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July 25, 2018 (Cleveland)

Behavioral Health RoundTable Addresses Issue of Healthcare Workplace Violence

Healthcare Workplace ViolenceAnecdotal reports along with direct first-hand experience have led the members of the Behavioral Health RoundTable of Cuyahoga County to examine the issue of healthcare workplace violence. In recent months, participants in the BHRT of Cuyahoga County have been experiencing and hearing from others about an increase in incidence of episodes of verbal and physical violence stemming from patients in all care settings. The group chose to move forward with an effort to address the issue, beginning first with the collection of data to better measure the problem.


A survey was distributed in June to members of the RoundTable, including hospitals and behavioral health agencies, as well as to chief nursing officers of The Center for Health Affairs’ Northeast Ohio hospital members. A total of 46 survey responses were received, with more than half (51.7 percent) reporting an increase in violence on med-surg units, 68.9 percent in emergency departments, and 72.4 percent on inpatient behavioral health units. Respondents reported the opioid epidemic along with the increased acuity of psychiatric patients as some of the factors in these increases.

Almost two-thirds reported their organization has a top-down approach to violence prevention and more than half reported their organization has a zero-tolerance approach toward violence, starting at the top of their organizations. 


Nearly three-quarters of survey respondents reported their organizations have a process for reporting violent episodes and well over half (58.6 percent) reported that after an incident there is a debriefing period for staff and the patient or client. More than two-thirds (67.3 percent) reported there are resources available to support staff who have been involved in incidents of violence in their organization. Many of these reported the employee assistance program as a primary resource, while some reported on-site behavioral health or social work professionals. Almost one-fourth of respondents (23.9 percent) believe staff turnover has increased due to violent episodes or fear of violence. There is some concern these incidents can lead to high turnover especially among first-year nursing graduates. 

Trauma-informed care (TIC) is increasingly being recognized as an important aspect of effectively caring for the whole patient. It is relevant to the issue of healthcare workplace violence because the concepts of TIC are tools that can be used to help prevent violent patient behaviors from occurring or escalating. However, awareness of TIC among caregivers is still a work in progress. Just over one-third of organizations reported their staff have a general awareness of trauma-informed care concepts, while just under a third reported they do not. For the remainder of respondents, this was not applicable to their organizations or this question was not answered.

A small proportion of respondents (17.3 percent) reported they believe there is a connection between customer service initiatives or satisfaction survey results and the issue of increasing violence in their organizations, while more than half responded they did not believe so and about one-quarter did not respond to the question. Among those who reported a connection, some believe the emphasis on customer service and patient satisfaction, particularly given the link between reimbursement and satisfaction scores under federal healthcare programs, makes nurses and frontline staff more vulnerable to patient violence. Less than half (47.8 percent) reported their organization has a process for holding patients or clients accountable for violent behaviors.


The Violence Work Group of the RoundTable also utilized the survey to assess whether an educational opportunity, in the form of a conference, would be useful to area organizations, and a strong majority were found to be in favor. The Work Group is beginning the planning process, seeking to secure a national speaker, tentatively scheduled for late fall 2018. The conference will be designed with non-behavioral health staff in mind and the objective will be to provide concrete takeaways attendees can immediately begin implementing in their own workplaces.

For more on the RoundTable’s work on healthcare workplace violence, contact us.