Workplace violence in healthcare: stakeholder views on strategies to address client-initiated aggression in the Victorian public healthcare sector

Abstract

Workers’ rights to be safe at their workplace are fundamental to occupational health and safety (OHS). In healthcare, client-initiated aggression is a prevalent form of workplace violence and occupational hazard that affects workers’ safety and quality of healthcare. Healthcare services must balance the needs of the client and their obligation to address healthcare service hazards. A multifaceted, organisation-wide strategy to assess, prevent and manage client-initiated aggression is important, one that balances social policy, responds to the risk, reduces exposure and incidents of the hazard, and is responsive to the needs of the client.

The research described in this thesis identified key factors for inclusion in a strategy designed to manage client-initiated aggression in the Victorian public healthcare sector. This research is important because it explores the interplay of workplace violence, client stakeholder views, barriers and enablers of implementation, and methods to sustain a strategy.

Previous Australian studies found that the healthcare workforce is in the top seven industry groups exposed to workplace violence and subject to the second highest rate of physical assault. The hazard is generated by ill-health, stress, healthcare discipline practice, and organisational, social and economic factors. Workplace violence affects remote, rural and metropolitan healthcare services in Australia and the costs and impacts are significant. The severity and frequency of incidents per capita and the impacts on the community are higher in rural than metropolitan settings, and highest in remote areas.

Using a qualitative approach, interviews and focus groups were conducted with stakeholders in the healthcare sector to understand the phenomenon of client-initiated aggression and factors to include in a prevention and management strategy. These are presented around key themes according to the literature and other themes stemming from the data. These themes were refined (according to the scope of text within the interviews and focus groups) into twelve sets reflecting both a content and thematic analysis. The twelve factors are policy, procedure and practice, workplace design, training and education, monitoring and review, risk management, funding, an overarching approach, prevention, practice management, organisation and culture, bullying and harassment and client perspectives.

The research established that these twelve factors, in addition to evidence and consultation, are required in a client-initiated aggression strategy. All factors must aim to achieve continuous improvement in quality, safety and standardisation in the healthcare setting. Executive commitment throughout an organisation is required through monitoring and review processes. The key to an effective strategy is to proactively promote prevention measures, to state organisational tolerance to client-initiated aggression, and uphold a rights and responsibilities statement for clients, staff and the healthcare organisation.