Threat Assessment Strategies to Mitigate Violence in Healthcare


Creating the Team

The first step in creating a TA process is developing a team.  The after action reports following many targeted violence incidents have shown that there was scattered information among many people and agencies over months and even years prior to the incident. [53]  Coordinating that information would have led to a better overall picture of the threat and may have prevented the incident from occurring.  The TA team must be multi-disciplinary to ensure communication across all relevant departments in the organization and should include, at a minimum, representatives from security, human resources, legal, risk, front line supervisors from areas with the highest risk and mental health professionals.[54]  Additional internal team members to consider include labor union representatives, if applicable, patient advocates and employee educators/trainers.[55]  The most essential external team members are local law enforcement.

The healthcare sector has a clear advantage in team development in that various mental health personnel are often employed within the healthcare organization.  Individuals who are the subject of a TA may have history with the mental health services of the organization. This relationship could give mental health professionals valuable insight into the potential threat an individual may pose and his/her previous behaviors.  Local law enforcement is also a critical component of the team.  Law enforcement will be able to bring information about an individual’s behavior in the community, previous dealings with law enforcement and outstanding legal actions, if applicable.  They may also have information about ownership or access to weapons. 

No specific guidance was found on how often the TA team should meet.  This decision should be based on the needs and size of the organization and the volume of potential threats requiring attention. Some organizations schedule TA teams to meet on a quarterly, monthly or even weekly basis while others convene only when a potential threat is identified.


Probably the most crucial step in TA is identifying that a potential threat exists. Proactive identification of threats provides the organization the opportunity to intervene before there is a crisis.  To ensure that reporting happens, organizations must have a clear process for how to report behaviors of concern and what types of behavior should be reported.  Employees cannot be afraid to make a report.  Managers must not feel threatened that their effectiveness may be questioned.  Those who are victims of stalking, harassment or intimate partner violence cannot fear co-worker retaliation or potential job loss.[56]


Most importantly, organizations must create a culture of reporting in order to best detect threats.  Employees must not be afraid to report threatening behavior and know where and what to report.  To achieve a culture of reporting, The Joint Commission recommends:

  • Leadership must commit to and visibly support an environment with a goal of zero harm from violence to patients and staff
  • Emphasize the importance of reporting all events involving physical and verbal aggression, no matter how small they may seem
  • Encourage conversations about workplace violence during daily unit huddles, including team leaders asking if any team members have been victims of physical or verbal abuse or if any patients or family situations may pose a heightened risk for violence
  • Provide a protocol for how to report threats and concerning behavior and to whom
  • Create simple, trusted and secure reporting systems[57]

Employees may be reluctant, unwilling, or unsure about reporting potential violence, threats or abnormal behavior.  Anonymous surveys or an anonymous reporting tool should also be provided to give employees a means to identify situations that they are uncomfortable reporting directly to management.[58]

Investigation & Assessment

When a threat has been made, identified or reported, the TA team must determine whether an actual threat is posed.  J. Reid Meloy et. al. state that “in the workplace context, communicated threats per se, although they should always be taken seriously, are not very accurate predictors of violent outcomes. Threats may indicate actual intent—a crucial risk factor—but statistically they more commonly have other purposes or meanings; for example, to ventilate frustration (“I could just kill my boss!”), to manipulate others (“You’ll be sorry if I’m ever demoted”), or to get attention (“I would never do it, but I can understand a guy coming in and shooting up his workplace”).”[59]


[53] Rick Shaw, Workplace Violence Threat Assessment Teams & Dangerous Disconnects, (, 2016)

[54] Matthew Doherty, From protective intelligence to threat assessment: Strategies critical to preventing targeted violence and the active shooter, (Journal of Business Continuity and Emergency Planning, 2016), 14-15.

[55] Ron Wyatt et. al., Workplace Violence in Health Care, 1038.

[56] James Kenny, Risk Assessment and Management Teams: A Comprehensive Approach to Early Intervention in Workplace Violence, (Journal of Applied Security Research, 2010), 163.

[57] The Joint Commission, Sentinel Event Alert:59.

[58] Kenny, Risk Assessment and Management Teams, 163.

[59] J. Reid Meloy et. al, Workplace Assessment of Targeted Violence Risk: The Development and Reliability of the WAVR-21*, (Journal of Forensic Science, 2013): 1354.