Workplace violence intervention effectiveness: A systematic literature review☆
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:
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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.
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“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”.