In the healthcare risk management realm, the focus is patient safety, but of mounting concern is the threat to clinician and staff workplace safety. They are interrelated. Workplace violence leads to job stress, which in turn may affect patient safety and quality of care.

Gone are the days when violence in the healthcare setting seemed a rarity. I recall an incident of workplace violence that my father, a physician, shared with me from over 40 years ago. A physician at the local hospital had shot and killed a colleague in the doctor’s lounge. My father was in the next room. He heard shots fired and headed to the room where the gunman handed over the weapon. Needless to say my father was shocked and thought, “I never thought something like this would happen in the hospital where I work!” That was long ago, and nowadays we can’t turn a blind eye, but must acknowledge that violence directed against healthcare workers is very real. The reality is evident when headlines bring attention to violent, sometimes fatal, tragedies in the healthcare setting: 

  • November 2018: Mercy Hospital & Medical Center/Chicago—gunman kills a Chicago police officer, a physician and a first-year pharmacy resident.
  • November 2017: Affinity Medical Center/Ohio—cardiologist in Ohio was shot and killed in the hospital parking lot.
  • July 2017: Bronx-Lebanon Hospital Center—employee kills a doctor and wounds six other people before taking his own life.
  • May 2017: Northwestern Medicine Delnor Hospital/Geneva—hospitalized jail inmate assaults nurse and then was fatally shot by police

Statistics of workplace violence also provide a dose of reality: 

  • Bureau of Labor Statistics data from 2014: Over half of workplace violence incidents reported were healthcare-related.
  • The Occupational Health & Safety Administration’s (OSHA) data:
    • From 2002–2013, violence was four times more common in a healthcare setting than in private industry.
    • Of the approximately 25,000 workplace assaults reported annually; 75% occur in the healthcare industry.
    • 80% of all violence against healthcare workers is perpetrated by their patients.
  • The Bureau of Labor Statistics data: In 2013, 27% of fatalities in healthcare and social service settings that occurred were due to assaults and violent acts.
  • Emergency Nurses Association (ENA) Emergency department violence study: 25% of psychiatric nurses experience disabling injuries from patient attacks.
What is workplace violence?

The Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) define workplace violence as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.² Day-to-day incidents of violence, such as verbal abuse or bullying, seldom capture public attention. They often do not even attract the attention of workplace supervisors, because many of these incidents go unreported. Imagine the statistics if all such incidents were reported.3

Why the lack of reporting?
  • Research cites some of the following reasons given by healthcare workers:
  • Culturally normative: Many consider violence “part of the job” or “unavoidable.” Their mindset is: “This happens all the time, so it must be normal.”
  • Justification: “He was just disoriented” or “It was not intentional, the old woman was just having a bad day.”
  • Lack of training on reporting mechanisms.
  • Complaints of reporting procedures: time-consuming, not user friendly.
  • Lack of support by supervisors or coworkers.
  • Fear of retaliation or blame.
What to do to manage it?

I. JCAHO has suggested seven actions to manage the problem.

In summary:

  1. Define workplace violence and create reporting systems
  2. Track and trend all reports of violence
  3. Counsel victims and others
  4. Review each case and analyze data
  5. Develop QI initiatives to reduce incidents
  6. Train all staff in de-escalation, etc…
  7. Evaluate workplace violence reduction initiatives.⁴

II. Gallagher Resource: A Cost-Effective Plan for Managing Violence in the Healthcare Setting by John K. Walpole. This whitepaper discusses quality workplace violence programs, including those which address “active shooter” planning. It discusses how programs can be affordable and provides additional resources.⁵

How do some organizations deal with the issue and with what degree of success?

A number of federal and state agencies provide easy access to information and tools to assist in minimizing workplace violence. OSHA’s Guidelines for Preventing Workplace Violence for Healthcare And Social Service Workers lists steps to assess, monitor and analyze violent events and to evaluate the effectiveness of your workplace violence program. It also includes engineering and administrative controls to help reduce the risk. See pps. 15–18.⁶

Success Stories:

The Joint Commission website reports some concrete examples of healthcare facilities who have implemented safe workplace programs with much success:

Violence program in Portland VA Medical Center. It identified patients with a violent history. This program reduced number of incidents by over 90% by alerting staff to take additional safety measures when caring for these patients.

Aria-Jefferson Health implemented Operation Safe Workplace, a multidisciplinary approach to hospital violence. They reported a reduction of violent incidents by about 55% over a three-year period after implementation of their program.⁷

Workplace violence can be mitigated in your organization if you become aware and prepare. Coverage options, such as Violent Malicious Acts (VMA), are available so let us know if you are interested.


  1. ECRI Institute. Violence in healthcare facilities. Healthcare Risk Control. 2017 May 24.

  2. “Workplace Violence,”

  3. National Institute for Occupational Safety and Health (NIOSH). Violence in the workplace. DHHS (NIOSH) Publication Number 96-100, Current Intelligence Bulleting 57. Atlanta, GA: DOL, July 1996.

  4. Sentinel Event Alert publication of The Joint Commission, Issue 59, April 17,

  5. Gallagher’s A Cost-Effective Plan for Managing Violence in the Healthcare Setting by John K. Walpole, Area Senior Vice President, Gallagher A Cost-Effective Plan for Managing Violence in the Healthcare Setting 

  6. OSHA. Guidelines for Preventing Workplace violence for Healthcare and Social Service Workers

  7. Beard D and Conley M. Operation Safe Workplace: A multidisciplinary approach to workplace violence. Philadelphia: Aria-Jefferson Health,

  8. AHA, Cost of Community Violence to Hospitals and Health Systems, Data and Insights,

  9. OH&S Occupational Health & Safety. OSHA Cites Health Facility for Exposing Employees to Workplace Violence. May 3, 2018.



The information contained in this newsletter was obtained from sources which to the best of the writer’s knowledge are authentic and reliable. Arthur J. Gallagher & Co. makes no guarantee of results and assumes no liability in connection with either the information herein contained or the safety suggestions herein made. Moreover, it cannot be assumed that every acceptable safety procedure is contained herein, or that abnormal or unusual circumstances do not warrant or require further or additional procedures.

Additionally, this publication is not intended to offer legal advice. Any descriptions of coverage provided herein are not intended as an interpretation of coverage. Policy descriptions do not include all the policy terms and conditions contained in an actual policy, and should not be relied on for coverage interpretations. An actual insurance policy must always be consulted for full coverage details. For more information about your policy and coverages, please consult your Gallagher advisor.