive action planning and prevent other injuries
  • Holding daily unit- or department-based huddles centered on identifying local system issues or concerns that were or could be adverse to patient safety, worker safety or quality and experience of care in the next 24 hours
  • Representing these issues and concerns on a learning board organized into sections for new, in-process and resolved issues to build awareness among staff that these concerns are a priority and are being thoughtfully addressed 

learning board example

Example learning board

While there is no one-size-fits-all solution to ending workplace violence in health care, we know that establishing a safety culture founded on mutual respect, continuous improvement, hazard-specific prevention and local learning will better protect the safety of health care workers and patients and accelerate the journey to Zero Harm.