Using patient engagement to build trust 

Workplace violence has long been prevalent in healthcare, but the last several years have shown an alarming spike with incidents doubling between 2018 and 2022.[1] Moreover, this surge doesn’t account for incidents that go unreported, which is likely a significant number.  

Workplace violence has serious ramifications for the healthcare industry, contributing to staff burnout,[2] depression,[3]  turnover, and injuries. It is an occupational risk that is unmatched in any other profession. In fact, healthcare workers are five times as likely to suffer a workplace violence-related injury than workers overall, surpassing even police officers in rates of nonfatal injuries.1,[4] According to a 2024 report by National Nurses United,[5] eight out of ten nurses were subjected to workplace violence in the last year, and around half said it had increased on their unit. 

Despite this concerning trend, healthcare leaders can support their staff in many ways. Enhanced security, de-escalation training, and zero-tolerance policies are non-negotiable, but leaders can go further. One underutilized strategy is prevention by promoting patient engagement. When patients understand and become partners in their care, they are less likely to perpetrate violence.  

Why is Workplace Violence Prevalent in Healthcare? 

Reports describe elevated violence in healthcare as far back as the 1990s. Patients come into healthcare settings with high emotions — often experiencing fear, loss of control, and anger. They may feel that doctors should be able to cure them and find treatments inadequate. They may feel that their voice isn’t heard, mistrust staff, or feel that they aren’t being treated with respect. Mental illness can play a role, as can confusion due to health conditions or the influence of drugs and alcohol.  

While violence can occur between staff, a recent Premier survey revealed that more than half of assaults in healthcare are from combative patients.[6] The trend in increased violence follows the timing of the COVID-19 pandemic, and it’s no coincidence. Pandemic-related stresses put additional pressure on an environment that was already emotionally charged — public trust in healthcare workers dropped from 71% in April 2020 to 40% by January 2024.  

This lack of trust showcases a major divide between patients and providers, but also highlights significant potential. Healthcare institutions prioritizing patient engagement can rebuild trust and enhance partnership across the healthcare system.  

The Power of Patient Engagement 

Patient engagement means informing patients about their care and involving them in decisions to create a true partnership. Engagement leads to a host of benefits, including improved safety and quality, along with better health outcomes.[7] Patients have higher satisfaction scores [8] and are less likely to seek lawsuits [9] if they are well engaged. It stands to reason that increased engagement would lead to less violence, too.  

Research supports this conclusion. A study that examined the relationship between engagement and violent tendencies found that patients who were more engaged and had a better understanding of their care, rights, and responsibilities were much less likely to have violent intentions. These patients were also much more likely to report they trusted their doctor.[10]  

How to Enhance Engagement 

The key to enhancing patient engagement is informing and involving patients. While engagement needs to be built into all points of the patient journey, hospitalization is a particular opportunity. Engagement created through an excellent hospital experience can carry forward to future interactions with the healthcare system.  

According to the Agency for Healthcare Research and Quality’s Guide to Patient and Family Engagement in Hospital Quality and Safety, promoting engagement during a hospital stay revolves around clear communication.  

Here are some tips:  

• Encourage participation. Examine the language you use to communicate with patients and their family members, both verbal communications and written materials. Ensure that you encourage them to participate as advisors and partners in the care team. 

• Promote communication. Beginning with admission, promote clear communication between patients, their family members, and all members of the care team. Use clearly written printed materials to promote understanding and use clear language when speaking. Build in systems and checkpoints to ensure patients understand their care. 

• Involve patients in care continuity. Use change of shift reports at the bedside for safe care continuity and to keep patients informed about who is caring for them.   

• Start early with discharge planning. Plan for discharge throughout the hospital stay and involve patients and family in after-care decisions. 

• Use high-quality education. Educate patients frequently throughout their stay to promote information retention and understanding of their plan of care.  

The patient education materials from Patient Guide Solutions encourage participation at every step with clear language to promote understanding. When patients know what to expect and understand the reasons behind medical recommendations, it improves engagement, satisfaction, and outcomes.  

Managing Workplace Violence: More Strategies 

Workplace violence in healthcare is a complex issue with many contributing factors. The best strategy will be a combination of multiple approaches. Here are some more strategies to consider: 

• Implement a zero-tolerance policy for violence institution-wide and communicate it clearly. 

• Invest in security personnel and systems to prevent violence and protect staff.  

• Support legislation aimed at increasing protection for healthcare workers. 

• Make reporting easy and blame-free.  

• Offer follow-up counseling. In one study, organizations that made follow-up counseling available helped employees avoid burnout after violent incidents.[3] 

• Encourage a culture of patient safety. Research shows a patient safety culture —including teamwork across units and clear communication at handoffs — was associated with lower rates of workplace violence. [11]  

Workplace violence is a critical issue that healthcare leaders can’t afford to ignore, but patient engagement can have a big impact. Healthcare providers can build patient trust with clear communication and respect. When patients are involved in their care and understand what’s happening, they approach healthcare as a partnership, rather than with antagonism that can lead to violent conflict.  

References:

[1] Workplace Violence in Healthcare, 2018: U.S. Bureau of Labor Statistics. Bureau of Labor Statistics. Published November 17, 2022. Accessed August 13, 2024. https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm

[2] Prioritizing our Healthcare Workers: The Importance of Addressing the Intersection of Workplace Violence and Mental Health and Wellbeing | Blogs | CDC. Cdc.gov. Published May 29, 2024. Accessed August 14, 2024. https://blogs.cdc.gov/niosh-science-blog/2024/05/29/hcw_violence_mh/

[3] Vincent-Höper S, Stein M, Nienhaus A, Schablon A. Workplace Aggression and Burnout in Nursing—The Moderating Role of Follow-Up Counseling. International Journal of Environmental Research and Public Health. 2020;17(9):3152-3152. doi:https://doi.org/10.3390/ijerph17093152

[4] Cross A. Healthcare workers are more likely than law-enforcement officers to have injuries and illnesses that keep them away from work – Kentucky Health News. Uky.edu. Published August 15, 2023. Accessed August 14, 2024. https://cidev.uky.edu/kentuckyhealthnews/2023/08/15/health-care-workers-are-more-likely-than-law-enforcement-officers-to-have-injuries-and-illnesses-that-keep-them-away-from-work/

[5] NNU report shows increased rates of workplace violence experienced by nurses. National Nurses United. Published February 5, 2024. Accessed August 13, 2024. https://www.nationalnursesunited.org/press/nnu-report-shows-increased-rates-of-workplace-violence-experienced-by-nurses

[6] Premier Survey Reveals Key Insights on Workplace Violence Incidents…. Premier. Published 2023. Accessed August 14, 2024. https://premierinc.com/newsroom/blog/premier-survey-reveals-key-insights-on-workplace-violence-incidents-in-healthcare

[7] Guide to Patient and Family Engagement in Hospital Quality and Safety. Content last reviewed March 2023. Agency for Healthcare Research and Quality, Accessed September 14, 2023 https://www.ahrq.gov/patient-safety/patients-families/engagingfamilies/index.html

[8] Al-Nafea A, Alshargi O, Algethami M. Patients and family members perspectives on the use of bedside whiteboards and its implication to treatment outcomes and patient satisfaction: A pilot survey in general and tertiary hospitals in Makkah, Saudi Arabia. F1000Res. 2022;11(150):150. doi:10.12688/f1000research.74088.1

[9] Section 2: Why Improve Patient Experience? Ahrq.gov. Accessed October 24, 2023. https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/2-why-improve/index.html

[10] Çağatay A, Kızılkaya S. A Relational Analysis of Violence inflicted on Healthcare Professionals. Journal of International Health Sciences and Management. October 2023;9(18):22-26. doi:10.48121/jihsam.1299036

[11] Rebecca K. Patient Safety Culture: The Impact on Workplace Violence and Health Worker Burnout - Sinhye Kim, Rebecca Kitzmiller, Marianne Baernholdt, Mary R. Lynn, Cheryl B. Jones, 2023. Workplace Health & Safety. Published 2023. Accessed August 14, 2024. https://journals.sagepub.com/doi/10.1177/21650799221126364