Contextual Considerations: What Gets Reported as Workplace Violence in Hospitals?

Background:  Under-reporting of non-fatal violence perpetrated by patients or visitors (type II) against healthcare workers is a recognized barrier to adequately examining the risk of these events.  We sought to improve methods for reporting type II violence through formal hospital-based surveillance systems.

Methods:  A mixed methods approach of surveys, focus groups and key-informant interviews among workers at 6 U.S. hospitals was employed to ascertain details about the mechanisms through which workers report and factors that influenced reporting.    

Findings:   Workers were more likely to report verbally to coworkers rather than reporting through a formal hospital reporting system.  Contextual factors that influenced formal reporting  included type of event (physical abuse more than verbal); workers’ injury severity and feeling worried about safety at work; management involvement and their level of response in prior violence events; and, perpetrator’s age, medical condition,  and (perceived) intent to harm.   Institutional policies that place an emphasis on patient satisfaction fostered concern among workers about being blamed for violent events or for mismanaging them which deterred some from reporting, while others felt compelled to formally document their actions to avoid being reprimanded. 

Conclusion:  These contextual factors contribute to the incomplete capturing of events resulting in underestimates of exposure to type II violence for workers.  Incomplete capture of events results in underestimates of exposure for workers, as well as erroneous conclusions that could result in failure to intervene in high risk areas.   Institutional policies that focus on patient satisfaction can give workers mixed messages about “acceptable” reporting practices.