Workplace Violence in the Public Health Sector In Australia

Rationale / Objectives

Occupational violence is an increasing concern in developed countries, and this concern extends to workers in the healthcare sector. Events that may be considered to be occupational violence include homicide, assaults, threats, verbal abuse, stalking, bullying among workers or between managers and workers, and behaviors that create an environment of fear. The objective of the research was to explore the pattern of violence and establish a baseline which could be used to inform prevention measures.

Project/Program Description & Major Achievements

For this exploratory study, face to face interviews were conducted among 400 public health professions working in a variety of areas from October 2001 to March 2002. The participants were asked about violent incidents that they had experienced over the most recent 12-month period. Both quantitative and qualitative data were collected. Participants also completed a General Health Questionnaire (GHQ-12) to determine their levels of distress. The study helped identify several high risk scenarios for health workers. About 67% of the 400 participants reported verbal abuse events. 10.5% of them were bullied, and 12% were assaulted. On average, each health worker personally experienced around 1.5 events that involved some level of violence over the 12-month period. Over 3/4 of all reported events were perpetrated by clients.

Lessons Learned

Having the same person conduct all the interviews ensured that the interpersonal manner was consistent for all participants. Severe violent events were not discussed due to the small sample size of the study, and therefore risk factors were not identified. Verbal abuse was a common occurrence. Assaults were most often carried out by patients with dementia, patients with a mental health condition, or those under the influence of drugs or alcohol. Based on the GHQ-12, a statistically significant relationship was found between exposure to violence at work and healthcare workers' stress levels, as well as between bullying at work and healthcare workers' stress levels. Where violence was normalized (due to frequency of occurrence), there was severe under-reporting of assaults. Most perpetrators suffered no negative consequences as a result of their violent acts. CEO commitment was seen as the first step towards a Zero Tolerance of Violence policy.

Further Description

Occupational violence can be categorized into three groups:

  • “External” violence which occurs between workers with people outside of the organization
  • “Client-initiated” violence which occurs between workers with customers or clients
  • “Internal” violence which occurs between workers within an organization

The research conducted by Mayhew and Chappell in cooperation with the ILO/ICN/WHO/PSI Joint Programme on Workplace Violence in the Health Sector (2003) was aimed at investigating the experience of occupational violence occurring among public health workers in Australia. The research helped to identify high-risk scenarios taking place with health workers and characteristics of the perpetrators. With this information, preventive strategies could be developed effectively. The research was conducted among 400 public health workers working in allied health, ambulance, ancillary, medical office, and nursing. They were interviewed face-to-face over the period from the 25th of October 2001 to the 3rd of March 2002. High-risk scenarios for health workers were listed as below:

  • The range of uncontrolled environments where operational ambulance officers work
  • Emergency departments, drug and alcohol clinics and mental health units
  • Maternity/delivery wards, ICU, CCU and other sites where high-stress events frequently occur
  • Child/pediatric wards
  • Some rural health care settings
  • Remote rural sites at night (when few staff members are usually scheduled)
  • Emergency and outpatient facilities with long waiting times, particularly where explanations were perceived as inadequate

Preventive intervention strategies for public health workers were to reduce the high-risk scenarios by increasing worker awareness of their working conditions and patients’ health status. 1

Major Achievements

Metric Result Additional Detail
Total number of violent events during 12-month period 583

includes verbal abuse, threats, assaults, bullying and other forms of violence 1

Number of cases of verbal abuse 447 Reported perpetrators: patients and/or their visitors 1
Number of threats 131 1
Number of assaults 80 Reported perpetrators: patients with dementia, affected by drugs or alcohol, or with a mental health condition 1
Number of cases of bullying 42 1