Monitoring violence in healthcare. A lesson from the pandemic

Abstract Introduction Violence against healthcare workers is a serious, underreported, and underestimated problem. Only a few healthcare companies have efficient violence monitoring systems and risk assessment is often entrusted to non-validated algorithms. The monitoring system implemented in 2005 in a public health company allowed for an accurate analysis of the phenomenon. Methods For the entire observation period (2005-2023), the one-year prevalence of violent incidents (physical assaults, threats, and harassment) has been reported by all during the periodic medical examination in the workplace. Furthermore, after each periodical inspection of workplaces, the occupational doctor requested a detailed description of violent events that occurred in the department, using the Violent Incident Form distributed online anonymously. Results In 2005/6 the one-year prevalence of physical assaults was 8.2%. Prevention efforts led to a moderate reduction in the rate (7.8% in 2011/12). A collapse in rates was observed in 2021 (3.2%). In 2022, physical violence rose again to 5.6%. Harassment affected 19.6% of workers in 2005/6, falling to 7.2% in 2021 and rising again to 21.6% in 2022. Physical violence perpetrated by patients was more frequent in psychiatric services (OR 25.7, CI95% 11.1; 59.6) and violence perpetrated by visitors in emergency and urgence services (OR 8.8, CI95% 3.8; 20.5) than in general services. Workers attributed the drop in attacks primarily to the filtering of access to work areas, which limited the presence of visitors and relatives. The lower demand for services had also resulted in an optimal ratio between staff and patients, improving the quality of care. Furthermore, in the very first pandemic phase, health workers enjoyed a very favorable consideration from the population, which had further reduced the causes of conflict. Conclusions The pandemic has shown that better relationships between patients/visitors and staff are effective in reducing violence. Key messages • Monitoring of violence against healthcare workers shows that it has decreased during the pandemic. • HCWs believe that (i) limiting visitor access (ii) better balancing demand for services and (iii) better opinion towards HCWs were the causes of the reduced rate of violence.