The Value of Reducing Incidents of Workplace Violence

Financial costs to the healthcare industry can add up fast as a result of unmitigated workplace violence. A Bureau of Labor Statistics report noted, “Over half of the approximately 2.9 million private industry injury and illness cases reported in 2015 involved days away from work, job transfer, or restriction (DART). These cases occurred at a rate of 1.6 cases per 100 full-time workers (BLS, USDL-16-2056).” One hospital system had a total annual cost of more than $94,000 for treatment and lost wages for employees who were victims of workplace violence. While that number may seem negligible to large systems, the costs may be direct, with self-insured hospitals, or indirect, causing increases in insurance premiums.25

The costs associated with workplace violence are varied in nature. In addition to medical expenses, lost wages, legal fees, insurance administrative costs, lost fringe benefits, and household production costs, workplace violence can also lead to increased turnover and attrition of valuable workforce employees. AHA (2017) reported the cost of replacing a nurse to be between $37,700 and $58,400. Emotional and psychological impacts, such as an increased prevalence of post-traumatic stress disorder (PTSD), has been noted among clinical workers assigned to emergency departments, with incidences of symptoms reported at rates between 12 percent and 20 percent, as compared to rate in the general adult population of 3.5 percent. Diminished ability to focus, lack of attention to detail, and difficulty managing the demands of the job were just some of issues experienced by nurses suffering from PTSD as a result of workplace violence. The treatment and care required for affected staff to return to optimal performance can take time, and all of this can bear heavily on work performance and availability of valuable staff.26

In July 2017, the AHA estimated that U.S. hospitals spent $233 million a year on emergency preparedness training, with approximately $174.6 million of that amount being focused on violence-related issues. In addition, the cost for hospitals to provide uncompensated or insufficiently compensated care and treatment to victims of violence totaled $852.2 million in 2016.27 Fines assessed as a result of OSHA findings that employers did not provide adequate levels of protection for staff have totaled as much as $100,000, while state fines can be as much a $5,000 for each incident.

Impact on Branding and Reputation

Workplace violence in a healthcare setting can have consequences beyond the victims. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a survey used to assess patients’ satisfaction based upon the perception of quality of care received from healthcare facilities. Since consumers are generally afforded the luxury of choice as to where they seek healthcare, hospitals must compete for their business. Low HCAHPS scores reported by patients, particularly in the area of disruptive behaviors and a hospital’s failure to adequately address such concerns, may cause damage to a healthcare system’s finances and reputation.28

The intangible costs of negative branding can greatly reduce a healthcare system’s public trust. Consider the effects of press coverage for events such as an infant abduction or an Ebola breakout. While the initial effects may be contained in a relatively brief period of weeks or months, the lasting effects can damage a hospital’s reputation for years. Similarly, a hospital’s failure to address known or recognizable risks of violence from patients can negatively affect the perception of patients who witness violence.

Workplace violence in healthcare is a complex and continuing issue with many approaches attempting to resolve the problem. Healthcare workers continually find themselves vulnerable to the hazards of disruptive behaviors and assaults, suffered at the hands of the patients they serve. OSHA regulations, Joint Commission standards, and various state laws have emphasized that the onus is on healthcare leaders to provide for a safe environment for workers. Data from the U.S. Bureau of Labor Statistics reflects increased DART scores and incidents of workplace violence against healthcare workers far exceeds the rate in other private industries, creating high financial and reputational costs. It is vital that healthcare leaders invest the time and resources to educate staff regarding early warning signs, predictive tools, and appropriate responses to alleviate the effects of violence when it occurs. While the value of at-risk patient screening may be considerable, the costs of doing nothing are immeasurable.