Global HCPs face alarming rates of workplace violence

A gynecologist in Egypt, a cardiologist in India, and a general physician in Italy all have one thing in common—they have been victims of violence while at work.^[] Unfortunately, these incidents are not isolated, as healthcare workers globally face workplace violence,^[][] with the World Health Organization (WHO) reporting a prevalence of 63%.^[]

The World Medical Association considers violence against healthcare workers as a “scourge which undermines the very foundations of health systems and ultimately impacts critically on patient’s health,” and calls it an “international emergency.”^[] In 2018, a staggering 73% of US workplace injuries or harm caused by violence involved healthcare workers.^[]

The magnitude of the problem, and its ramifications, are worthy of further research into motivations and preventions.

ViSHWaS: International survey of healthcare workers

The Violence Study of Healthcare Workers and Systems (ViSHWaS) used a global network of volunteers to survey healthcare workers in 79 countries on the nature of violence in their respective healthcare system.^[] ViSHWaS collected responses from approximately 5,000 healthcare workers, with the US and India providing the highest number of participants.

In the introduction to their report, the authors noted the WHO’s definition of physical and psychological workplace violence as "incidents where staff is abused, threatened, or assaulted in the circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being, or health.”

The study revealed the following disturbing trends:

• Among HCPs who hadn't experienced violence firsthand, 16% reported their colleagues had.

• The most frequent perpetrators were patients and their family members, followed by supervisors and coworkers. Verbal abuse was the most prevalent form of mistreatment, followed by emotional and physical aggression.

• One out of every four HCPs who faced violence experienced a violent incident every month, while 2% reported facing daily abuse and violence. Among the participants, 36.6% believed the frequency of violence had escalated during the COVID-19 pandemic.

• A majority (75%) of participants stated they had not received enough training to handle a potentially violent scenario, and an equal proportion felt they weren’t prepared to deal with one at all.

Causes and context

Patients and their family members sometimes act violently toward HCPs due to emotional stress and high expectations, especially when the condition being treated is critical or life-threatening. 

A meta-analysis of global studies on workplace violence found a high prevalence among North America and Asian countries, compared with European nations.^[] In Asia, a paucity of HCPs per 1,000 citizens and lower government funding for healthcare were purported to be contributing factors. Studies from other countries, as reviewed in Annals of Medicine & Surgery, noted additional contributors, including language and cultural barriers, inadequate or inexperienced staff, prolonged waiting times, overbooked hospitals, and limited visitation hours.^[]

Violence against HCPs escalates during tumultuous events such as wars, civil unrest, or other forms of mass upheaval. Under these conditions, people become anxious, scared, or confused. ER doctors and inpatient caregivers become especially vulnerable to violence, according to Annals of Medicine & Surgery.

Consequences

The repercussions of workplace aggression extend beyond physical harm, sometimes leading to the development of psychological disorders, according to the authors. These disorders include depression, anxiety, burnout, and PTSD. Burnout among physicians correlates with a surge in iatrogenic errors, increased absenteeism, and a greater probability of quitting their jobs. 

The ViSHWaS survey also noted anxiety among the majority of the healthcare staff, with many feeling unprepared to handle violent situations. 

Less than half of the participants reported violent occurrences to hospital authorities or law enforcement. Unfortunately, many doctors perceive workplace violence as routine and avoid reporting it due to worries about social stigma, insufficient assistance, and the possibility of reprisals by offenders. 

Creating a safe haven for HCPs

According to the WHO, only one-third of nations across the globe have national policy tools to safeguard healthcare practitioners' health, welfare, and security.

According to Annals of Medicine & Surgery, impeding factors include the lack of a standardized reporting system, trauma-crisis counseling, and employee assistance programs in many nations. A comprehensive reporting mechanism and strict zero-tolerance policy against violence are the first steps toward building a secure workspace for healthcare workers. 

The WHO and the International Labour Organization have created a guide for occupational health and safety programs for HCPs. They are also working with global partners to strengthen the implementation of these programs in various countries.