Steps to Reduce Hospital Violence

Even before the pandemic, hospital violence was becoming widespread in the United States. In the face of COVID-19, attacks on health care workers by patients, their families, and visitors continue to rise. However, we rarely hear about it.

That’s because hospital administrators tend to keep assaults, aggressive behavior, and outright violence secret. They know the patients as well as their families and friends are under extreme stress and therefore may provide them more leeway than would be allowed in a traditional work setting.

Further, any legal action taken as a result of an incident of violence can open a Pandora’s box of issues. ECRI, a nonprofit advisory organization for the health care industry, reports that litigation following acts of workplace violence is a “major direct cost” for organizations including hospitals, as much as $3.1 million per person per incident.

The Reality of Hospital Violence

Nevertheless, hospital violence cannot be ignored. In February 2020, just one month before the pandemic shut down US businesses, 50 percent of emergency room physicians reported being assaulted by patients, their families, or friends. The same study found that 70 percent of nurses reported being hit or kicked while on the job.  It is believed these numbers have gotten worse over the past two years.

“We’re not just talking about punching or hitting. It’s also things like spitting, biting, and shoving,” said Laura Monaco, JD, an associate in the Employment, Labor, and Workforce Management practice at Epstein Becker Green in New York City.

In an interview with Health Leaders Media, Monaco noted that hospital administrators must “be mindful [that] this is an urgent situation that they need to be on top of . . . because it is such a large threat.”

Fortunately, hospital administrators can take steps to address hospital violence. And the first step is simple: know your applicable state laws. 

These laws can vary considerably.  Often hospital administrators, doctors, nurses, and staff do not know if or when a patient’s aggressive behavior has crossed the line or if they are required to report it. In such cases, they may make subjective decisions instead of basing their decisions on statutes in their state or community.

However, in a sense, it does not matter what the laws are in your state regarding hospital violence. Each hospital is its own “village,” and as such, it must establish its own policies and procedures when it comes to investigating, reporting, and dealing with hospital violence or abusive behavior. Some essential protocols include the following:

Speak Up about Hospital Violence

Each member of the health care team should be responsible for alerting all other hospital staff if a patient is potentially violent. View this step as a heads-up for everyone in the hospital.

Conduct Investigations

Investigating a violent or abusive situation in a hospital setting can prove beneficial in many ways. First, it uncovers the details as to what happened, illuminating ways it could have been prevented, and what steps can be taken to avoid such a situation in the future.

As part of this step, hospitals should set up their own “exploratory response team” to investigate workplace violence. Members of these teams come from HR, the hospital’s legal department, nurses and staff members, and security staff. Some hospitals also coordinate with professional safety and risk assessment organizations. Outside risk assessment professionals bring a depth of experience that can prove enormously valuable in the investigation.

Set Parameters and Enforce Policies

We just mentioned that one of the benefits of investigating hospital violence and abusive behavior is that it can help administrators create new policies and procedures to ensure such a situation does not happen again. 

Once these policies are determined, they should be formalized. This means they should be in writing, in language that is easy to read and understand, and shared with all hospital staff.

However, with that said, we must realize that facilities can change.  Their demographics, for instance, can change, which could mean more or less hospital violence occurring.

This means these policies cannot be set in stone. To adjust to changing times, many medical facilities call in risk assessment professionals at regular intervals to determine if the current policies in place are still relevant and which may need to be altered or adjusted.

Johnathan Tal is Chief Executive Officer of TAL Global Corporation, an international investigative and risk-consulting firm. He served as a military field intelligence officer for the Israeli armed forces during the 1970s. Tal has also served as an antiterrorism security specialist. He is a licensed investigator, Certified Private Investigator (CPI), and Certified Fraud Examiner (CFE), and he holds a Bachelor of Science degree. He can be reached through his company website at

© TAL Global, 2019