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Workplace Violence in the Health Sector Workplace violence in the health sector Relationship between work stress and workplace violence in the health sector by Vittorio di Martino Geneva, 2003 ILO/ICN/WHO/PSI Workplace violence in the health sector Relationship between work stress and workplace violence in the health sector by Vittorio di Martino * [email protected] Geneva, 2003 * Vittorio di Martino is an international consultant who specializes in health and safety at work, enterprise development and organizational well-being. He is Visiting Professor in Employment Policies at the University of Bath and Senior Research Fellow at UMIST in Manchester, UK. His recent books include Work organization and ergonomics, ILO, Geneva, 1998; Violence at work, ILO, Geneva, 1998 (1st ed.), 2000 (2nd ed.); The high road to teleworking, ILO, Geneva, 2001. Foreword Stress and violence are increasingly noted in health sector workplaces. Doctors, nurses and social workers are all high on the list of occupations with serious stress levels, while violence in the health sector constitutes almost a quarter of all violence at work. The enormous cost of work stress and violence at work for the individual, the workplace and the community at large is becoming more and more apparent. Employers and workers are equally interested in the prevention of violence and severe stress at the workplace. In 2000, the International Labour Office (ILO), the International Council of Nurses (ICN), the World Health Organization (WHO) and Public Services International (PSI) launched a joint programme in order to develop sound policies and practical approaches for the prevention and elimination of violence in the health sector. When the programme was first established and information gaps were identified, it was decided to launch a number of country studies as well as cross-cutting theme studies and to conclude by drafting guidelines to address workplace violence in the health sector. A list of the Joint Programme working papers is included in the appendix to this document. This study was carried out in the framework of the Joint Programme in 2001. It presents an analysis of the relationship between work stress and workplace violence in the health sector. In response to the growing concern about work stress and workplace violence in all services sectors, the ILO’s Sectoral Activities Department further commissioned a series of working papers in preparation for the Meeting of Experts to be held from 8 to 15 October 2003 in Geneva, to consider and review a draft and to adopt a Code of practice on violence and stress at work in services: A threat to productivity and decent work. That Meeting is part of the continuing work of the department on 22 sectors of economic activity, of which the health sector is one. More information is available online at http://www.ilo.org/public /english/dialogue/sector/themes/violence.htm . It is hoped that this study can help to promote action to tackle violence and stress in health sector workplaces, and complement work being carried out by the ILO, ICN, WHO, PSI and other organizations at various levels to assist in reducing or eliminating stress and violence at workplaces in services sectors around the world. Steering Committee of the ILO/ICN/WHO/PSI Joint Programme on Workplace Violence in the Health Sector WP/Formatted only/health.doc iii Contents Page Foreword ........................................................................................................................................... iii Executive summary ........................................................................................................................... vii Part I. Understanding concepts.......................................................................................................... 1 1. Definition of stress and violence............................................................................................. 1 1.1. Stress ............................................................................................................................ 1 1.2. Violence........................................................................................................................ 1 2. Stress as a source of workplace violence ................................................................................ 3 2.1. The Karasek model ....................................................................................................... 3 2.2. How stress generates violence ...................................................................................... 4 2.3. Applying the model to the health sector ....................................................................... 5 3. Workplace violence as a source of stress................................................................................ 6 3.1. The Chappell – di Martino model................................................................................. 6 3.2 How violence generates stress............................................................................ 7 3.3. Applying the model to the health sector ....................................................................... 7 4. Cumulative effects of stress and violence............................................................................... 10 4.1. Magnitude of the problem ............................................................................................ 10 4.2. Broader inter-connections............................................................................................. 11 Part II. Specific implications for the health sector ............................................................................ 12 5. Sector-specific environment and change processes as causes of stress and violence ........... 12 5.1. Identifying the relevant factors..................................................................................... 12 5.2. Selecting common key issues ....................................................................................... 14 6. Impact on working conditions and employment..................................................................... 15 6.1. Personal/interpersonal issues ........................................................................................ 15 6.2. Gender issues ................................................................................................................ 18 6.3. Environmental issues .................................................................................................... 19 6.4. Organizational issues .................................................................................................... 20 6.5. Change issues................................................................................................................ 22 7. The impact on costs................................................................................................................. 24 7.1. Direct and indirect costs ............................................................................................... 24 7.2. Costs in the health sector .............................................................................................. 25 WP/Formatted only/health.doc v Part III. Approaches to coping .......................................................................................................... 26 8. In search of the high road........................................................................................................ 26 8.1. Prevention..................................................................................................................... 26 8.2. Participation.................................................................................................................. 26 8.3. Diffusion of best practices ............................................................................................ 27 References ......................................................................................................................................... 29 Appendix ........................................................................................................................................... 33 vi WP/Formatted only/health.doc/v2 Executive summary Based on an extensive literature analysis, this study tackles the topical issues of stress and violence at work in the health sector. The paper highlights the magnitude of the problem; the key factors at stake; the way such factors interrelate; their impact on working conditions and employment; and the cost to the individual, the enterprise and the community. Part III of the paper offers innovative approaches to coping effectively with such problems. Stress and violence are widespread in the health sector. Doctors, nurses and social workers are all high on the list of occupations with serious stress levels while violence in the health sector constitutes almost a quarter of all violence at work. When stress and violence interact at the workplace, and they often do, their negative effects cumulate in an exponential way, activating a vicious circle which is very difficult to break. Focusing on the interrelationship between stress and violence at the workplace, the study identifies negative stress as a cause of violence. The more negative stress is generated the greater the likelihood of violence, up to the most extreme forms such as burnout, suicide and homicide. The connection is not, however, an automatic one. The vast majority of people under severe negative stress – and this happens
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