Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Prevalence and prevention of workplace aggression in Australian clinical medical practice

Danny J. Hills A C , Catherine M. Joyce A and John S. Humphreys B
+ Author Affiliations
- Author Affiliations

A Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne VIC 3004, Australia. Email: catherine.joyce@monash.edu

B School of Rural Health, Monash University, PO Box 666, Bendigo, VIC 3552, Australia. Email: john.humphreys@monash.edu

C Corresponding author. Email: danny.hills@monash.edu

Australian Health Review 35(3) 253-261 https://doi.org/10.1071/AH10983
Submitted: 1 December 2010  Accepted: 1 March 2011   Published: 25 August 2011

Abstract

Objective. To determine the extent of aggression directed towards Australian doctors and the implementation of aggression prevention and minimisation strategies in medical workplaces.

Methods. Data were obtained from the pilot phase (n = 321) of the Medicine in Australia: Balancing Employment and Life survey of the clinical medical workforce in 2010. Descriptive statistics were generated in relation to doctors’ experiences of aggression at work in the previous 12 months, and the implementation of workplace aggression prevention and minimisation strategies. Distributions of the outcome variables were evaluated by doctor type and sex.

Results. More than 70% of doctors experienced verbal or written aggression and almost a third experienced physical aggression. Higher proportions of hospital non-specialists and specialists-in-training experienced aggression from patients, patient relatives or carers and co-workers. Higher proportions of female doctors experienced verbal or written aggression from patient relatives or carers and co-workers. Overall, the more basic aggression prevention and minimisation strategies had been implemented in approximately two-thirds of clinical settings, with lower rates for more extended strategies.

Conclusions. Many Australian doctors experience workplace aggression. The more widespread adoption of measures that support the prevention and minimisation of aggression in medical practice settings appears necessary.

What is known about the topic? The limited research on workplace aggression in Australian medical practice primarily focusses on the prevalence of patient aggression in General Practice.

What does this paper add? Current evidence is provided on the extent of workplace aggression directed towards Australian doctors from multiple sources and the implementation of workplace aggression prevention and minimisation strategies in diverse clinical settings.

What are the implications for practitioners? More concerted efforts need to be undertaken to ensure that effective aggression prevention and minimisation strategies are implemented in medical practice.


References

[1]  Dowling J. Peril on frontline at Box Hill Hospital. Whitehorse Leader, 24 March 2010. Available at http://whitehorse-leader.whereilive.com.au/news/story/peril-on-frontline-at-box-hill-hospital/ [verified 22 July 2011].

[2]  AAP. Doctor stabbed in surgery. The Sydney Morning Herald, 1 April 2009. Available at http://www.smh.com.au/national/doctor-stabbed-in-surgery-20090401-9jgu.html [verified 22 July 2011].

[3]  Stark J, Gough D, Egan C. Stabbing a brutal end to a life of generosity. The Age, 18 June 2006. Available at http://www.theage.com.au/articles/2006/06/17/1149964788046.html [verified 22 July 2011].

[4]  Dayton L. Mayhem in the emergency ward: violence against health professionals. The Weekend Australian, 25 September 2010. Available at http://www.theaustralian.com.au/news/health-science/mayhem-in-the-emergency-ward-violence-against-health-professionals/story-e6frg8y6-1225928611989 [verified 22 July 2011].

[5]  Daily Liberal. Violence ‘risk’ blamed for closure of Gulgong hospital. Dubbo Daily Liberal, 19 August 2010. Available at http://www.dailyliberal.com.au/news/local/news/health/violence-risk-blamed-for-closure-of-gulgong-hospital/1917191.aspx [verified 22 July 2011].

[6]  Brown D. Violent abuse hits health staff. The Mercury, 18 October 2010. Available at http://www.themercury.com.au/article/2010/10/18/179851_tasmania-news.html [verified 22 July 2011].

[7]  Hoel H, Sparks K, Cooper CL. The cost of violence/stress at work and the benefits of a violence/stress-free working environment. Geneva: International Labour Organization; 2001.

[8]  Mayhew C, Chappell D. Workplace violence: an overview of patterns of risk and the emotional/stress consequences on targets. Int J Law Psychiatry 2007; 30 327–39.
Workplace violence: an overview of patterns of risk and the emotional/stress consequences on targets.Crossref | GoogleScholarGoogle Scholar |

[9]  di Martino V. Workplace violence in the health sector. Country case studies Brazil, Bulgaria, Lebanon, Portugal, South Africa, Thailand and an additional Australian study. Synthesis report. Geneva: International Labour Office, International Council of Nurses, World Health Organization and Public Services International. Joint Programme on Workplace Violence in the Health Sector; 2002.

[10]  di Martino V. Workplace violence in the health sector: relationship between work stress and workplace violence in the health sector. Geneva: International Labour Office, International Council of Nurses, World Health Organization and Public Services International. Joint Programme on Workplace Violence in the Health Sector; 2003.

[11]  Hahn S, Zeller A, Needham I, Kok G, Dassen T, Halfens RJG. Patient and visitor violence in general hospitals: a systematic review of the literature. Aggress Violent Behav 2008; 13 431–41.
Patient and visitor violence in general hospitals: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar |

[12]  Hoosen IA, Callaghan R. A survey of workplace bullying of psychiatric trainees in the West Midlands. Psychiatr Bull 2004; 28 225–7.
A survey of workplace bullying of psychiatric trainees in the West Midlands.Crossref | GoogleScholarGoogle Scholar |

[13]  Miedema B, Hamilton R, Lambert-Lanning A, Tatemichi SR, Lemire F, Manca D, et al Prevalence of abusive encounters in the workplace of family physicians: a minor, major, or severe problem? Can Fam Physician 2010; 56 e101–8.

[14]  Judy K, Veselik J. Workplace violence: a survey of paediatric residents. Occup Med 2009; 59 472–5.
Workplace violence: a survey of paediatric residents.Crossref | GoogleScholarGoogle Scholar |

[15]  Gale C, Arroll B, Coverdale J. Aggressive acts by patients against general practitioners in New Zealand: one-year prevalence. N Z Med J 2006; 119 1237

[16]  Aydin B, Kartal M, Midik O, Buyukakkus A. Violence against general practitioners in Turkey. J Interpers Violence 2009; 24 1980–95.
Violence against general practitioners in Turkey.Crossref | GoogleScholarGoogle Scholar |

[17]  Kansagra SM, Rao SR, Sullivan AF, Gordon JA, Magid DJ, Kaushal R, et al A survey of workplace violence across 65 US emergency departments. Acad Emerg Med 2008; 15 1268–74.
A survey of workplace violence across 65 US emergency departments.Crossref | GoogleScholarGoogle Scholar |

[18]  Carmi-Iluz T, Peleg R, Freud T, Shvartzman P. Verbal and physical violence towards hospital- and community-based physicians in the Negev: an observational study. BMC Health Serv Res 2005; 5 54
Verbal and physical violence towards hospital- and community-based physicians in the Negev: an observational study.Crossref | GoogleScholarGoogle Scholar |

[19]  Hughes FA, Thom K, Dixon R. Nature & prevalence of stalking among New Zealand mental health clinicians. J Psychosoc Nurs Ment Health Serv 2007; 45 33–9.

[20]  Cheema S, Ahmad K, Giri SK, Kaliaperumal VK, Naqvi SA. Bullying of junior doctors prevails in Irish health system: a bitter reality. Ir Med J 2005; 98 274–5.
| 1:STN:280:DC%2BD2MnhvFWitQ%3D%3D&md5=02e957c265f0e7fed4e0aac129ee3d8cCAS |

[21]  Paice E, Smith D. Bullying of trainee doctors is a patient safety issue. Clin Teach 2009; 6 13–7.
Bullying of trainee doctors is a patient safety issue.Crossref | GoogleScholarGoogle Scholar |

[22]  Scott J, Blanshard C, Child S. Workplace bullying of junior doctors: cross-sectional questionnaire survey. N Z Med J 2008; 121 10–4.

[23]  Wear D, Aultman JM, Borges NJ. Retheorizing sexual harassment in medical education: Women students’ perceptions at five US medical schools. Teach Learn Med 2007; 19 20–9.
Retheorizing sexual harassment in medical education: Women students’ perceptions at five US medical schools.Crossref | GoogleScholarGoogle Scholar |

[24]  Magin P, Adams J, Joy E, Ireland M, Heaney S, Darab S. Violence in general practice: perceptions of cause and implications for safety. Can Fam Physician 2008; 58 1278–84.

[25]  Tolhurst H, Baker L, Murray G, Bell P, Sutton A, Dean S. Rural general practitioner experience of work-related violence in Australia. Aust J Rural Health 2003; 11 231–6.
Rural general practitioner experience of work-related violence in Australia.Crossref | GoogleScholarGoogle Scholar |

[26]  Magin P, Adams J, Sibbritt D, Joy E, Ireland M. Experiences of occupational violence in Australian urban general practice: a cross-sectional study of GPs. Med J Aust 2005; 183 352–6.

[27]  Magin P, Adams J, Ireland M, Joy E, Heaney S, Darab S. The response of general practitioners to the threat of violence in their practices: results from a qualitative study. Fam Pract 2006; 23 273–8.
The response of general practitioners to the threat of violence in their practices: results from a qualitative study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD283otlChug%3D%3D&md5=398a7aba842e1cc29bf06742ac2b71a8CAS |

[28]  Magin P, Adams J, Joy E, Ireland M, Heaney S, Darab S. General practitioners’ assessment of risk of violence in their practice: results from a qualitative study. J Eval Clin Pract 2008; 14 385–90.
General practitioners’ assessment of risk of violence in their practice: results from a qualitative study.Crossref | GoogleScholarGoogle Scholar |

[29]  Tolhurst H, Talbot J, Bell P, Murray G, Sutton A, Dean S, et al Rural general practitioner apprehension about work related violence in Australia. Aust J Rural Health 2003; 11 237–41.
Rural general practitioner apprehension about work related violence in Australia.Crossref | GoogleScholarGoogle Scholar |

[30]  Koritsas S, Coles J, Boyle M, Stanley J. Prevalence and predictors of occupational violence and aggression towards GPs: a cross-sectional study. Br J Gen Pract 2007; 57 967–70.
Prevalence and predictors of occupational violence and aggression towards GPs: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |

[31]  Alexander C, Fraser J. Occupational violence in an Australian healthcare setting: implications for managers. J Healthc Manag 2004; 49 377–92.

[32]  Mayhew C, Chappell D. The occupational violence experiences of 400 Australian health workers: an exploratory study. J Health Safety Environ 2003; 19 3–43.

[33]  White GE. Sexual harassment during medical training: the perceptions of medical students at a university medical school in Australia. Med Educ 2000; 34 980–6.
Sexual harassment during medical training: the perceptions of medical students at a university medical school in Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7ivFOgtQ%3D%3D&md5=d03c33dbcab28ff28f245f89d4e7f180CAS |

[34]  Allnutt S, Samuels A, Taylor G. The harassment and stalking of plastic surgeons by their patients in Australasia. Aust N Z J Surg 2009; 79 533–6.
The harassment and stalking of plastic surgeons by their patients in Australasia.Crossref | GoogleScholarGoogle Scholar |

[35]  Rowe L, Morris-Donovan B, Watts I. General practice – a safe place: tips and tools. Melbourne: The Royal Australian College of General Practitioners; 2009.

[36]  Rowe L, Morris-Donovan B, Watts I. General practice – a safe place: education module. Melbourne: The Royal Australian College of General Practitioners; 2009.

[37]  WorkSafe Victoria. A handbook for workplaces: prevention and management of aggression in health services. Melbourne: Victoria State Government; 2008.

[38]  Workplace Relations and Management Branch. Zero tolerance response to violence in the NSW Health workplace. North Sydney: NSW Department of Health; 2003.

[39]  Productivity Commission. Performance benchmarking of Australian business regulation: Occupational health & safety, research report. Canberra: Commonwealth of Australia; 2010.

[40]  Mayhew C, Chappell D. Occupational violence: types, reporting patterns, and variations between health sectors. Working paper series 139. Sydney: School of Industrial Relations and Organisational Behaviour and Industrial Relations Research Centre, University of New South Wales; 2001.

[41]  Joyce C, Scott A, Jeon S-H, Humphreys J, Kalb G, Witt J, et al The ‘Medicine in Australia: Balancing Employment and Life (MABEL)’ longitudinal survey – protocol and baseline data for a prospective cohort study of Australian doctors’ workforce participation. BMC Health Serv Res 2010; 10 50
The ‘Medicine in Australia: Balancing Employment and Life (MABEL)’ longitudinal survey – protocol and baseline data for a prospective cohort study of Australian doctors’ workforce participation.Crossref | GoogleScholarGoogle Scholar |

[42]  Stata statistical software: release 11. College Station, TX, USA: StataCorp LP; 2009.

[43]  Cohen JS, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ 2005; 5 21
Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta.Crossref | GoogleScholarGoogle Scholar |

[44]  Nora LM, McLaughlin MA, Fosson SE, Stratton TD, Murphy-Spencer A, Fincher R-ME, et al Gender discrimination and sexual harassment in medical education: perspectives gained by a 14-school study. Acad Med 2002; 77 1226–34.
Gender discrimination and sexual harassment in medical education: perspectives gained by a 14-school study.Crossref | GoogleScholarGoogle Scholar |

[45]  Stratton TD, McLaughlin MA, Witte FM, Fosson SE, Nora LM. Does students’ exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection? Acad Med 2005; 80 400–8.
Does students’ exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection?Crossref | GoogleScholarGoogle Scholar |

[46]  Frank E, Carrera JS, Stratton T, Bickel J, Nora LM. Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey. BMJ 2006; 333 682–7.
Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey.Crossref | GoogleScholarGoogle Scholar |

[47]  Arnetz JE, Arnetz B. B. Vioence toward health care staff and possible effects on the quality of patient care. Soc Sci Med 2001; 52 417–27.
B. Vioence toward health care staff and possible effects on the quality of patient care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3mtFyktw%3D%3D&md5=d4b3323c360893a02adbc22d60ecd351CAS |

[48]  Forrest L, Parker R, Hegarty K, Tuschke H. Patient initiated aggression and violence in Australian general practice. Aust Fam Physician 2010; 39 323–6.

[49]  Ceramidas DM, Parker R. A response to patient-initiated aggression in general practice: Australian professional medical organisations face a challenge. Aust J Primary Health 2010; 16 252–9.

[50]  Crompton R-S, Mayman S, Sherriff B. National review into model occupational health and safety laws: first report. Canberra: Commonwealth of Australia; 2008.

[51]  Crompton R-S, Mayman S, Sherriff B. National review into model occupational health and safety laws: second report. Canberra: Commonwealth of Australia; 2009.