Name
Chamberlain University
NR-544: Quality & Safety in Healthcare
Prof. Name
Date
Risk management in healthcare refers to the proactive process of identifying, evaluating, and mitigating risks that may cause harm to patients, staff, visitors, or the organization itself. Unlike other industries, the stakes in healthcare are life and death; therefore, risk management practices directly influence patient safety and organizational sustainability (Riskonnect, 2022). The ultimate goal is to prevent harm while preserving the hospital’s ability to provide safe, effective care.
Although hospitals are designed to promote healing, they have increasingly become the setting for violent incidents. Such incidents place not only patients but also medical professionals at significant risk, as they are often the primary targets of verbal threats, harassment, intimidation, or even physical attacks.
Perpetrators may include patients, visitors, family members, vendors, and even current or former healthcare employees. Factors such as staff shortages, high patient morbidity rates, encounters with aggressive individuals, and inadequate violence-prevention programs exacerbate this issue (CDC, 2022).
To address these risks, healthcare facilities should implement zero-tolerance policies, emphasizing that physical, verbal, or psychological violence will not be tolerated. Any offender, regardless of status, should face disciplinary measures, which may include suspension or termination.
Workplace violence remains one of the greatest safety threats in healthcare. According to the Bureau of Labor Statistics (BLS) and National Crime Victimization Survey (NCVS), most workplace injuries requiring time away from work occur in healthcare and social service settings (OSHA, 2022).
Healthcare organizations must evaluate risk factors systematically. OSHA recommends having a structured workplace violence prevention program that integrates management accountability, staff participation, hazard identification, and continuous evaluation (Ross, 2020).
| Question | Answer |
|---|---|
| Is there an issue with the workplace being understaffed? | Yes. Staff shortages often increase patient frustration and can overwhelm healthcare workers, raising the likelihood of conflicts. |
| Do the employees perform jobs that might put them in conflict with others? | Yes. Staff working in emergency departments, psychiatric wards, or high-stress units are particularly vulnerable due to direct exposure to distressed or aggressive patients. |
| Are workplace hazards evaluated regularly? | Not consistently. Some facilities lack routine assessments, leading to unaddressed safety gaps. |
| Is there a written violence-prevention program in place? | In many institutions, such programs exist but are not effectively implemented or updated. |
This structured evaluation provides insights into the gaps that increase the vulnerability of both healthcare providers and patients.
Numerous studies highlight the prevalence of violence in healthcare environments. Research shows that both physical and non-physical violence occur frequently in hospitals. Non-physical violence includes verbal abuse and threats, while physical violence involves direct attacks on healthcare professionals (Chakraborty et al., 2022).
In emergency departments, men tend to face more physical assaults, while female nurses are disproportionately exposed to sexual harassment. Moreover, older or married nurses experience higher instances of verbal abuse.
The U.S. Bureau of Labor Statistics (2018) reported that homicides accounted for 4% of fatalities in private healthcare and social assistance industries.
Li et al. (2020) revealed that most workplace violence incidents are perpetrated by patients or visitors, with a 1:5 ratio globally each year.
Wallace (2019) emphasized that many healthcare workers fail to report violence, perceiving it as “part of the job.”
These findings highlight the urgent need for policy enforcement, staff training, and operational research to reduce workplace violence.
Workplace violence in healthcare arises from multiple interacting elements. The following table summarizes the most frequently cited contributing factors:
| Contributing Factor | Description |
|---|---|
| Excessive waiting times | Prolonged delays often frustrate patients and families, leading to aggressive behaviors. |
| Unrealistic expectations | Patients or families may expect immediate recovery or constant attention, resulting in conflict when expectations are unmet. |
| Poor understanding of the healthcare system | Miscommunication and lack of awareness regarding procedures can create misunderstandings. |
| Staff communication gaps | Limited communication skills or unprofessional behavior may escalate tensions. |
| Patient health status | Substance abuse, psychiatric conditions, or severe pain can contribute to violent behaviors. |
| Inadequate policies | Absence of strong workplace safety policies weakens preventive efforts. |
Additionally, cases of violence often go unreported, further complicating prevention efforts. Emotional stressors such as poor prognoses or unfamiliar hospital environments also play a role in violent outbreaks (OSHA, 2022).
One applicable framework is the Broken Window Theory (BWT), originally proposed by Wilson and Kelling. This theory suggests that visible signs of disorder, such as neglect or minor misconduct, create an environment where further crime and violence are more likely (Ellis et al., 2020).
In healthcare, a disorganized or unsafe environment may normalize negative staff behaviors and unsafe practices, which ultimately harm patients. Applying BWT to hospitals emphasizes the need to maintain order, accountability, and a culture of respect to promote both staff well-being and patient safety.
The Quality and Safety Education for Nurses (QSEN) project aims to equip nurses with the knowledge, skills, and attitudes necessary to improve healthcare quality (QSEN, 2022). Two core competencies are highly relevant in mitigating workplace violence:
Safety: Focuses on minimizing the risk of harm to patients and staff through structured safety protocols.
Quality Improvement (QI): Involves systematically collecting and analyzing data to design effective violence-prevention interventions and policies.
By integrating these competencies into daily practice, healthcare facilities can foster a safer and more resilient work environment.
Workplace violence in healthcare is both common and preventable. With an estimated two million annual cases in the United States, and approximately 25% going unreported, the issue is far more pervasive than many realize (OSHA, 2022).
By implementing OSHA-recommended measures, enforcing zero-tolerance policies, and strengthening QSEN-based competencies, healthcare organizations can significantly reduce violence-related risks. Ultimately, prioritizing workplace safety benefits not only staff but also enhances patient safety and quality of care.
Centers for Disease Control and Prevention. (2022). Common reasons for workplace violence. https://wwwn.cdc.gov/WPVHC/Nurses/Course/Slide/Unit3_6
Chakraborty, S., Mashreky, S., & Dalal, K. (2022). Violence against physicians and nurses: A systematic literature review. Journal of Public Health, 1–10. https://doi.org/10.1007/s10389-021-01689-6
Ellis, L., Churruca, K., Tran, Y., Long, J., Pomare, C., & Braithwaite, J. (2020). An empirical application of “broken windows” and related theories in healthcare. BMC Health Services Research, 20(1), 1123. https://doi.org/10.1186/s12913-020-05974-0
Li, Y., Li, R., Qiu, D., & Xiao, S. (2020). Prevalence of workplace physical violence against health care professionals: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 17(1), 299. https://doi.org/10.3390/ijerph17010299
Occupational Safety and Health Administration. (2022). Guidelines for preventing workplace violence for healthcare and social service workers. https://www.osha.gov/sites/default/files/publications/osha3148.pdf
Quality and Safety Education for Nurses. (2022). QSEN competencies. https://qsen.org/competencies/pre-licensure-ksas/
Riskonnect. (2022). What is risk management in healthcare – and why is it important? https://riskonnect.com/healthcare
Ross, B. (2020). Prescription for safety: Preventing workplace violence in health care. Risk Management Magazine. https://www.rmmagazine.com/articles/article/2020/03/02
U.S. Bureau of Labor Statistics. (2018). Workplace violence in healthcare: 2018. https://www.bls.gov/iif/oshwc/cfoi/workplace-violence-healthcare-2018.htm
Wallace, S. (2019). Violence against healthcare workers: A rising epidemic. American Journal of Managed Care (AJMC). https://www.ajmc.com/view/violence-against-healthcare-workers-a-rising-epidemic
