By Christopher Cheney
A survey of physicians found that a significant proportion of the clinicians had experienced mistreatment in the prior year, with patients and visitors the most common source of abuse, a new research article says.
Mistreatment of healthcare staff including workplace violence has become a pressing national issue. In March, American Hospital Association President and CEO Richard Pollack wrote a letter to Merrick Garland urging the U.S. attorney general to back legislation to protect healthcare workers from assault and intimidation. “For medical professionals, being assaulted or intimidated can no longer be tolerated as ‘part of the job.’ This unacceptable situation demands a federal response,” Pollack wrote.
The new research article, which was published by JAMA Network Open, reports the results of a survey of nearly 1,400 physicians conducted from September to October 2020. The study features several key data points:
- 23.4% of physicians reported that they had experienced mistreatment in the prior year
- Patients and visitors were the most common perpetrators of mistreatment, with 16.6% of physicians reporting mistreatment by patients and visitors
- Other physicians were the second most common perpetrators of mistreatment, with 7.1% of survey respondents reporting mistreatment by physicians
- Female physicians were more than twice as likely to report mistreatment than male physicians (31% versus 15%)
- The most common forms of mistreatment were verbal abuse (reported by 21.5% of physicians), sexual harassment (5.4%), and physical intimidation or abuse (5.2%)
- On a scale of 1 to 10, experiencing any type of workplace mistreatment was linked to a 1.13-point increase in burnout
- On a scale of 1 to 10, experiencing any type of mistreatment was linked to a 0.99-point drop in professional fulfillment
- Lower perception that protective workplace systems were in place was linked to higher levels of burnout and lower levels of professional fulfillment
- Workplace mistreatment was linked to 129% higher odds of moderate or greater intent to leave employment within two years
“This survey study found that mistreatment was common among physicians, varied by gender, and was associated with occupational distress. Patients and visitors were the most frequent source, and perceptions of protective workplace systems were associated with better occupational well-being. These findings suggest that healthcare organizations should prioritize reducing workplace mistreatment,” the study’s co-authors wrote.
Interpreting the data
The lead author of the research article told HealthLeaders that it was unsurprising that patients and visitors were the most common source of mistreatment.
“Mistreatment of healthcare workers has been described for decades, but it appears to be growing much more widespread and more severe. On one level it makes sense—we are all experiencing an extraordinary confluence of stressors: the pandemic, of course, but also accelerating epidemics of mental illness and opioid use disorders; financial insecurity; erosion of public trust and politicization of science and healthcare; and race- and gender-based trauma, to name a few recent stressors,” said Susannah Rowe, MD, MPH, an ophthalmologist at Boston Medical Center, and chair of the Wellness and Professional Vitality Council at Boston University Medical Group.
New tools are required to address healthcare worker mistreatment by patients and visitors, she said. “Organizations have traditionally relied on Human Resources to address employee mistreatment by other employees, a strategy that is both appropriate and essential given the incidence of mistreatment by coworkers and supervisors. Addressing mistreatment by patients and visitors requires a different approach and would most likely succeed through broad collaboration among those working in patient experience, patient advocacy, health equity, public safety, and workforce well-being. Local and federal policy level interventions could also be needed as healthcare institutions may not be able to do this without additional support.”
The study highlighted the importance of perceiving that there are systems in place to ensure healthcare workers are treated with dignity and respect, Rowe said. “Supporting a culture of bystanders represents one promising strategy, especially when managers know how to respond effectively to bystander action. Ensuring that workers can discuss and report mistreatment without repercussions (for example via anonymous reporting systems and confidential resources) will, at the very least, help organizations diagnose where problems lie.”
Another emerging strategy relies on promoting positive actions—initiatives that actively affirm people’s dignity may be even more powerful than preventing mistreatment alone, she said. “Some examples include fostering inclusive language in the workplace, equitable hiring and promotion practices, education about counteracting unconscious biases, and upstander training. Providing ways for feedback, input, and ideas may also help, allowing for consistent assessments and changes to institutional policies and practices that truly prevent harm and keep workers safe.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.