Advancing healthcare worker safety in an academic hospital setting: a mixed methods quality improvement initiative protocol

Background There is growing evidence that workplace violence (WPV) including physical, verbal, psychological, racial and sexual violence against healthcare workers (HCW) is a globally increasing burden, with serious negative effects on the wellbeing of healthcare workers and deleterious outcomes for patients and healthcare systems. Many healthcare systems have put in place some evidence-based programs to combat WPV to provide the most safe and supportive environment while providing the highest quality, safe and compassionate care to their communities. However, the incidence of WPV continues to escalate. Objectives The aim of this paper is to describe the methodology for quality improvement initiative to advance safety culture, by addressing WPV at St Joseph's Healthcare Hamilton (SJHH), an academic Health Sciences Centre which is part of the St Joseph's Health System in Ontario, Canada. The objectives are to: (i) assess barriers and facilitators to physician reporting of WPV incidents; (ii) evaluate gaps in existing WPV data and reporting systems; (iii) identify system-level opportunities to improve WPV prevention and response; and (iv) monitor changes in WPV related outcomes over time, including reporting rates, incident trends, and priorities identified through staff engagement. Methods We set up the Workplace Safety Governance Committee as an advisory body to champion our strategy against WPV. Building on the work of an operational Prevention of Violence in the Workplace Committee and relying on a set of guiding principles, the Committee will use a multi component quality improvement approach informed by mixed methods that includes: (i) conducting a scoping review on physician reporting of WPV incidents; (ii) participating in an audit conducted by the Institute of Healthcare Improvement of our current practices and structures and to identify areas for improvement; (iii) engaging with provincial Workplace Safety and Insurance Board regarding mental stress injuries at SJHH, including a comparison with similar organizations; (iv) doing ‘rounds' in different hospital units to elicit concerns and advance open communication about WPV, to generate ideas for solutions and to provide regular updates and communication to share progress updates on the Committee work. Outcomes and analysis We will use descriptive statistics and process charts to display trends over time in order to monitor changes and progress on different types of WPV related outcomes. We will also use qualitative descriptions to capture themes from the scoping review and audit. Discussion WPV against HCW is a major barrier to achieving the goal of better health outcomes for patients and HCW. As part of the organization's 2024–25 priorities, SJHH is committed to fostering a physically and psychologically safe environment for our healthcare workers, volunteers and learners. Our quality improvement initiative consists of robust methodological approach using mixed evidence-based methods for data collection from different sources, including a survey of the literature, engagement of external stakeholder expertise on WPV and a review of our current practices and standards.