An exploration of worker to worker violence in hospitals: A form of counterproductive work behavior

Background and Objectives: Workplace violence between employees (Type III) represents a type of counterproductive work behavior that is prevalent in healthcare settings, ranging from verbal aggression to physical assault. Type III violence undermines a culture of safety, reduces productivity, harms employee well-being, and promotes further violence. There is a lack of research based on actual incidents of Type III violence. This study was designed to identify catalysts and circumstances of this violence. Methods: Data were collected from a system-wide database maintained by a large hospital system to record reported incidents of workplace violence. Qualitative content analysis was conducted on the total sample of 183 Type III incidents documented by hospital employees in 2011. Results: Documented incidents revealed two primary themes of catalysts: Work Organization and Work Behavior. Work Organization concerned aggressive and violent behavior related to following hospital and care protocols, limited resources, workload, and patient assignments. Aggression related to Work Behavior concerned employee performance, responsibility for work duties, methods of patient care, and unprofessional interaction. All documented incidents reflected work stress, poor communication, and/or dissatisfaction with coworkers. Incident reports focused on the actions of specific coworkers, rather than organizational factors interfering with performance. Conclusions: Employee descriptions of Type III violent events provide a rich data source for better understanding the causes, circumstances, and outcomes of aggression between co-workers. Hospitals are high stress work environments conducive to violence between employees. Identifying patterns of catalysts of Type III violence enables hospital stakeholders to develop targeted strategies for intervention and prevention.