Elsevier

Safety Science

Volume 47, Issue 8, October 2009, Pages 1049-1055
Safety Science

Workplace violence intervention effectiveness: A systematic literature review

https://doi.org/10.1016/j.ssci.2008.12.001Get rights and content

Abstract

This is a systematic review of literature published since 1992, to determine the effectiveness of interventions in preventing workplace violence and to suggest interventions that need further evaluation research. The health care industry is the topic of 54% of the papers, the retail industry is the topic of 11% of the papers, and the remaining papers address the workplace in general or other situations. This finding drives the organization of this review: the first group of papers discussed in this review evaluates interventions to prevent workplace violence in the retail industry – mostly to prevent robbery and violence to retail workers. Singly or in combination, environmental designs in the retail industry, such as increased lighting to improve visibility and a limited cash-handling policy, can make workers safer, but more research is needed to overcome the barriers to implementation of environmental designs, especially in small businesses. The second group of papers in this review is about interventions to prevent violence to health care workers – mostly training and techniques of dealing with combative patients. Training health care workers to better cope with violent patients and to avoid injury is becoming standard practice, but research is needed to identify specific aspects of training and patient management programs that are most effective.

Introduction

Previous literature reviews have, in some limited ways, described the relative effectiveness of workplace violence interventions from the 1970s to recent times. (Anderson, 2004, Barish, 2001, Cabral, 1996, Casteel and Peek-Asa, 2000, Erickson, 1996, Farrell and Cubit, 2005, Flannery, 1996, Flannery et al., 1998, Fletcher et al., 2000, Kraus et al., 1995, Kraus and McArthur, 1996, Lipscomb et al., 2002, Morrison, 2003, Peek-Asa, 2001, Runyan et al., 2000, Stirling et al., 2001). Most of these papers include a review of incidence, prevalence, and risk factors and focus on specific workplace settings. They may describe multiple approaches to interventions, but they often include intervention effectiveness only as a secondary consideration. There has been no systematic review of the whole body of workplace violence literature from roughly 1992 to the present. This article attempts to provide that review and to answer several questions about the current state-of-the-art in workplace violence interventions. According to the literature, what interventions have been demonstrated to work to reduce workplace violence incidents of various types? Which interventions have yielded mixed or no reliable results in the studies? Where are the gaps, and what research efforts are needed to fill them?

Deriving answers to these questions is critical, given the recent evidence of the devastation due to workplace violence. Although US workplace homicides have declined by 6.2% annually over 1993–2002, the decline was not similar for all industries, with the smallest decline in the health services industry (Hendricks et al., 2007). The most recent data indicate that there were 610 workplace homicides recorded in 2007 in the US, a 13% increase from 2006 (USDL, 2008a).

In 2007, there were 16,840 non-fatal injuries due to assault and violent acts (by persons), with a median of 5 days away from work, for a rate of 1.8 per 10,000 full-time workers. This represents a 5% increase from 2006. Sixty four percent of the assaults and violent acts (by persons) occurred in the education and health care services (USDL, 2008b). The National Crime Victimization Survey estimates an average 1.7 million violent victimizations to workers per year in the US between 1993 and 1999 (Duhart, 2001).

Violence in the workplace can take various forms, ranging from abusive language, threats, and bullying to physical assault and homicide. The highest rates of occupational violence incidents occur in occupations involving retail sales, law enforcement, teaching, health care, transportation and private security (Peek-Asa et al., 2001). Nursing assistants in long-term care have the highest incidence of assaults among all workers in the US (Gates et al., 2005). Convenience store clerks are at high risk for incidents of assault and homicide, most often associated with robbery or attempted robbery (Peek-Asa et al., 2004). In addition to criminal intent incidents, violence can occur in hostile customer/client confrontations, coworker vs. coworker conflict, and personal relationship incidents involving domestic violence expressed in the workplace. The continuing harmful consequences of workplace violence, which often draws intense media attention, indicate the need for interventions that work to make workplaces safer. However, over 70% of US workplaces do not have a formal program or policy that addresses workplace violence (USDL, 2006). The modern workplace violence literature describes some intervention evaluations, while many other interventions have been adopted because of an urgent need to address the problem but are untested and unproven.

Section snippets

Methods

A review of the modern literature requires a recognition that workplace violence is not of a uniform type. For research purposes, this article categorizes workplace violence into four types (Bowie et al., 2005, Howard, 1996, Peek-Asa et al., 1997) according to the relationship between the violence perpetrator and the victim, as follows:

  • Type I: External/intrusive violence: workplace violence events of criminal intent by unknown assailants, as in a robbery. Also includes terrorist acts, protest

General Results

This review identified nearly 100 papers which were categorized by type of study or study design. The health care industry is the focus of 54% of the papers, and the retail industry is the focus of 11%, with the remainder addressing the workplace in general or other situations. This finding drives the organization of this review. Section 4 will examine the major papers that evaluate interventions to prevent workplace violence in the retail industry – mostly concerning environmental designs to

Comments on selected studies

The modern literature demonstrates that environmental design interventions have been the most effective in preventing and reducing workplace violence injuries inflicted by strangers in the commission of criminal acts. Most of these violence incidents occurred in retail settings. For example, an evaluation of a crime prevention through environmental design (CPTED) model included multiple components and identified 16 studies that evaluate one or more of the components (Casteel and Peek-Asa, 2000

Comments on selected studies

In 1995, a systematic review of English language articles in US peer-reviewed journal articles from 1980 to 1994 found that a patient management strategy was associated with decreased levels of Type II violence in health care settings (Kraus et al., 1995). Other literature reviews address specific subtopics, such as the effect of legislation and regulations on workplace violence (Barish, 2001) and a guide for use by occupational health nurses to increase awareness of violence when treating

Conclusion

This systematic literature review has identified health care and retail as two major industries where interventions to prevent workplace violence have been evaluated. The quality of the evaluations has been variable, with a few studies demonstrating careful attention to study design and quantitative details leading to credible results. Clearly, many of the promising preliminary results should be verified through well controlled and well designed follow-up studies.

This attempt to identify all

Acknowledgments

The findings and conclusions in this report are those of the author and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

References (58)

  • C. Peek-Asa et al.

    The role of surveillance and evaluation research in the reduction of violence against workers

    American Journal of Preventive Medicine

    (2001)
  • C. Peek-Asa et al.

    Compliance to a workplace violence prevention program in small businesses

    American Journal of Preventive Medicine

    (2004)
  • C.W. Runyan et al.

    Administrative and behavioral interventions for workplace violence prevention

    American Journal of Preventive Medicine

    (2000)
  • H.S. Shannon et al.

    Methodological criteria for evaluating occupational safety intervention research

    Safety Science

    (1999)
  • G. Stirling et al.

    Violence in a&e departments: a systematic review of the literature

    Accident and Emergency Nursing

    (2001)
  • H.E. Amandus et al.

    Reevaluation of the effectiveness of environmental designs to reduce robbery risk in Florida convenience stores

    Journal of Occupational and Environmental Medicine

    (1995)
  • D.G. Anderson

    Workplace violence in long haul trucking: occupational health nursing update

    AAOHN Journal

    (2004)
  • J.E. Arnetz et al.

    Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers

    Journal of Advanced Nursing

    (2000)
  • B. Beech et al.

    Evaluating a management of aggression unit for student nurses

    Journal of Advanced Nursing

    (2003)
  • R. Cabral

    Policies for developing workplace violence prevention strategies

    Journal of Occupational Medicine: State of the Art Reviews

    (1996)
  • C. Casteel et al.

    Effectiveness of crime prevention through environmental design in reducing criminal activity in liquor stores: a pilot study

    Journal of Occupational and Environmental Medicine

    (2004)
  • C. Deans

    Nurses and occupational violence: the role of organisational support in moderating professional competence

    The Australian Journal of Advanced Nursing

    (2004)
  • Duhart, D., 2001. National crime victimization survey: workplace violence 1993–1999. 190076. Bureau of Justice...
  • R.J. Erickson

    Retail employees as a group at risk for violence

    Journal of Occupational Medicine: State of the Art Reviews

    (1996)
  • G. Farrell et al.

    Nurses under threat: A comparison of content of 28 aggression management programs

    International Journal of Mental Health Nursing

    (2005)
  • R.B. Flannery et al.

    Replicated declines in assault rates after implementation of the assaulted staff action program

    Psychiatric Services

    (1998)
  • T.A. Fletcher et al.

    Violence in the workplace: new perspectives in forensic mental health services in the USA

    The British Journal of Psychiatry

    (2000)
  • C. Gale et al.

    Management of violence in the workplace: a New Zealand survey

    Acta Psychiatrica Scandinavica

    (2002)
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