Workplace aggression prevention and minimisation in Australian clinical medical practice settings – a national study
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, 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 37(5) 607-613 https://doi.org/10.1071/AH13149
Submitted: 15 January 2013 Accepted: 2 August 2013 Published: 11 October 2013
Abstract
Introduction This report describes the extent to which 12 workplace aggression prevention and minimisation actions have been implemented in Australian clinical medical practice settings.
Methods Using a cross-sectional, self-report survey conducted as part of a national longitudinal study of the Australian medical workforce, differences in the proportions of medical clinicians reporting the implementation of 12 aggression prevention and minimisation actions in their main workplace were determined.
Results Only one-third of aggression prevention and minimisation actions achieved point-prevalence rates of greater than 60%, including aggression policies and protocols (65.7%) and incident reporting systems (68.2%). Overall, lower point-prevalence rates were detected for general practitioners and specialists compared with hospital non-specialists and specialists in training, largely reflecting those for doctors mainly working in private rooms compared with public hospitals. Key environmental interventions had relatively low point-prevalence overall, including duress alarms and optimised clinician escape in consulting and treatment areas, and after-hours and off-site safety strategies.
Conclusions More widespread adoption of aggression prevention and minimisation measures in medical practice settings is required. Specific legislative and accreditation provisions and funding support may provide the necessary impetus for reform. Further studies can enhance the evidence base on the most effective approaches to the prevention and minimisation of workplace aggression in medical practice settings.
What is known about the topic? With the exception of a small number of qualitative studies in general practice, there is a lack of research reporting on the implementation of workplace aggression prevention and minimisation interventions across clinical medical practice settings in Australia.
What does this paper add? Baseline evidence is provided on the point-prevalence of 12 workplace aggression prevention and minimisation interventions in diverse medical practice settings in Australia, which suggests that key approaches recommended by leading international organisations and researchers are not widely implemented in many clinical medical workplaces.
What are the implications for practitioners? More concerted efforts need to be undertaken to achieve the widespread implementation of aggression prevention and minimisation interventions in clinical medical practice settings.
References
[1] 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.[2] Packham C. Violence at work: findings from the 2009/10 British crime survey. London: Health Service Executive; 2011.
[3] Estrada F, Nilsson A, Jerre K, Wikman S. Violence at work – the emergence of a social problem. J Scand Stud Criminol Crime Prev 2010; 11 46–65.
| Violence at work – the emergence of a social problem.Crossref | GoogleScholarGoogle Scholar |
[4] Hills D, Joyce C, Humphreys J. A national study of workplace aggression in Australian clinical medical practice. Med J Aust 2012; 197 336–40.
| A national study of workplace aggression in Australian clinical medical practice.Crossref | GoogleScholarGoogle Scholar | 22994831PubMed |
[5] Gerberich SG, Church TR, McGovern PM, Hansen HD, Nachreiner NM, Geisser MS, et al An epidemiological study of the magnitude and consequences of work related violence: the Minnesota nurses’ study. Occup Environ Med 2004; 61 495–503.
| An epidemiological study of the magnitude and consequences of work related violence: the Minnesota nurses’ study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2c3ltF2msA%3D%3D&md5=8bb8463203f19caa099208c50a982537CAS | 15150388PubMed |
[6] Nachreiner NM, Gerberich SG, Ryan AD, McGovern PM. Minnesota nurses’ study: Perceptions of violence and the work environment. Ind Health 2007; 45 672–8.
| Minnesota nurses’ study: Perceptions of violence and the work environment.Crossref | GoogleScholarGoogle Scholar | 18057810PubMed |
[7] 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 |
[8] Arnetz JE, Arnetz BB. Violence toward health care staff and possible effects on the quality of patient care. Soc Sci Med 2001; 52 417–27.
| Violence toward health care staff and possible effects on the quality of patient care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3mtFyktw%3D%3D&md5=28f1f4da24696b3cc9dbceb06ebaf32cCAS | 11330776PubMed |
[9] Mayhew C. Occupational violence/bullying in the health industry. In McCarthy P, Mayhew C, editors. Safeguarding the organization against violence and bullying: an international perspective. Houndmills, UK: Oalgrave Macmillan; 2004. p. 110–28.
[10] Joint Programme on Workplace Violence in the Health Sector. Framework guidelines for addressing workplace violence in the health sector. Geneva: International Labour Office; 2002.
[11] Occupational Safety and Health Administration. Guidelines for preventing workplace violence for health care & social service workers. Washington: US Department of Labor; 2004.
[12] Chappell D, di Martino V. Violence at work. 3rd edn. Geneva: International Labour Office; 2006.
[13] Rowe L, Morris-Donovan B, Watts I. General practice – a safe place: tips and tools. Melbourne: The Royal Australian College of General Practitioners; 2009.
[14] Cohen LE, Felson M. Social change and crime rate trends: a routine activity approach. Am Sociol Rev 1979; 44 588–608.
| Social change and crime rate trends: a routine activity approach.Crossref | GoogleScholarGoogle Scholar |
[15] Felson M. Crime and everyday life. 3rd edn. Thousand Oaks, USA: Sage Publications; 2002.
[16] Groff ER. Simulation for theory testing and experimentation: an example using routine activity theory and street robbery. J Quant Criminol 2007; 23 75–103.
| Simulation for theory testing and experimentation: an example using routine activity theory and street robbery.Crossref | GoogleScholarGoogle Scholar |
[17] Loomis D, Marshall SW, Wolf SH, Runyan CW, Butts JD. Effectiveness of safety measures recommended for prevention of workplace homicide. JAMA 2002; 287 1011–7.
| Effectiveness of safety measures recommended for prevention of workplace homicide.Crossref | GoogleScholarGoogle Scholar | 11866649PubMed |
[18] Cozens PM, Saville G, Hillier D. Crime prevention through environmental design (CPTED): a review and modern bibliography. Property Management 2005; 23 328–56.
| Crime prevention through environmental design (CPTED): a review and modern bibliography.Crossref | GoogleScholarGoogle Scholar |
[19] 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 | 18373581PubMed |
[20] 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.
[21] 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=940ff6903d86471b4531e73a2fdaefbcCAS | 16461449PubMed |
[22] Forrest LE, Herath PM, McRae IS, Parker RM. A national survey of general practitioners’ experiences of patient-initiated aggression in Australia. Med J Aust 2011; 194 605–8.
| 21644878PubMed |
[23] Parker RM, Ceramidas DM, Forrest LE, Herath PM, McRae I. Patient initiated aggression and violence in the Australian general practice setting. Canberra: The Australian Primary Health Care Institute; 2010.
[24] 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.
| A response to patient-initiated aggression in general practice: Australian professional medical organisations face a challenge.Crossref | GoogleScholarGoogle Scholar |
[25] Australasian Medical Publishing Company (AMPCo). Australasian Medical Publishing Company. Sydney: AMPCo; 2011. Available at http://www.ampco.com.au/
[26] 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 | 20181288PubMed |
[27] Hills DJ, Joyce CM, Humphreys JS. Prevalence and prevention of workplace aggression in Australian clinical medical practice. Aust Health Rev 2011; 35 253–61.
| Prevalence and prevention of workplace aggression in Australian clinical medical practice.Crossref | GoogleScholarGoogle Scholar | 21871183PubMed |
[28] Cuzick J. A Wilcoxon-type test for trend. Stat Med 1985; 4 87–90.
| A Wilcoxon-type test for trend.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL2M7pt1Sntw%3D%3D&md5=1556d501982b9d7fd2b836130e7b58f4CAS | 3992076PubMed |
[29] Nachreiner NM, Gerberich SG, McGovern PM, Church TR, Hansen HE, Geisser MS, et al Relation between policies and work related assault: Minnesota nurses’ study. Occup Environ Med 2005; 62 675–81.
| Relation between policies and work related assault: Minnesota nurses’ study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2MvpvVehsg%3D%3D&md5=3b970547ccf6f0a901e73495a4271dbcCAS | 16169912PubMed |
[30] Feda D, Gerberich S, Ryan A, Nachreiner N, McGovern P. Written violence policies and risk of physical assault against Minnesota educators. J Public Health Policy 2010; 31 461–77.
| Written violence policies and risk of physical assault against Minnesota educators.Crossref | GoogleScholarGoogle Scholar | 21119652PubMed |
[31] Hills D. Relationships between aggression management training, perceived self-efficacy and rural general hospital nurses’ experiences of patient aggression. Contemp Nurse 2008; 31 20–31.
| Relationships between aggression management training, perceived self-efficacy and rural general hospital nurses’ experiences of patient aggression.Crossref | GoogleScholarGoogle Scholar | 19117498PubMed |
[32] Bowers L, Nijman H, Allan T, Simpson A, Warren J, Turner LR. Prevention and management of aggression training and violent incidents on UK acute psychiatric wards. Psychiatr Serv 2006; 57 1022–6.
| Prevention and management of aggression training and violent incidents on UK acute psychiatric wards.Crossref | GoogleScholarGoogle Scholar | 16816288PubMed |
[33] Hodgson MJ, Reed R, Craig T, Murphy F, Lehmann L, Belton L, et al Violence in healthcare facilities: lessons from the veterans health administration. J Occup Environ Med 2004; 46 1158–65.
| Violence in healthcare facilities: lessons from the veterans health administration.Crossref | GoogleScholarGoogle Scholar | 15534503PubMed |
[34] Kansagra SM, Rao SR, Sullivan AF, Gordon JA, Magid DJ, Kaushal R, et al A survey of workplace violence across 65 U.S. emergency departments. Acad Emerg Med 2008; 15 1268–74.
| A survey of workplace violence across 65 U.S. emergency departments.Crossref | GoogleScholarGoogle Scholar | 18976337PubMed |
[35] Health Policy and Economic Research Unit. Violence in the workplace: the experience of doctors in Great Britain. London: British Medical Association; 2008.
[36] 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 | 19150889PubMed |
[37] 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 | 14641220PubMed |
[38] Catanesi R, Carabellese F, Candelli C, Valerio A, Martinelli D. Violent patients: what Italian psychiatrists feel and how this could change their patient care. Int J Offender Ther Comp Criminol 2010; 54 441–7.
| Violent patients: what Italian psychiatrists feel and how this could change their patient care.Crossref | GoogleScholarGoogle Scholar | 19420286PubMed |
[39] Stanko EA. Knowledge about the impact of violence at work in the health sector. In Cooper CL, Swanson N, editors. Workplace violence in the health sector: state of the art. Geneva: World Health Organization; 2002. pp. 49–60.
[40] Langley GJ, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. The improvement guide: a practical approach to enhancing organizational performance. 2nd edn. San Francisco: Jossey-Bass; 2009.
[41] Goldmann D. Ten tips for incorporating scientific quality improvement into everyday work. BMJ Qual Saf 2011; 20 i69–72.
| Ten tips for incorporating scientific quality improvement into everyday work.Crossref | GoogleScholarGoogle Scholar | 21450777PubMed |
[42] Harvey G, Wensing M. Methods for evaluation of small scale quality improvement projects. Qual Saf Health Care 2003; 12 210–4.
| Methods for evaluation of small scale quality improvement projects.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3s3ms1Wgsg%3D%3D&md5=cde1821020fb1aef4b820474befb6737CAS | 12792012PubMed |
[43] Productivity Commission. Performance benchmarking of Australian business regulation: occupational health & safety, research report. Canberra: Commonwealth of Australia; 2010.
[44] Johnstone R, Quinlan M, McNamara M. OHS inspectors and psychosocial risk factors: evidence from Australia. Saf Sci 2011; 49 547–57.
| OHS inspectors and psychosocial risk factors: evidence from Australia.Crossref | GoogleScholarGoogle Scholar |
