Systematic Violence Monitoring to Reduce Underreporting and to Better Inform Workplace Violence Prevention Among Health Care Workers: Before-and-After Prospective Study

• Published in: JMIR public health and surveillance 2023-11, Vol.9, p.e47377
• Main Authors: Veronesi, Giovanni, Ferrario, Marco Mario, Giusti, Emanuele Maria, Borchini, Rossana, Cimmino, Lisa, Ghelli, Monica, Banfi, Alberto, Luoni, Alessandro, Persechino, Benedetta, Di Tecco, Cristina, Ronchetti, Matteo, Gianfagna, Francesco, De Matteis, Sara, Castelnuovo, Gianluca, Iacoviello, Licia
• Format: Article
• Language: English
• Subjects: Assaults; Cluster Analysis; Data collection; Female; Health care; Health Personnel; Hospitals; Humans; International standards; Male; Medical personnel; Multimedia; Original Paper; Prevention; Prospective Studies; Psychologists; Questionnaires; Violence; Workplace; Workplace violence; Workplace Violence - prevention & control
• ISSN: 2369-2960; 2369-2960
• DOI: 10.2196/47377

Monitoring workplace violence (WPV) against health care workers (HCWs) through incident reporting is crucial to drive prevention, but the actual implementation is spotty and experiences underreporting. This study aims to introduce a systematic WPV surveillance in 2 public referral hospitals in Italy and assess underreporting, WPV annual rates, and attributes "before" (2016-2020) and "after" its implementation (November 2021 to 2022). During 2016-2020, incident reporting was based on procedures and data collection forms that were neither standardized between hospitals nor specific for aggressions. We planned and implemented a standardized WPV surveillance based on (1) an incident report form for immediate and systematic event notification, adopting international standards for violence definitions; (2) second-level root cause analysis with a dedicated psychologist, assessing violence determinants and impacts and offering psychological counseling; (3) a web-based platform for centralized data collection; and (4) periodic training for workforce coordinators and newly hired workers. We used data from incident reports to estimate underreporting, defined as an observed-to-expected (from literature and the "before" period) WPV ratio less than 1, and the 12-month WPV rates (per 100 HCWs) in the "before" and "after" periods. During the latter period, we separately estimated WPV rates for first and recurrent events. In the "before" period, the yearly observed-to-expected ratios were consistently below 1 and as low as 0.27, suggesting substantial violence underreporting of up to 73%. WPV annual rates declined in 1 hospital (from 1.92 in 2016 to 0.57 in 2020) and rose in the other (from 0.52 to 1.0), with the divergence being attributable to trends in underreporting. Available data were poorly informative to identify at-risk HCW subgroups. In the "after" period, the observed-to-expected ratio rose to 1.14 compared to literature and 1.91 compared to the "before" period, consistently in both hospitals. The 12-month WPV rate was 2.08 (95% CI 1.79-2.42; 1.52 and 2.35 in the 2 hospitals); one-fifth (0.41/2.08, 19.7%) was due to recurrences. Among HCWs, the youngest group (3.79; P