The Joint Commission (TJC) has issued new hospital violence prevention requirements that call for an annual workplace risk assessment, formation of a safety committee, an incident reporting system, and staff education. The requirements will take effect in January 2022.

TJC has posted a compendium document of resources to help enact these new requirements, which were added as elements of performance under existing standards.1

“The Joint Commission is one of several organizations and associations who have made a commitment to safety in the workplace,” says Antigone Kokalias, MBA, MSN, RN, TJC project director. “[We have] taken the position of formally defining workplace violence to lend guidance to hospitals in increasing the awareness and the understanding of what workplace violence is. The new and revised workplace violence prevention requirements provide guidance for developing, implementing, and sustaining effective workplace violence prevention systems that not only decrease workplace violence, but also promote a culture of safety.”

Hospital Employee Health spoke to Kokalias about the new requirements in the following interview, which has been lightly edited for length and clarity.

HEH: Healthcare workers put their lives on the line during the pandemic, which also has spurred calls for changes in healthcare. Is this an opportunity to end the perception of violence as a part of the job?

Kokalias: I do not believe many could argue the commitment healthcare workers have to the care they give. This was [certainly] emphasized during the pandemic. With the challenges that the COVID-19 pandemic has brought to the field of healthcare, I believe that change is inevitable. What we want and hope to see is that the change is meaningful and sustainable. What better place to begin than by assessing your organization’s commitment to staff safety?

The pandemic does present an opportunity to place a spotlight on violence in the workplace. What is important to remember is that we have an obligation to make this opportunity count. There are a few things we can do, new approaches we can take. A critical first step would be to concentrate efforts on understanding what workplace violence is and increasing awareness. This will help set a solid foundation for other important elements, one being staying informed of both the prevalence of workplace violence as well as the organizations’ progress on their journey to a safe environment. Another important element is the utilization of tools and resources available to assist organizations in a workplace violence prevention program.

HEH: What are some of the first things accreditation surveyors might ask when assessing a facility’s violence prevention program? For example, should a hospital show documentation of its annual worksite analysis “to identify and resolve workplace violence, safety, and security risks”?

Kokalias: It is important to acknowledge organizations are faced with different challenges. We hope to provide organizations with the flexibility to develop a program that reflects [their] needs. The new requirements will [necessitate] accompanying documentation for the accreditation survey. An example of this would be the annual worksite analysis. Documentation will assist in supporting the conversation on how the organization has utilized the results of their annual worksite analysis to identify and resolve any actual or potential incidents or security risks. Understanding the process from identification of incidents to mitigation, and through the follow-up is important, especially when evaluating the effectiveness of the program. In addition, a proactive worksite analysis can help ensure the organization is examining the entire process and not just individual incidents.

HEH: The elements of performance include “verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors.” Why did TJC define violence so broadly?

Kokalias: Many organizations have identified workplace violence, but one nationally recognized definition does not exist. We hope to see this as a step forward in that direction. A great deal of thought went into developing both the definition and the requirements. We conducted a literature review, consulted with key stakeholders and experts in workplace violence prevention, and examined legislation across the country to understand the challenges organizations are facing and identify best practices. The definition is not intended to be all-encompassing. Defining workplace violence is a starting point for understanding the breadth of incidents that organizations should consider when developing a workplace violence prevention program.

Another critical element in workplace violence prevention programs is training and education. Both are important in creating awareness, and in establishing, implementing, and evaluating processes, which include reporting. The program is expected to be led by a designated individual and developed by a multidisciplinary team who are responsible to report incidents to the governing body.

HEH: A recurrent problem is these incidents go unreported by healthcare workers. How can these requirements change that through education and requiring that “the hospital monitors, reports, and investigates safety and security incidents, including those related to workplace violence”?

Kokalias: There could be many reasons why incidents go unreported. We first have to go back to what I originally talked about, which is identifying what workplace violence is and the importance of increasing awareness. There may be instances when individuals may not realize the situation they are in, or the incidents that have occurred could be workplace violence-related, which would be missed opportunities for reporting. Easy and accessible reporting systems can have an impact on the number of incidents that are reported. If the reporting system is complicated, the individuals affected may determine that the effort involved in submitting a report is too cumbersome. Employees also might struggle with whether they should report an incident, weigh the chances that actions will be taken to mitigate or resolve the situation as well as concerns of possible retaliation. This all falls under the umbrella of an organization’s safety culture and their commitment to zero harm.

Editor’s Note: TJC welcomes comments and feedback sent to: on the compendium referenced below. More violence prevention resources are available on the TJC website.


  1. The Joint Commission. Workplace violence prevention compendium of resources.