Violence in the Health Workplace

Dr Klee Benveniste, Research Fellow at the Australian Patient Safety Foundation (APSF) in Adelaide, and colleagues examined the data collected using the Australian Incident Monitoring System (AIMS). They found that among 42 338 incidents reported from 1 July 2000 to 30 June 2002, 9 per cent of all incidents involved patients and physical violence or violent verbal exchange. Staff injury was reported in 5 per cent of cases.

The proportion of incidents involving violence was higher in emergency departments (16 per cent, with frequent involvement of mental health problems or alcohol or drug intoxication), and mental health units (28 per cent).

With the closure of public psychiatric hospitals in the past decade, more patients with mental illness are seeking care in public hospital emergency departments, say the authors.

AIMS analysis highlights the importance of understanding the contributing and precipitating factors in violent incidents, and supports a variety of preventive initiatives, including de-escalation training for staff; violence management plans; improved building design to protect staff and patients; and fast-tracking of patients with mental health problems as well as improved waiting times in public hospital emergency services.

Mr John Forster and colleagues from Austin Health in Victoria say that strategies to prevent and manage violence and aggression in the health care setting have become a primary health and safety issue. Through a series of vignettes, they highlight key elements in developing a program for preventing violent behaviour and aggression in a tertiary hospital.

Key components of the program include staff education and training, risk assessment and management practices, the use of patient contracts and policy development.

Parker Magin and colleagues from the University of Newcastle say that occupational violence is a considerable problem in Australian urban general practice.

Their research showed that about 64 per cent of GPs who responded to a survey had experienced violence in the previous year. The most common forms of violence were "low-level" violence: verbal abuse (42.1 per cent), property damage or theft (28.6 per cent) and threats (23.1 per cent). A smaller proportion of GPs had experienced "high-level" violence: sexual harassment (9.3 per cent) and physical abuse (2.7 per cent).

They found violence was significantly more likely to be directed towards female GPs, less experienced GPs and GPs working in areas of social disadvantage, mental health problems and drug and alcohol problems. Younger GPs and GPs providing after hours care were also at greater risk.

The authors concluded that formal education programs in preventing and managing violence would be appropriate for GPs and doctors-in-training.

Associate Professor Marcus Kennedy, Director of Emergency Services at the Royal Melbourne Hospital, says violence in emergency departments (EDs) has reached a level that requires concerted action and a shift in attitude - to eradicate a socially and professionally unacceptable peril. In some EDs, violence is a daily occurrence, with nursing staff reporting several episodes each week. He says violence in emergency departments is often under-reported — in a setting of care victims are likely to excuse the behaviour and lack the time required to complete reports on violent incidents. The key to successful intervention is a strong preventive orientation.

Dr Claire Mayhew and Professor Duncan Chappell, in an editorial in the same issue of the Journal, say that although in Australia the risk of death or serious physical injury from a violent workplace incident is quite remote, each year about one Australian health worker is murdered at work and large numbers are either verbally abused, bullied or assaulted. They say the challenge for health authorities is to implement effective preventive strategies and a zero-tolerance policy.

All workplace violence prevention strategies should be multi-faceted and organisation-wide, and involve widespread consultation with all workers in their development and implementation, say the authors.

The Medical Journal of Australia is a publication of the Australian Medical Association.