Survey: Workplace Violence Prevention Training in Healthcare is Lacking

By Jay Kumar

A new survey from Crisis Prevention Institute (CPI) finds that healthcare professionals do not feel confident with the workplace violence prevention training they receive. This leaves them unprepared to deal with the increased wave of violence in their organizations.

“I’ve been at CPI for the past 15 years and I’ve been shocked at the level of violence against our care workers in the healthcare setting. That was different for me coming into this industry,” says Tony Jace, CEO of CPI, a provider of de-escalation training for healthcare organizations.

In CPI’s second Workplace Violence Prevention Training Annual Report for healthcare, the survey of 1,200 healthcare professionals found:

• Health professionals lack confidence in their organization’s workplace safety and violence prevention policies.
• Health systems have made incremental progress in establishing workplace violence committees but lack clearly defined policies and systemwide training.
• Most health systems do not provide frequent de-escalation training and their staff is not comfortable addressing a crisis.
• There are opportunities to improve training implementation, role definition, and systemwide collaboration.

Key statistics from the survey findings include:

• Nearly 1 in 5 respondents (17%) believe their staff feel very or mostly unsafe.
• 55% of respondents believe their workplace violence policies are only somewhat or not effective in reducing workplace violence.
• Nearly 70% of organizations do not have an established workplace violence committee with clearly defined policies and governance.
• Almost half (48%) only have defined roles for patient-facing staff in acute areas or for security personnel during a crisis situation.
• Only 33% of healthcare organizations report implementing systemwide de-escalation training to all staff.
• Approximately two-thirds (64%) of organizations do not provide frequent de-escalation training.
• Less than half of respondents (41%) think their staff are comfortable or very comfortable addressing a crisis.

Setting a benchmark

This year’s report also includes a new feature, the Health Care Industry Workplace Violence Prevention Index Score, which CPI developed to set a benchmark for an effective and sustainable workplace violence program. The group summarized respondents’ feelings around the safety of their workplace and their organization’s preparedness to resolve conflicts on a 1-4 scale and then transposed them to a 0-100 scale. These were broken into four segments:

• Leaders: 76-100
• Above average: 51-75
• Below average: 26-50
• Laggards 0-25

CPI set the benchmark for an effective workplace violence program at 76, but the 2023 Index score was 55. Only 18% of the survey respondents scored in the Leaders category, 33% were above average, 39% were below average, and 10% were laggards.

Jace has two main takeaways from the survey results.

“One is that it’s pretty flat year on year, so that in some ways could show that there’s still a lot of work to be done,” he says. “But secondly, I also did see that the awareness is much higher and we see that in just our own cohort and the involvement of these 1,200 professionals. You’re trying to assess where they are on the maturity scale of their organization and how well they manage life’s daily crisis moments.”

Another surprise is that only one third of U.S. healthcare workplaces have a de-escalation training policy in place, Jace notes.

“That’s a large gap,” he says. “It should be 90%, not 30%, so we have a lot of work to be done there.”

Why is violence so bad in healthcare?

Workplace violence is a problem in all industries, but healthcare settings have been the hardest hit.

“The frequency and the severity of these crisis moments have been on an increase, not just in healthcare settings, but a lot of settings, and pandemic for sure sort of fomented a lot of that,” Jace says. “In addition, what’s happening is that it’s not just the patients or the families that are bringing the patient in that are exhibiting distressed behavior.”

Healthcare professionals are also under stress and may be prone to acting out.

“[Healthcare] professionals are coming to our own workplace with a level of stress that’s been a lot higher than it has been in the past,” says Jace. “For whatever reason, that sort of creates a need for managing these potential crisis moments and de-escalating them when they start popping up. Obviously in the healthcare sector, there’s been a lot of operating margin pressure over the past few years and if you look at the industries most affected by the pandemic, healthcare has got to be number one.”

Another problem in healthcare is a disconnect between leadership and frontline workers, he says.

“In general, there’s been an erosion of trust in frontline workers with management or management with owners or the community with the system,” says Jace. “There’s so many mishits in terms of trust being eroded that it’s going to take us a while to pull that back. So I do believe that there are so many headwinds in the healthcare industry that leaders almost become catatonic.”

Jace says CPI is working to improve the culture in healthcare by reaching out to leadership.

“We can show them by just taking a step, allowing us to take one step together, we can help them fundamentally change the culture in their workplace,” he says. “And over a three- to four-year time frame, really turn it on its head and have engaged, confident workers, community members happy to be there, and just make it a much more person-centered caregiving place than it is today.”

With 600,000 healthcare workers undergoing CPI training each year, Jace says he’s optimistic that organizations will be able to improve their workplace safety and preparedness.

“We’re using a lot of technology enablement and microlearning to deliver this reinforcement training in the line of service,” he adds. “It’s not just an event to come to our training, you actually live it on a daily basis. So delivering these little helps along their day, it has been powerful.”

Jace encourages organizations that haven’t taken the survey to do so and get an assessment of their workplace safety and preparedness.