Some may tend to think of violence as a random event that may not be preventable — and, indeed, it often manifests that way. However, as hospital violence has become a national issue and the subject of a possible federal regulation, researchers are showing that interventions using the basic epidemiologic principles of measurement and feedback can reduce unit-level violence by patients against healthcare workers.

To evaluate the effects of a randomized, controlled intervention on the incidence of patient-to-worker (Type II) violence and related injury in hospitals, researchers looked at 41 randomized units in seven hospitals. Of those, 21 received unit-level violence data to develop prevention strategies. As controls, 20 similar units received no feedback data.

“Six months post-intervention, incident rate ratios of violent events were significantly lower on intervention units compared with controls,” the researchers reported.1 “At 24 months, the risk for violence-related injury was lower on intervention units, compared with controls. This data-driven, work site-based intervention was effective in decreasing risks of patient-to-worker violence and related injury.”

The intervention consisted of a 45-minute discussion with unit supervisors in which unit-specific data regarding violent incidents in their workplace were shared along with an array of improvement strategies. Unit supervisors then were directed to work with their teams to develop action plans to address violence, although they were free to adopt whatever solutions they deemed best.

“We had documented incidents, which gave us the ability to link up with the human resources database so we could get data on paid productive hours,” says lead author Judith Arnetz, PhD, MPH, PT, a professor and associate chair for research in the department of family medicine at Michigan State University in East Lansing. “In other words, rather than counting numbers of incidents, we were calculating rates. We were applying epidemiological principles to the study of workplace violence.”

Specifically, the intervention consisted of a work site visit by one or two members of the research team and a stakeholder representative from the hospital system.

“The project was carried out in very close collaboration with security, human resources, nursing, quality and safety, and occupational health services, so we always had one stakeholder with us on the worksite visit,” she says. “We met with a unit supervisor, and that person could bring one or two people with him or her.”

When designing the intervention, Arnetz explains that it was a priority to make sure that unit operations were not disrupted to a large extent.

“We presented data directly from the database that would give the unit its rates of violence for the previous three-year period, and the rates were compared to rates for the entire hospital system,” she says. “Then, we broke down the data into details about where the incidents occurred, who was involved — the bare facts.”

At the conclusion of the visit, the researchers provided the unit supervisor with a checklist of possible intervention strategies that originally was developed by OSHA and adapted for the healthcare workplace by the study team.

“The unit supervisor and his or her team could look at environmental strategies, administrative strategies, or behavioral strategies,” Arnetz says. “They were then supposed to come up with an action plan as to what, exactly, they were going to do.”

The basic idea behind the intervention was that unit leaders would glean specific data from their own work setting that they could use to customize appropriate strategies for curbing or preventing workplace violence events. “They were not given any direction by the research team,” Arnetz adds. “They were given the flexibility to come up with what they thought would work best and be most effective.”


  1.  Arnetz J, Hamblin L, Russell J, et al. Preventing patient-to-worker violence in hospitals: Outcome of a randomized controlled intervention. J Occup Environ Med 2017;59:18-27.