I recently returned from the ASHRM (American Society of Healthcare Risk Managers) Annual Conference. We were there with our booth to promote our training program and talk with the represented hospitals, physician groups, risk insurers, etc., about how our offerings can help organizations prevent workplace violence and its associated costs.
It’s inspiring to gather with so many committed professionals with a passion for their work. This year’s theme was “Everyone Is a Risk Manager.” Our booth was near the “bite-sized learning” stage—with 20-minute presentations on various topics. We heard about fall prevention programs and daily safety huddles aimed at improving communication, ASHRM research grant opportunities, and challenges and solutions for implementing an ERM program.
Puzzling Comments and Perplexing Conversations
A few sessions scattered throughout the days focused on workplace violence risk, but I was still surprised to hear so many people say they were not really providing any training to prevent and manage workplace violence: “We’re a physician’s practice . . .”; “it’s costly so I get a lot of pushback”; “we don’t have a behavioral health unit”; “oh, that? That’s security’s responsibility.”
These comments were echoed by a second set of questions that were equally puzzling to me:
Me: “Are you familiar with CPI?”
Risk Manager: “Um . . . no. What do you do?”
Me: “We provide training in workplace violence prevention, safely managing assaultive and disruptive behavior.”
Risk Manager: “Oh, there’s a huge need for that right now,” and they began to browse our resources.
And then, “Excuse me. Do you have anything for patients?”
Me: “Yes, that’s what we do—prevent workplace violence.”
Repeating these discussions left me feeling a bit confused. Then I realized people are differentiating what they consider “workplace violence.” You see, I think many people would say that workplace violence is when someone enters your workplace and perpetrates violence, like the Aurora, CO movie theater shooting, or last week’s shooting at the mall in New Jersey, or the recent naval yard shooting.
Workplace Violence Occurs Along a Continuum
True, an individual entering your healthcare facility with a weapon is an act of workplace violence and we need to prepare and practice to respond to such situations. However, what we are losing sight of is the violence that nursing staff, security, and other hospital employees deal with daily. At CPI, we talk about a continuum of workplace violence.

Workplace violence occurs along a continuum of behaviors that may be present in any workplace on any given day. Sadly, many workplaces chronically struggle with some of these behaviors like disrespect or harassment. Other workplaces, by nature of their services, are also at risk for behaviors like verbal assaults and physical aggression. We have seen and heard story after story of bullying that escalated to physical aggression; we have seen and heard story after story of how an individual, who was verbally assaulting someone, threatened the person and then followed through with aggression such as retrieving a gun and returning to a facility to shoot someone.
Many of the healthcare facilities I work with indicate that risk claims from workplace violence are in the top five— if not three—highest categories of claims. Their systems pay out hundreds of thousands of dollars in worker’s compensation claims annually, stemming from incidents linked to workplace violence. Hospital systems are committing many resources to reduce risk claims associated with slips, trips, and falls; patient handling; or needle sticks and infection control—also high-risk claims categories—but I continually hear that it’s too costly to train staff to prevent workplace violence or manage it as it occurs.
Preventing workplace violence is a multi-faceted task
There may be things you can prevent using hardware or software, but largely, workplace violence reduction comes when we equip staff with the “soft skills” of awareness, verbal de-escalation, personal safety, debriefing strategies, and maybe physical restraint skills. Training is a necessary step in “engineering out” workplace violence. Investing in staff skills in this important subject can mitigate claims costs related to workplace violence. In some cases, reducing one claim could cover the costs of training all high-risk employees in your hospital.
So, the next time you ask for training dollars and are told the hospital can’t afford it, I encourage you to ask if your hospital can afford not to do it. Can you afford to allow another head injury due to a patient assault? Can you afford to manage the negative press when your facility isn’t known for resolving conflict well? Can you afford staff shortage because bullying behaviors dishearten new staff? Patient safety and staff safety are inherently intertwined. Equipping staff with the skills to recognize and respond to potential workplace violence might not prevent every incident; but many hospitals have significantly reduced the risks associated with workplace violence by investing in their staff.
Read more about workplace violence prevention training on our Knowledge Base page.