Understanding challenges in hospitals’ workplace violence reporting systems

Institute for Work & Health study on workplace violence reporting in health care examines reasons why incidents are not disclosed

Published: August 3, 2020

Seven years after it became mandatory for Ontario hospitals to report incidents of workplace violence, a study found reporting across health-care facilities to be inconsistent, with the majority of incidents undetected by hospital reporting systems.

The study, conducted in late 2017 by the Institute for Work & Health (IWH), examined self-reported rates of different types of violence over a 12-month period at six hospitals. It found the most serious acts of violence—physical assaults, which were experienced by 15 to 25 per cent of study respondents—were brought forward only 44 per cent of the time to the hospital reporting system.

The most common types of violence—threats, which were experienced by about 30 per cent of the study respondents—were reported only 18 per cent of the time. Attempted assaults, experienced by 20 to 30 per cent of respondents, were reported 29 per cent of the time.

To address a problem, we need to fully grasp its magnitude. This means having reporting systems that collect reliable and valid indicators of workplace violence events in a consistent way over time, and across workers and workplaces, says IWH Senior Scientist Dr. Peter Smith, who shared findings from the study at an IWH Speaker Series presentation in May 2018.

He notes the parallels between these findings and those of a more recent study on injury reporting. In the context of the current COVID-19 pandemic, we are relying more and more on various health surveillance systems to guide policy and prevention activities and evaluate their effectiveness, adds Smith. As we do so, it is important that we concurrently check to ensure that these systems are capturing all the information they were designed to collect.

Mandatory reporting

Since 2010, it has been mandatory for all workplaces in Ontario to have policies and programs in place to deal with workplace violence, workplace harassment and domestic violence. This includes having procedures in place for workers to report incidents of workplace violence and for workplaces to investigate them.

In 2018, in response to recommendations by the Workplace Violence Prevention in Health Care Leadership Table, Ontario mandated that every hospital in the province must publicly report to Health Quality Ontario (now part of Ontario Health) the number of workplace violence incidents that have occurred at the hospital in the previous 12 months. This study took place before this mandate took effect.

The IWH study set out to examine the prevalence of workplace violence and reasons for potential under-reporting. The six hospitals that took part in the study were similar in many respects: they were large community or teaching hospitals, in urban or semi-urban settings. All had emergency departments and similar reporting systems for workplace violence.

Workers at the six hospitals were invited to complete a survey about their experience and reporting of physical assaults, attempted assaults, threats and any other forms of workplace violence in the previous 12 months. For the most serious incidents, workers were also asked about the consequences of the incidents, whether they reported the incidents to the hospital system and, if not, why not. About five to 15 per cent of the staff across the six hospitals took part, for a total sample of 1,500. 

Survey results showed reporting varied greatly across the six hospitals. When it came to physical assaults, the proportions of workers who said they always reported varied from 24 per cent at one hospital to 67 per cent at another. Percentages of workers who said they never reported also varied greatly—from 35 per cent to 73 per cent.

The researchers also examined factors linked to workers’ decisions to report or not report. Here, they found some interesting patterns. Workers who needed time off work or modified duties were by far the most likely to report incidents to the hospital system—80 to 90 per cent did so. Such incidents requiring time off or modified work constituted only eight and four per cent, respectively, of all workplace violence events.

Also notable were reporting patterns among workers who were physically injured, needed medical care, felt frightened, were psychologically traumatized, felt fear or perceived their assailants’ intent to harm. Despite the apparent seriousness of the violent incidents described, only between 40 to 55 per cent of them were reported to the hospital system.

When asked about the reasons for not reporting, the most common set of reasons was related to workers downplaying the incidents (for example, they weren’t hurt or the incident was not serious). The next common set of reasons related to workers being desensitized to violence or perceiving it as part of the job. The third common set of reasons had to do with the time required to report. This was followed closely by workers feeling that nothing would happen as a result of reporting, or that there was no point in reporting.

The reasons cited in this study dovetail with findings from another IWH study examining the challenges of implementing Ontario’s anti-violence legislation in hospitals. This 2016 study was carried out at five Ontario hospitals and involved interviews and focus groups with 157 staff members about workplace violence challenges and concerns. Employees spoke of resources involved in training, the quality and consistency of organizational risk assessment, policies for patient flagging, the use of alarms to summon assistance, and the roles of security staff, both internal and external.

One takeaway from this study is the need for us all to use extreme caution when we see workplace violence data from hospital reports, says Smith. Developing robust reporting systems can be challenging. As the numbers are made available to the public, we need to be careful to not stigmatize hospitals that have higher numbers of incidents. These just might be the ones doing the most commendable work to encourage reporting and protect their workers.