Understanding and preventing work-related violence in hospital settings: a systems thinking approach: final report
Research that applied systems thinking methods to enhance understanding of work-related violence in hospital settings in NSW and to develop a series of novel interventions designed to support enhanced prevention and management of the issue.
Work-related violence in hospital settings is a complex and growing issue that has significant personal, societal and economic costs. The complexity and multi-factorial nature of the issue is such that it is extremely difficult to understand and manage, and interventions have had varying levels of success. Systems thinking is one approach that is currently popular in the field of safety science when attempting to understand and respond to complex safety-related issues.
As part of their ongoing efforts to support improved prevention and management of work-related violence in hospital settings, SafeWork NSW funded the Centre for Human Factors and Sociotechnical Systems to undertake an exploratory research project applying systems thinking to the issue of work-related violence in hospital settings in New South Wales (NSW).
The research aims were to apply systems thinking methods to enhance understanding of work-related violence in hospital settings in NSW and to develop a series of novel interventions designed to support enhanced prevention and management of the issue. The research involved three phases, including:
1. Development of an ActorMap showing the stakeholders who share the responsibility for work-related violence in hospital settings in NSW;
2. Development of an AcciMap showing the factors which, according to the literature and subject matter experts, interact to create work-related violence in hospital settings in NSW; and
3. Development of a series of PreventiMaps outlining networks of potential interventions which could enhance the prevention and management of workrelated violence in hospital settings.
All three phases involved the conduct of workshops with stakeholders who either currently share the responsibility for work-related violence in the healthcare sector; are responsible for designing and implementing incident prevention strategies within hospitals; or are experienced in human factors and systems thinking.
The findings demonstrate that work-related violence is an emergent property that is influenced by a large and diverse set of actors spanning multiple levels of the hospital system. In short, work-related violence is not a problem that is solely related to patients, healthcare workers, and security staff. Rather, there are multiple actors who share the responsibility for work-related violence.
The findings also demonstrate that work-related violence incidents in hospital settings are caused by multiple contributory factors from across the hospital system. The high number of contributory factors identified during this research suggests that there are many different causal pathways which lead to incidents of work-related violence. Improved prevention and management of work-related violence can therefore only be achieved
through system reform. To facilitate the identification of potential interventions, a series of key themes were identified. These include risk management, the provision of sufficient and capable staffing, timely and effective incident response, promoting the safety and dignity of patients and healthcare workers, incident reporting and learning systems, managing the risk of patients with a high propensity of violence, the design of hospital environments, collaboration, consultation and coordination across the hospital settings system, and public attitudes and behaviours towards healthcare workers. It is recommended that these themes be the immediate focus of future activities designed to enhance work-related violence prevention and management in hospital settings.
The final phase of the research resulted in a set of PreventiMaps showing potential interventions that could be explored in response to the key themes. The PreventiMaps include a range of interlinked interventions spanning all levels of the hospital setting system. A synthesis of the PreventiMaps revealed a core set of nine interventions which could have multiple positive impacts throughout the hospital system. It is recommended that stakeholders further investigate these nine interventions with a view to further development and implementation in the short term. In particular, the establishment of an independent multi-agency collaboration group is recommended as an important first step towards improved prevention and management of work-related violence in hospital settings in NSW.
Contents
- Introduction
- Systems thinking
- An ActorMap for work-related violence in hospital settings
- An AcciMap for work-related violence in hospital settings
- Strategies to prevent work-related violence in hospital settings
- Summary of project findings
- References
- Appendices
- Contact Information