Evidence from two cross-sectional surveys in under-resourced public hospitals shows that aggression toward doctors and nurses is not confined to conflict zones. Whether working amid economic hardship or in a metropolitan city, caregivers face physical assaults, verbal abuse and threats on a shocking scale. For HR and Occupational Health & Safety (OHS) leaders, the question is no longer “if” this will happen, but “when”—and “how” you can build a protective framework that transcends geography and politics.

1. The hidden epidemic of workplace violence in healthcare

Healthcare settings traditionally rank among the most trusted and respected workplaces. Yet across continents, hospitals and clinics are reporting rising incidents of workplace violence—assaults that range from shouted threats to punches in the face.
Violence in healthcare:

• Increases staff turnover, burnout and absenteeism
• Undermines patient safety and quality of care
• Drives up costs through workers’ compensation, security and lost productivity
• Erodes organisational culture and morale

For HR and OHS teams, workplace violence is both a human-rights issue and a strategic risk. Left unchecked, it damages your brand, inflates recruitment costs and seeds a culture of fear. To craft effective interventions, we turn to two granular surveys that paint a vivid picture of what caregivers endure, and why.

2. Survey insights: Two public-hospital settings under the microscope

2.1 Study A: Five public hospitals in an economically strained region

Context & Methodology
In mid-2011, researchers surveyed 240 full-time physicians and nurses across five public hospitals serving an under-resourced territory (Gaza and Israel). These facilities endured chronic budget shortfalls, medicine and supply shortages, overcrowded wards and heavy bed occupancy. Frontline staff also doubled as responders to periodic political emergencies.

Key findings

• 80.4% of respondents experienced some form of workplace violence in 12 months
  • 20.8% encountered physical assaults (punches, shoves, objects thrown)
  • 59.6% endured non-physical aggression (verbal abuse, threats, sexual harassment)
• Risk factors (logistic regression)
  • < 10 years’ experience: 8× greater odds of victimisation
  • Education below bachelor’s degree: 3× greater odds
• Perpetrators
  • Patient relatives and visitors (~ 50%)
  • Patients (38%)
  • Co-workers, including supervisors and peers (14%)
• Reporting & response gaps
  • 56% of incidents went unreported:
    • No formal reporting policy or point of contact
    • Belief that “nothing will change”
    • Fear of blame or reprisals
  • Fewer than 20% of staff received any violence-prevention training
  • Security measures (guards, alarms, cameras) were deployed inconsistently

Consequences

• Emotional distress: anger (44%), depression (22%), fear/stress (14%)
• Nearly half of physical-assault victims received no medical or psychological support
• Persistent health problems were reported by 18% of physical-assault victims and 31.5% of non-physical-assault victims
• Work disruptions: 48% of victims modified duties, took leave or requested transfers

(Kitaneh & Hamdan, BMC Health Services Research, 2012)

2.2 Study B: Four government hospitals in Karachi, Pakistan

Context & Methodology
In December 2012, a convenience sample of 354 MBBS-qualified doctors (trainees, residents and consultants) from four major public hospitals in Karachi responded to a survey adapted from a Swedish instrument. Private practitioners and basic-science doctors were excluded.

Key findings

• 74.9% of doctors reported at least one violent incident in 12 months
  • 93.2% of those incidents were verbal abuse
  • 15.1% were physical assault; 46% involved property damage; 3% were sexual harassment
• Aggressors
  • Patient attendants (62%)
  • Patients (15%) and mobs or groups (15%)
  • Others (8%)
• Triggers
  • Dissatisfaction with service (61%)
  • Long waiting times (48%)
  • Politically motivated aggression (45%)
• High-risk settings
  • Emergency department (39.6%)
  • General medicine (29.1%)
  • Surgery (18.9%)
• Reporting & impact
  • 71% said violence negatively affected their personal and family lives
  • 64% reported their incident; 32.5% did not—citing lack of support and ineffective follow-up
  • Of those who did report, most received only verbal assurances or temporary security increases

(Nayyer-ul-Islam et al., Journal of the College of Physicians and Surgeons Pakistan, 2014)

3. Common themes across disparate settings

Despite differences in geography and healthcare systems, both surveys reveal converging patterns:

1. Widespread exposure: Approximately 3 in 4 caregivers face aggression each year.
2. Economic strain as a driver: Under-resourced facilities, staffing shortages and service delays fuel frustration.
3. Politically motivated flare-ups: In one survey, nearly half of violent incidents were keyed to broader social tensions.
4. Under-reporting epidemic: Between 32% and 56% of incidents go undocumented, perpetuating impunity.
5. Psychological toll: From acute stress to chronic health issues, the human cost is severe.
6. Policy vacuum: Few institutions possess robust violence-prevention strategies, training curricula or clear reporting channels.

4. Why violence imperils organisational performance

Workplace aggression is more than a legal liability and a moral hazard. It disrupts operations, driving:

• Increased absenteeism and sick leave
• Higher turnover—and recruitment costs—among stressed staff
• Declining patient satisfaction scores and reputational damage
• Erosion of teamwork, communication and a safety-first culture
• Rising insurance premiums and workers’ compensation claims

For HR and OHS executives, curbing violence is essential to preserving both human capital and the bottom line.

5. A strategic framework for HR and OHS: seven pillars of violence prevention

To transform your healthcare facility into a safer environment, no matter its resource constraints or patient volumes.  Build a multi-layered strategy:

5.1 Leadership and culture

• Zero-tolerance stance: Publicly affirm that violence against staff is unacceptable, under any circumstances.
• Visible accountability: Executive sponsors (CEO, HR Director, OHS lead) should champion the initiative and review progress quarterly.
• Psychological safety: Encourage staff to speak up, share near-misses and participate in safety huddles without fear of blame.

5.2 Policy, governance and reporting

• Unified incident-reporting system: A single digital form, hotline or mobile app—anonymous options included.
• Clear escalation pathways: Define who investigates, responds and feeds back to victims.
• Data governance: Maintain dashboards of incident volumes, locations, types and resolutions for management review.

5.3 Training and capability building

• De-escalation skills: Role-play scenarios for front-line staff, security teams and managers.
• Conflict resolution: Workshops on verbal judo, active listening and boundary setting.
• Cultural competence: Tailor communication training to patient demographics and local sensitivities.

5.4 Environmental and technological controls

• Security staffing: Ensure trained officers are embedded in high-risk units (ED, outpatient reception).
• Alarm systems: Panic buttons, duress alarms and mobile alert badges linked to central security.
• Surveillance: Strategically placed CCTV with live monitoring, plus well-lit corridors and waiting areas.

5.5 Process redesign

• Optimised staffing: Adjust rosters to reduce single-staff coverage on evenings and nights.
• Lean patient flow: Triage models, rapid-assessment zones and digital queuing to minimise waiting times and frustration.
• Visitor management: Clear guidelines on visiting hours, identification badges and consent for accompaniment.

5.6 Victim care and support

• Immediate First Aid: On-site medical and psychological first response for any assault victim.
• Peer support groups: Facilitated sessions where staff can share experiences, coping strategies and resources.
• Return-to-work plans: Paid recovery leave, adjusted schedules and follow-up counselling.

5.7 Community and stakeholder engagement

• Patient and family education: Brochures, videos or digital signage explaining hospital policies, expected wait times and respectful behaviour.
• Media partnerships: Positive storytelling about your safety initiatives to bolster public trust.
• Collaboration: Engage local law enforcement, civic leaders and patient-advocacy bodies to align on zero-tolerance approaches.

6. Measuring success and continuous improvement

Establishing a robust framework is only the first step. Embed a cycle of:

1. Data collection: Regularly update your incident-reporting database.
2. Analysis: Identify hotspots—times, units or processes most prone to violence.
3. Intervention: Deploy targeted training or environmental changes.
4. Evaluation: Survey staff safety perceptions and track key metrics (incident rates, reporting compliance, staff turnover).
5. Iteration: Refine policies and controls based on feedback and trends.

Benchmark against peer institutions or published best practices to ensure you’re raising the bar year over year.

7. Conclusion: Safety as a strategic imperative

Workplace violence in healthcare is neither random nor isolated. Whether driven by economic hardship, long waits, service dissatisfaction or broader social tensions, aggression toward clinicians poses a systemic threat to organisational health.

For HR and OHS leaders, the challenge is clear: develop a comprehensive, data-driven violence-prevention programme that blends policy, training, environmental safeguards and community engagement. Doing so not only protects your most valuable asset—your people—but also secures patient trust, operational resilience and long-term viability.

No clinician should fear for their safety while caring for others. By implementing the seven-pillar framework, healthcare organisations can turn the tide on violence, cultivating a culture where staff and patients alike feel secure, respected and empowered—regardless of geography or resource constraints.