Workplace violence

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Workplace violence
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Workplace violence - is any violent act, including physical assault and the threat of assault, directed toward persons at work or on duty. The wording comes from the U.S. National Institute for Occupational Safety and Health (NIOSH), which describes workplace violence as "violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty"[1]. The range runs from threatening language to homicide.

Other bodies draw the line more widely. The U.S. Occupational Safety and Health Administration (OSHA) speaks of "any act or threat of physical violence, harassment, intimidation, or other threatening behavior that occurs at the work site", and notes that it can involve employees, clients, customers and visitors[2]. The broadest definition is international. The International Labour Organization's Violence and Harassment Convention, 2019 (No. 190), adopted in Geneva on 21 June 2019 and in force since 25 June 2021, treats violence and harassment as one concept: "unacceptable behaviours and practices, or threats thereof, whether a single occurrence or repeated, that aim at, result in, or are likely to result in physical, psychological, sexual or economic harm", explicitly including gender-based violence and harassment[3]. The Convention protects not only employees but also interns, apprentices, volunteers, jobseekers, dismissed workers and people exercising an employer's authority, in the private and public sectors, formal and informal economy alike[3].

Which definition is right? Depends on the purpose. A safety engineer measuring injury rates needs a narrow, countable definition. A human resources policy that wants to stop bullying before it turns into a fist fight needs the wide one.

Typology of workplace violence

The most widely used classification divides incidents by the relationship between perpetrator and workplace. It was popularised by the University of Iowa Injury Prevention Research Center in its February 2001 report Workplace Violence: A Report to the Nation, prepared after a research workshop held in Washington in April 2000[4]. Four types:

  • Type I – Criminal intent. The perpetrator has no legitimate relationship to the business or its staff and is usually committing another crime: robbery, shoplifting, trespassing. According to the report, 85% of workplace homicides fell into this category. Convenience store clerks, taxi drivers and security guards are typical victims.
  • Type II – Customer/client. The perpetrator has a legitimate relationship with the business and becomes violent while being served. Patients, students, inmates, passengers, customers. The report believed a large share occurs in health care, such as nursing homes and psychiatric units; attacks by inmates on guards or suspects on police officers also belong here.
  • Type III – Worker-on-worker. A current or former employee attacks or threatens a colleague. About 7% of workplace homicides were of this type, and the report found no occupation or industry clearly more or less prone to it.
  • Type IV – Personal relationship. The perpetrator usually has no tie to the business but has a personal relationship with the victim. In practice this means domestic violence spilling into the workplace. Victims are overwhelmingly, though not exclusively, women.

Why bother with categories? Because each type needs a different fix[4]. Bulletproof glass does nothing against a jealous ex-partner, and a conflict-resolution workshop will not stop an armed robber.

Forms of workplace violence

Violence at work is not only about physical injury. Most frameworks recognise several overlapping forms:

  • Physical assault – hitting, kicking, biting, pushing, use of weapons, sexual assault, homicide.
  • Threats – verbal, written or electronic threats, and threatening gestures or body language. NIOSH counts them as violence in their own right[1].
  • Verbal abuse and intimidation – shouting, insults, deliberate humiliation in front of others.
  • Harassment, including sexual and gender-based harassment, which C190 places within the same legal concept[3].
  • Bullying and mobbing – repeated, often subtle hostile behaviour by one person or a group, aimed at isolating or pushing out a colleague. It rarely produces a recordable injury, yet it can do lasting psychological damage and often grows out of unresolved sources of conflict in a team.

Psychological forms dominate survey data; physical forms dominate injury statistics.

Scale of the problem

Fatal violence (United States). According to the Bureau of Labor Statistics Census of Fatal Occupational Injuries, as summarised by OSHA, 5,283 workers died from work-related injuries in the United States in 2023; 740 of these deaths were due to violent acts, and 458 were homicides, which was 61.9% of violent-act deaths and 8.7% of all work fatalities[2]. Violent acts were the third-leading cause of fatal occupational injury.

Non-fatal violence in health care (United States). The BLS fact sheet Workplace Violence in Healthcare, 2018 (April 2020) reported that healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence in 2018. In private healthcare and social assistance, the rate of days-away-from-work cases caused by intentional injury by another person was 10.4 per 10,000 full-time workers, against 2.1 for all workers[5]. OSHA's guidelines cite earlier BLS data: between 2011 and 2013 workplace assaults involving days away from work ranged from 23,540 to 25,630 a year, with 70–74% occurring in healthcare and social service settings[6].

Global survey data. The first global survey on the subject, carried out by the ILO with the Lloyd's Register Foundation and Gallup and published in 2022, estimated that 22.8% of persons in employment (743 million people) had experienced at least one form of violence and harassment at work during their working life. Psychological violence and harassment was the most common form (17.9%), followed by physical (8.5%) and sexual (6.3%). Only 54.4% of victims had told anyone about their experience[7].

Almost half of victims stay silent. Any statistic built on reports is a floor, not a ceiling.

Risk factors and high-risk sectors

OSHA lists factors that raise the probability of violence: exchanging money with the public, working with volatile or unstable people, working alone or in isolated areas, providing services and care, working where alcohol is served, and working late at night or in high-crime areas[2]. Its healthcare guidelines add organisational factors that managers control directly – lack of policies and training for handling escalating behaviour, understaffing (especially at mealtimes and during visiting hours), high staff turnover, inadequate security, long waits, overcrowded waiting rooms, poorly lit corridors and car parks, and no means of emergency communication[6]. High employee turnover appears on that list as a cause, not only as a consequence.

High-risk sectors commonly identified:

  • Health care – emergency departments, inpatient psychiatry and geriatric long-term care are named by OSHA as the highest-risk settings[6].
  • Social services – home visits, child protection, community care, often done alone.
  • Retail – late-night shops, petrol stations, anywhere with cash (mostly Type I).
  • Policing, corrections and security – contact with unwilling clients is part of the job.
  • Transport – taxi and ride-share drivers, delivery drivers, bus and train staff.

A risk matrix of likelihood and severity per job role helps rank these exposures.

Prevention programmes

OSHA's Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers (OSHA 3148, revised in 2016, updating the 1996 and 2004 versions) remain the best-known template. They are voluntary – OSHA stresses that the document creates no new legal obligations – but they describe five building blocks[6]:

  1. Management commitment and worker participation.
  2. Worksite analysis and hazard identification.
  3. Hazard prevention and control.
  4. Safety and health training.
  5. Recordkeeping and programme evaluation.

The logic mirrors any other health and safety management system. First identify the risk, then evaluate and control it, then check whether the controls work.

Hierarchy of controls

The guidelines borrow the industrial hygiene idea of ranking controls by effectiveness: substitution first, then engineering controls, then administrative and work-practice controls[6]. Applied to violence:

  • Elimination/substitution – removing the exposure altogether, for instance transferring a patient with a history of violence to a more secure facility, or replacing cash with card-only payment.
  • Engineering controls – physical barriers and enclosures, door locks, metal detectors, panic buttons and personal alarms, better lighting, accessible exits, CCTV.
  • Administrative controls – adequate staffing, no lone working in high-risk tasks, buddy systems for home visits, flagging of patients with a history of aggression, visitor management, clear zero-tolerance policies.
  • Personal measures – personal alarms, GPS tracking for field workers, advice against wearing necklaces or chains.

Threat assessment teams

Many organisations set up a multidisciplinary team (HR, security, legal, occupational health, line management) to review warning signs and decide on interventions. OSHA's guidelines recommend involving threat assessment professionals in planning and in specific threat assessments[6]. The team is particularly useful for Type III and Type IV risks, where early signals (threats, stalking, protection orders) are often known to someone in the organisation but never reach the people who could act.

Training and de-escalation

Staff learn to recognise escalating behaviour, use verbal de-escalation, keep an exit route, call for help and, as a last resort, apply safe breakaway techniques. OSHA recommends that de-escalation and self-defence training include a hands-on component, that training be given annually and that high-risk settings may need refreshers more often[6]. Refresher training matters because skills fade quickly when they are rarely used.

Reporting and recordkeeping

Nothing can be managed if it is not reported. Programmes need a simple reporting channel, a promise of no retaliation and visible follow-up. In the U.S., assaults that meet OSHA's recording criteria must be entered in the OSHA 300 Log, and Section 11(c) of the OSH Act makes reprisal against a worker for reporting an incident unlawful[6].

Post-incident support

After an incident: first aid and emergency care, then prompt medical treatment and psychological evaluation, free of charge and regardless of severity. OSHA mentions trauma-crisis counselling, critical-incident stress debriefing and employee assistance programmes, and notes that victims may suffer psychological trauma, fear of returning to work and feelings of guilt or powerlessness[6]. Serious events also need incident management with a root-cause investigation; OSHA warns that uncorrected root causes recreate the conditions for the next incident.

Legal duties of employers

In the United States there is no general federal standard on workplace violence. The obligation rests on the General Duty Clause, Section 5(a)(1) of the Occupational Safety and Health Act of 1970, under which each employer "shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees"[8]. Where violence is a recognised hazard in an industry, it falls within this general duty. Several states have passed their own requirements, which OSHA advises employers to check[6].

In the European Union, Council Directive 89/391/EEC of 12 June 1989 (the OSH Framework Directive) obliges employers to ensure the safety and health of workers "in every aspect related to work" and to evaluate all risks[9]. Violence is not named, yet it falls inside that duty. The Directive's general principles of prevention – avoid risks, evaluate those that cannot be avoided, combat risks at source, adapt work to the individual, give collective protection priority over individual protection – read almost like a violence-prevention checklist. Countries that ratify ILO Convention No. 190 take on a further duty to adopt an inclusive, integrated and gender-responsive approach to preventing violence and harassment in the world of work[3].

Cost implications

The Iowa report noted that the costs of workplace violence to employers were estimated "in the billions of dollars" while admitting that information on economic impact was far thinner than data on fatal events[4]. Costs come in layers:

  • Direct costs – medical treatment, workers' compensation, wage replacement, legal fees, property damage, higher insurance premiums.
  • Indirect costs – overtime and agency staff to cover absent workers, lower productivity of witnesses, management time spent on investigations.
  • People costs – increased absenteeism, resignations and the associated turnover cost, and longer-term mental health problems. These are the hardest to price and often the largest.

Example of incident-rate and cost-benefit calculation

The following example is hypothetical. All figures are invented for illustration.

A regional hospital employs staff who worked 1,620,000 hours in year 1 (equivalent to 810 full-time workers at 2,000 hours each) and 1,650,000 hours in year 2. At the start of year 2 it introduces a violence-prevention programme: panic alarms and lighting upgrades, de-escalation training for all ward staff, a threat assessment team and a no-blame reporting campaign.

OSHA's recordkeeping forms give the standard incidence-rate formula[10]:

\[ IR = \frac{N \times 200\,000}{H} \]

where N is the number of cases and H the total hours worked by all employees. The 200,000 figure represents the hours that 100 employees working 40 hours a week for 50 weeks would work, so the result reads as cases per 100 full-time workers per year.

Measure Year 1 (before) Year 2 (after) Change
Hours worked 1,620,000 1,650,000 +1.9%
All reported violent incidents (incl. threats, no injury) 62 71
Rate per 100 FTE 7.65 8.61 +12.4%
Recordable assault injuries 22 13
Rate per 100 FTE 2.72 1.58 −42.0%
Assault injuries with days away from work 14 8
Rate per 100 FTE 1.73 0.97 −43.9%

For instance, the year 1 recordable rate is 22 × 200,000 / 1,620,000 = 2.72.

Reported incidents went up. That isn't failure; the reporting campaign made staff log threats they used to ignore. Injury-based rates, which are less sensitive to reporting habits, fell by over 40%. Reading the first number alone would have led to the wrong conclusion.

Cost-benefit. Assume an average cost of $28,000 per days-away assault case (treatment, compensation, replacement staffing) and $3,500 per medical-treatment-only case.

  • Avoided days-away cases: 14 − 8 = 6; 6 × $28,000 = $168,000
  • Avoided medical-only cases: (22 − 14) − (13 − 8) = 8 − 5 = 3; 3 × $3,500 = $10,500
  • Total benefit in year 2: $178,500

Programme cost in year 2: $95,000 one-off (alarms, lighting, course development) plus $60,000 running cost (trainers, coordinator time, team meetings) = $155,000.

\[ ROI = \frac{178\,500 - 155\,000}{155\,000} \times 100\% = 15.2\% \]

Net benefit in the first year: $23,500, a benefit-cost ratio of 1.15. If the improvement holds and only running costs recur, the following year's ratio becomes 178,500 / 60,000 = 2.98. Over two years: benefits $357,000 against costs $215,000, a net $142,000 (ratio 1.66). Morale and retention are left out, so the real return on investment may be higher – but the calculation also assumes the whole decline came from the programme, which one before-and-after comparison cannot prove.

Advantages of prevention programmes

  • Fewer injuries and deaths.
  • Lower direct and indirect costs, as the example shows.
  • Better staff retention and less sickness absence, which in turn removes understaffing as a risk factor.
  • Evidence of compliance with the General Duty Clause or the EU Framework Directive's risk-assessment duty.
  • A stronger organisational culture of safety and trust; staff who feel protected are more willing to raise concerns of any kind.
  • Data showing where and when incidents cluster, useful for rostering and design decisions.

Limitations

  • Underreporting. Only slightly more than half of victims in the ILO survey had told anyone[7], and OSHA's guidelines state that research shows workplace violence in health care is underreported[6].
  • Measurement problems. Definitions differ – NIOSH, OSHA and ILO do not count the same events. Injury statistics capture physical harm, surveys capture perceptions, and neither captures everything. The Iowa report complained that data were "scattered and sketchy"[4].
  • The reporting paradox. A successful awareness campaign raises reported numbers, which can look like deterioration, as in the example above.
  • Weak evidence base. The Iowa report pointed out that OSHA's voluntary guidelines had not been fully evaluated and that little research used rigorous methods[4]. Before-and-after comparisons in a single site cannot separate the programme's effect from other changes.
  • Displacement and side effects. Heavy security can make a hospital or welfare office feel hostile and may itself provoke some clients. Flagging systems raise privacy and fairness questions, which touch on organisational justice.
  • Limited reach over Type IV. Employers have little control over perpetrators with no link to the workplace.

References

Footnotes

  1. ↑ NIOSH, Violence: Occupational Hazards in Hospitals, DHHS (NIOSH) Publication No. 2002-101, 2002
  2. ↑ OSHA, Workplace Violence (web page), U.S. Department of Labor, citing BLS Census of Fatal Occupational Injuries 2023
  3. ↑ ILO, Violence and Harassment Convention, 2019 (No. 190), Articles 1-4
  4. ↑ University of Iowa Injury Prevention Research Center, Workplace Violence: A Report to the Nation, February 2001
  5. ↑ U.S. Bureau of Labor Statistics, Workplace Violence in Healthcare, 2018, Fact Sheet, April 2020
  6. ↑ OSHA, Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, OSHA 3148-06R, 2016
  7. ↑ ILO, Lloyd's Register Foundation, Gallup, Experiences of violence and harassment at work: A global first survey, 2022
  8. ↑ Occupational Safety and Health Act of 1970, Section 5(a)(1), 29 U.S.C. 654
  9. ↑ Council Directive 89/391/EEC of 12 June 1989, Articles 5-6
  10. ↑ OSHA, Forms for Recording Work-Related Injuries and Illnesses, Optional worksheet for computing incidence rates
Workplace violence — recommended articles
Workplace safety — Occupational health and safety — Hazard assessment — Incident management — Crisis management — Working conditions — Absenteeism in the workplace
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