Today, I want to talk briefly about health care workers and workplace violence. Bottom line? Policy reform is urgently needed. Let me explain.

Statistics show that U.S. healthcare workers, on average, confront a higher exposure to workplace violence than do other professionals. Between 2011 and 2013, workplace assaults ranged from 23,540 and 25,630 annually, with 70% to 74% occurring in healthcare and social service settings. For healthcare workers, assaults comprise 10% to 11% of workplace injuries involving days away from work, compared to 3% of injuries incurred by all private-sector employees.[1]

OSHA Guidelines Support Reporting Behaviors

As my colleague Michael Crane recently blogged about, the U.S. Department of Labor Occupational Safety and Health Administration (OSHA) Guidelines for Preventing Workplace Violence were updated in 2015. The new OSHA guidelines endorse our approach as they clearly state, “Report as required. Determine who needs to be notified, both within the organization and outside (e.g., authorities), when there is an incident. Understand what types of incidents must be reported, and what information needs to be included.”

Health Care Patient Satisfaction Surveys Obstruct Workplace Violence Reporting

A large component of preventing workplace violence is encouraging employees to report concerning behaviors. However, with the passing of the Affordable Care Act, patient satisfaction surveys make healthcare workers wary of reporting concerning behaviors.

Sarah Poggi, an obstetrician practicing in Alexandria, Virginia wrote a column in the Washington Post Editorial Page last week describing her very personal and compelling reason why it’s often difficult to for healthcare professionals to report patients with concerning behavior.

  • In January 2015, her medical school classmate, Michael Davidson, was shot to death at Boston’s Brigham and Women’s Hospital by a family member of a former patient.
  • She articulately describes how healthcare workers are reluctant to report behaviors of concern exhibited by patients as a result of patient satisfaction surveys dictated by the Affordable Care Act.
  • Her hospital management has made it clear that some of the federal funding they receive is tied to the proportion of satisfied patient surveys, “On one hand, we are told to watch for angry behavior and to report it. On the other, we are incentivized to excuse the same behavior and even accommodate it. In my office we treat patients civilly, using honorifics when we address them and speaking politely as we involve them in clinical decision-making. We do this not only because it’s the right way to treat people but also because we are aware of their ability to publicly shame us or to deny us compensation for issues that have nothing to do with the care we provide.”

2 Very Important Tips for Healthcare Security Directors

1.      Help ensure that employees within your healthcare organization recognize that patient satisfaction surveys used as a financial incentive dictated by the Affordable Care Act should never interfere with their moral obligation to report information relating to potential incidents of workplace violence in an effort to protect themselves and their co-workers.

2.      As I have previously written – and as we advise our clients in developing their workplace violence prevention programs – be aware of the public safety exceptions to the Health Insurance Portability and Accountability Act (HIPAA) as the program gathers information about a subject. In some situations, privacy is outweighed by certain interests.

As we know all too well, lack of information sharing when addressing behaviors of concern can have tragic consequences such as that of Sarah Poggi’s medical school classmate. If we learn from these events – and become better professionals – we can save lives.


[1] Cited in the U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics report, Workplace Violence.

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