As we recently saw in Las Vegas, there are violent people in the world who are willing to kill and injure others for no apparent reason. Violence can also be a real problem in the workplace. The Occupational Safety and Health Administration (OSHA) specifies that companies take steps to reduce workplace risk factors for workers, but sometimes this is easier said than done. Often an analysis is done after the fact, with the investigation biased by hindsight.

Violence in the workplace is not new. Some of us recall the term “Going postal” in reference to incidents at the Postal Service. Over 20 years ago the National Institute of Occupational Safety and Health (NIOSH) reviewed workplace violence and the recommendations made then still apply today. A few years later the Injury Prevention Research Center (IPRC) at the University of Iowa issued the study Workplace Violence, A Report to the Nation which summarized many of the key elements of the problem.

Most cases of reported violence deal with some form of physical violence, including assault with a weapon and rape. While fatal incidents are tracked at the Census of Fatal Occupational Injuries (CFOI), at the Bureau of Labor Statistics other forms of violence–bullying, psychological abuse and even poisoning of coworkers–may be underreported. The problem of workplace violence is much greater than most people realize. ¬†

Medical calculators developed to address this sensitive issue can help workers and administrators in any setting, including healthcare, follow evidence-based procedures and guidelines. In the discussion below, calculators are recommended that can be useful in identifying risks and standardizing approaches to potentially explosive situations.

  • Bullying Behavior by a PatientBullying Behavior by a Patient

Workplace Violence Risk Factors

Some workplaces are more dangerous than others. The risk tends to be greater in places where:

  1. There is money and things of value, such as banks and jewelry stores
  2. There are people dealing with the public for delivery of services or goods, as in healthcare
  3. There is little perceived risk for the perpetrator
  • Risk Factors Associated with Workplace ViolenceRisk Factors Associated with Workplace Violence

Perpetrators of Workplace Violence

A frequent question about violence is “Why?”

Sometimes the reason is unclear, as for the shooter in Las Vegas. Usually, a cause can be surmised, such as:

  1. Anger about a service
  2. Criminal intent (robbery or extortion)
  3. Gang-related activity
  4. Drug-related activity
  5. Interpersonal conflict, including divorce or break-up of a relationship
  6. Revenge against co-workers
  7. A serious psychological problem, especially paranoia and depression
  • Warning Signs of Aggressive Behavior in a Psychiatric PatientWarning Signs of Aggressive Behavior in a Psychiatric Patient

In healthcare, a common site for violence is the Emergency Department, which is a crossroads for all sorts of people with all sorts of problems.

  • Risk Factors for Workplace Violence Involving Emergency Department PhysiciansRisk Factors for Workplace Violence Involving Emergency Department Physicians

Prevention of Workplace Violence

Once the possibility of violence is accepted and the risk determined, then there needs to be a plan to reduce that risk. A good place to start is outlined in the Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers.  Initially and periodically thereafter there should be an inspection of the work site to identify problems and to suggest solutions. Engineering and administrative solutions need to be implemented and enforced.

  • Prevention Strategies to Reduce or Prevent Workplace ViolencePrevention Strategies to Reduce or Prevent Workplace Violence

Take Home Messages

Violence is an ongoing hazard in the healthcare workplace as well as in society in general.

Algorithms can help to identify risk factors for violence in healthcare and most other workplace settings and also help to identify possible perpetrators. They can also be used to develop a mitigation strategy that may reduce the risk to workers.