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Joint Commission issues alert on violence prevention in the health care workplace

Factors associated with health workplace violence, including understaffing and unrestricted public access to hospital rooms and clinics, are summarized.

Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCSEng(Hon), FRCSEd(Hon)

July 1, 2018

Workplace violence affects many industries, and health care is no exception. In 2015, a Boston surgeon was shot to death at the hospital where he practiced by a family member of a patient who the surgeon had treated.1 In November 2017, a cardiologist in Ohio was shot and killed in the hospital parking lot by a man who “shared a mutual love interest,” according to the story in USA Today.2 As these tragic incidents illustrate, physicians and surgeons can become targets.

According to the Occupational Safety and Health Administration (OSHA), about 75 percent of the nearly 25,000 workplace assaults reported annually occur in health care and social service settings.3 OSHA also reported that workers in a health care setting are four times more likely to be victimized than workers in private industry.4 Furthermore, the National Crime Victimization Survey shows that workers in a health care setting have a 20 percent higher risk of experiencing workplace violence than workers in other settings.5

With this in mind, The Joint Commission recently released Sentinel Event Alert, Issue 59: Physical and verbal violence against health care workers. The focus of the alert is to help health care organizations better understand these violent acts toward health care workers from patients and visitors.

Nature of violence in the health care setting

The Centers for Disease Control and Prevention National Institute for Occupational Safety and Health defines workplace violence as “violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.”

The Joint Commission’s Sentinel Event Policy states that rape, assault, or homicide of a patient, staff member, licensed independent practitioner, visitor, or vendor while on site at a health care facility is a sentinel event that warrants a comprehensive systematic analysis. Sentinel event data received by The Joint Commission includes 68 incidents of homicide, rape, or assault of hospital staff members over an eight-year period.

The alert states that most incidents of workplace violence in the health care industry are verbal; however, other violent acts include assault, battery, domestic violence, stalking, and sexual harassment.6

Typically, the most common perpetrators of these violent acts are patients or visitors,7 with a 2014 survey attributing about 75 percent of aggravated assaults and 93 percent of all assaults against health care workers to patients or customers.8

The alert states that each instance of workplace violence against health care workers should be communicated to leadership, internal security, and possibly law enforcement, although studies show that these incidents sometimes go unreported. One study showed that the reporting rate for emergency department (ED) physicians was just 26 percent.9 One possible reason is that health care workers believe that violence directed against them is “part of the job.”10

While workplace violence occurs in all care settings, most recorded incidents are in the ED and inpatient psychiatric settings.4

Possible causes

The alert lists many factors associated with workplace violence, including the following:

  • Stressful conditions, such as being given “bad news” related to a diagnosis or prognosis
  • Lack of organizational policies and training for security and staff to recognize and de-escalate hostile and assaultive behaviors from patients, clients, visitors, or staff
  • Inadequate security and mental health personnel on site
  • Understaffing, especially during mealtimes and visiting hours
  • Staff working in isolation or in situations in which they can be trapped without an escape route
  • Not having access to emergency communication, such as a cell phone or call bell
  • Unrestricted public access to hospital rooms and clinics

Read more—including seven actions that organizations can take to better handle or prevent workplace violence—by accessing the alert on The Joint Commission website.


The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.


  1. Payne E, Conlon K, Berlinger J. Boston doctor killed in hospital shooting had treated gunman’s mom. CNN.com. January 21, 2015. Available at: www.cnn.com/2015/01/20/justice/boston-hospital-shooting/index.html. Accessed May 29, 2018.
  2. Morgan C. Man shoots, kills doctor over ‘mutual love interest,’ police say. USA Today. November 14, 2017. Available at: www.usatoday.com/story/news/nation-now/2017/11/14/affinity-medical-center-murder-suicide/861303001/. Accessed May 29, 2018.
  3. Occupational Safety and Health Administration. Guidelines for preventing workplace violence for healthcare and social service workers (OSHA, 3148-04R). Available at: www.osha.gov/Publications/osha3148.pdf. Accessed May 29, 2018.
  4. Security Industry Association and International Association of Healthcare Security and Safety Foundation. Mitigating the risk of workplace violence in health care settings. Available at: www.securityindustry.org/wp-content/uploads/2017/11/Workplace-Violence-In-Health-Care-Settings-IAHSS.pdf. Accessed May 29, 2018.
  5. Harrell E. Workplace violence, 1993–2009. March 2011. Available at: www.bjs.gov/content/pub/pdf/wv09.pdf. Accessed May 29, 2018.
  6. Rugala EA, Isaacs AR, eds. Workplace violence: Issues in response. U.S. Department of Justice. Available at: www.fbi.gov/file-repository/stats-services-publications-workplace-violence-workplace-violence/view. Accessed May 29, 2018.
  7. Howard J. State and local regulatory approaches to preventing workplace violence. Occup Med (London). 1996;11(2):293-301.
  8. Vellani KH. The 2014 IHSSF crime survey. J Healthc Prot Manage. 2014;30(2):28-35.
  9. Behnam M, Tillotson RD, Davis SM, Hobbs GR. Violence in the emergency department: A national survey of emergency medicine residents and attending physicians. J Emerg Med. 2011;40(5):565-579.
  10. McPhaul KM, Lipscomb JA. Workplace violence in health care: Recognized but not regulated. Online J Issues Nurs. 2004;9(3):7.