Sustainability and reliability of methods for monitoring violence in health care

Abstract Problem Workplace violence (WV) is a growing problem for healthcare workers (HCWs). Knowledge of the incidence and characteristics of the phenomenon is important to take targeted preventive measures. Description Few healthcare companies consistently monitor this problem. In Italy, those that have collected the official injury reporting of workers have found annual aggression rates of between 0.2 and 1%, while those who have conducted ad hoc surveys have found incidence rates between 35% and 96%. Underreporting and overreporting are very common in HCWs. Lacking original data, most companies estimate WV through non-validated algorithms. However, inaccurate data prevents proper management of WV and causes resource waste. Data collection performed by the occupational health physician during the mandatory periodical visits in the workplace reduces recall bias and socially desirable responses. Results For over 20 years, WV against HCWs has been monitored in a Public Health Company by the Health Surveillance Service. The census does not burden the service and allows the phenomenon to be monitored in the various work sectors, verifying the effects of the preventive measures taken. For example, the incidence of physical aggression fell from 8.2% (CI95% 6.9; 9.7) in 2005 to 3.2% (CI95%1.9; 4.6) in 2021 and rose again to 7.5% (CI95%5.7; 9.6) in 2023. Nurses and physicians were the most exposed categories. The psychiatric and emergency departments were the services at greatest risk of WV. Experiencing WV was associated with a high risk of effort/reward imbalance, job strain, anxiety and depression in the following year. The conversation between workers and doctor avoids under- and overreporting and provides a more precise understanding of the problem and allows workers’ counseling. Lessons Occupational health physicians can measure the incidence of violence against HCWs more realistically than using the widely diffused algorithms. Key messages • Monitoring workplace violence through health surveillance is a sustainable, economical and efficient method. • Knowledge of actors’ experiences is preferable to algorithms that come from heterogeneous sources.