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Violence In Healthcare Facilities: Lessons From the Veterans Health Administration

Originally Published:
Key Point Summary

The authors examined assault frequency and risk factors in healthcare.


The authors conducted a cross-sectional questionnaire survey in 142 hospitals. Questions from the National Crime Victimization Survey addressed the perception of safety and the physical infrastructure characteristics for violence prevention (guards, keycards, controlled entrance) in the facility. The violence survey was part of a broader national organizational development survey, namely Organizational Assessment Survey (OAS), developed by the Office of Personnel Management. All full-time and part-time Veterans Health Administration employees were eligible to participate in the survey.

Design Implications
Although work in healthcare is associated with high rates of assaults, closer scrutiny suggests specific possible intervention strategies, including understanding the drivers of patient-associated violence and providing educational tools (e.g., alternative dispute resolution strategies), which were found to be effective.

Between October and November 2002, around 74,662 responses were received, for a response rate of 36.5%. Over 70% administrative and 33% each of clinical/professional, clerical, technical and wage-grade staff responded to the survey. Some 13% percent of employees described at least one assault in the last year; the proportion assaulted per facility ranged from 1% to 26%. Patients were the most common assaulters. Working in geriatrics, mental health, and rehabilitation or in nursing represented a high risk for assault. Hours of work and work patterns represented major risk factors for assault, as did higher measures of organizational stress. The penetration of training in alternate dispute resolution strategies was associated with lower rates of assaults.


Some of the limitations of this study were:

  • The study data was collected using a survey, which has a potential of participant bias. The results of the study are only as accurate as the survey contents.
  • The study findings must be generalized with caution, as the study setting might have some unique characteristics that might not be found in other settings.
Outcome Category
Patient / resident health outcomes|Patient / resident satisfaction and comfort|Staff health outcomes
Primary Author
Hodgson, M.J.