Read this article if you are a compliance officer, risk manager, or healthcare administrator in an ambulatory care practice, federally qualified health center, or rural health center and have responsibility for developing your organization’s workplace violence prevention program or complying with state reporting requirements.
Did you know workplace violence is increasingly prevalent in the healthcare industry? If your organization doesn’t have a plan, it might be time to consider one. This article addresses the definition and types of workplace violence, regulations, plan elements, and other considerations.
Workplace violence in healthcare by the numbers
Data from the US Bureau of Labor Statistics shows that prior to the COVID-19 pandemic, the incidence rate of nonfatal workplace violence to full-time healthcare workers was 10.4 per 10,000 in comparison to an all-worker rate of 2.1 per 10,000. In 2018, healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence.
Post-pandemic, the Bureau of Labor Statistics reported that healthcare and social assistance workers experienced the highest counts and annualized incidence rates for workplace violence of any private industry sector over the two-year period from 2021 – 2022. There were 41,960 total nonfatal cases of workplace violence requiring days away from work, job restriction, or transfer in the healthcare and social assistance industry over this time, accounting for 72.8% of all cases in private industry over the two-year period. These cases occurred at an annualized incidence rate of 14.2 cases per 10,000 full-time workers.
How is workplace violence defined?
In its 2024 Comprehensive Accreditation Manual for Behavioral Health Care and Human Services Glossary, The Joint Commission (TJC) defined workplace violence as, “Any act or threat occurring in the workplace that can include any of the following:
- Verbal, nonverbal, written, or physical aggression
- Threatening, intimidating, harassing, or humiliating words or actions
- Bullying
- Sabotage
- Sexual harassment
- Physical assaults
- Other behaviors of concern involving staff, licensed practitioners, patients, or visitors”
How is workplace violence classified?
The Institute for Healthcare Improvement (IHI) is a leading, globally recognized, nonprofit healthcare improvement organization that has been applying evidence-based quality improvement methods to meet healthcare challenges for more than 30 years. In its Framework for Standardized Data Collection of Workplace Violence Incidents in Health Care, the IHI classifies workplace violence incidents into five distinct categories:
- Type 1: The offender has no connection to the workplace or its employees.
- Type 2: The offender is a customer or patient associated with the workplace or its staff.
- Type 3: The offender is a current or former employee of the organization.
- Type 4: The offender maintains a personal relationship with employees but has no ties to the workplace itself.
- Type 5: Violence motivated by ideological, religious, or political beliefs targeting a healthcare facility, its personnel, or property. This type is carried out by extremists or groups driven by their convictions.
Have you developed a workplace violence prevention program?
Key aspects of your healthcare organization’s or practice group’s program should include:
- Conducting an environmental risk assessment
- Contacting local law enforcement to build or enhance relationships
- Performing trend analysis of reported incidents by site, location on the premises, day of week/time of day, and classification type
- Obtaining feedback from staff: What do they consider to be reportable? This will help you develop meaningful training
- Recognizing staff champions while building the program
- Testing your reporting system
- Providing staff training, soliciting anonymous feedback, and identifying any unresolved questions
- Identifying program gaps and developing remediation strategies
- Keeping executive leadership and the Board regularly informed about the program and emerging trends or needs
Which states require employer-sponsored workplace violence prevention programs?
Two factors have led states to establish requirements for healthcare organizations to develop workplace violence prevention programs. The first reason for state action: There has been no corresponding action by the federal Occupational Safety and Health Administration (OSHA). Secondly, the proposed Workplace Violence Prevention for Health Care and Social Service Workers Act has not been enacted by Congress.
As of January 2026, 20 states require mandatory workplace violence prevention plans or workplace safety* plans. These are Arizona, California, Connecticut, Illinois, Hawai’i, Kentucky*, Louisiana, Maine*, Maryland, Minnesota, Nevada, New Hampshire, New Jersey, New York, Ohio, Oregon, Texas, Vermont, Virginia, and Washington.
In addition, seven states now require mandatory reporting of workplace violence incidents to a designated state agency. These states are California, Connecticut, Maryland, Montana, North Carolina, Oregon, and West Virginia.
BerryDunn can help
Has your healthcare organization developed a workplace violence prevention plan? If yes, has it been reviewed recently? How do you train your staff to respond when a situation escalates? How do you analyze incidents? Do you have questions about your healthcare organization’s compliance with state requirements for submitting its plan? Does your state require you to submit incident reports to a designated state agency?
Our healthcare compliance team can help. We incorporate deep, hands-on knowledge with industry best practices to help your organization manage compliance and revenue integrity risks. Learn more about BerryDunn’s healthcare compliance consulting team and services.
Additional resources for workplace violence prevention planning: