Policy Without Protection? A Surgeon’s Perspective on the Current Status of Workplace Violence Prevention in Healthcare

On June 28, 2000, Dr. Rodger C. Haggitt, a 57‑year‑old world‑renowned gastrointestinal pathologist and professor at the University of Washington Medical Center, was shot and killed in a murder‑suicide in his private office.¹ The news sent shockwaves through the medical community and the public at large. 

As a new surgical attending at the University of Washington, I often passed a plaque bearing Dr. Haggitt’s name outside the Department of Laboratory Medicine and Pathology. Reflecting on this tragedy raised important questions: how often do surgeons face workplace violence (WPV), what are the risk factors, and what efforts exist to mitigate them? 

In a survey among orthopedic surgeons, 77.1% reported experiencing WPV of any type, with verbal abuse being the most common (71.6%).² Healthcare workers (HCW), including surgeons, experience WPV rates that are substantially higher than workers in other industries. Between 2011 and 2013, nearly 75% of approximately 24,000 annual workplace assaults occurred in healthcare settings, with patients responsible for 89% of assaults against physicans.³

Specific risk factors increase the vulnerability of surgeons. Trauma surgeons and cancer surgeons report the highest prevalence of WPV among surgical subspecialities. Female surgeons are particularly at risk, reporting more WPV events per practice year (2.25 vs. 0.65 for male surgeons) and increased likelihood of physical threats and assaults from coworkers. Surgeons with 0-15 years in practice also experience high rates of violence.² The primary drivers of WPV against surgeons include patient non-compliance with procedures, communication issues, and dissatisfaction with care. Again, most incidents are verbal (71.9%), though physical violence accounts for 28.1% of cases.⁵

Addressing WPV requires simultaneous action at the individual, organizational, and legislative levels.³ Despite decades of research, no evidence-based intervention has been proven to reliably reduce WPV. Metal detectors – the most studied countermeasure – has resulted in large numbers of weapons being confiscated without a decrease in violence.³

De-escalation training is the most widely studied and recommended individual-level intervention, yet the evidence for its effectiveness in reducing violence is surprisingly weak. In a 2020 Cochrane systematic review, a paradoxical finding complicated interpretation in that training possibly increased awareness and willingness to report incidents or made workers more willing to engage in high-risk situations, thereby offsetting any true reduction in violence.⁶ Other specific recommendations, of varying efficacy, include zero-tolerance reporting policies, supervisor support, flagging charts of patients with a history of violence, improving staffing during high-volume periods, and legislative action making battery against healthcare workers a felony.³

In California, Senate Bill 1299 (SB 1299), signed into law in 2014, directed Cal/OSHA to develop the first enforceable, healthcare-specific workplace violence prevention standard in the United States, which took effect on April 1, 2017.^{7, 8} The regulation requires every covered healthcare facility to develop and implement a written Workplace Violence Prevention Plan (WVPP) that includes hazard assessments, mandatory incident reporting, detailed violent incident logs, employee training, post-incident support, anti-retaliation protections, and annual program review.⁷

In 2022, Doucette et al. conducted a rigorous assessment of SB 1299’s impact using Bureau of Labor Statistics data from 2011-2019 and found that the standard led to ~473 additional reported injuries in California in its first year, compared to the rest of the United States. Sensitivity analyses confirmed that non-violence-related injuries did not change in the same period, strongly suggesting the increase reflected improved reporting rather than a true rise in violence.⁸

SB1299 served as a model for subsequent state and federal legislative efforts, including the bipartisan Safety from Violence for Healthcare Employees (SAVE) Act introduced in the U.S. Senate in September 2023.⁴ The Joint Commission subsequently adopted similar WPV prevention requirements for all accredited hospitals and behavioral health organizations.⁹

So where are we today? In the existing framework of “reporting as mitigation,” the challenge remains that even where standards are mandated, there is wide variability in interpretation and implementation, which limits generalizability and consistent application across institutions.⁴ While regulatory frameworks provide structure, their effectiveness depends on strong leadership commitment and integration of complex prevention strategies.¹⁰ Further, ongoing data collection is essential to identify trends, evaluate interventions, and enable benchmarking across organizations.⁹ Whether the scope and extent of the problem of WPV has been adequately defined and interventions measured in order to develop more effective and targeted strategies remains uncertain. 

Author bio:

References:

1. Barker K, Rivera R, Shors B. UW shooting victim ‘was widely regarded all over the world.’ Seattle Times, 29 June 2000, ;https://archive.seattletimes.com/archive/20000629/4029286/uw-shooting-victim-was-widely-regarded-all-over-the-world.
2. Workplace Violence in Orthopaedic Surgery: A Survey of Academy of Orthopaedic Surgeons Membership. The Journal of the American Academy of Orthopaedic Surgeons. 2024. Ponce B, Gruenberger E, McGwin G, Samora J, Patt J.
3. Workplace Violence against Health Care Workers in the United States. The New England Journal of Medicine. 2016. Phillips JP.
4. The Growing Burden of Workplace Violence Against Healthcare Workers: Trends in Prevalence, Risk Factors, Consequences, and Prevention – A Narrative Review. EClinicalMedicine.2024. O’Brien CJ, van Zundert AAJ, Barach PR.
5. The Frequency of Workplace Violence Against Healthcare Workers and Affecting Factors. PlosS One. 2023. Sari H, Yildiz İ, Çağla Baloğlu S, Özel M, Tekalp R. T.
6. Education and Training for Preventing and Minimizing Workplace Aggression Directed Toward Healthcare Workers. The Cochrane Database of Systematic Reviews. 2020. Geoffrion S, Hills DJ, Ross HM, et al.
7. Resource Document on Prevention of Patient Assaults on Mental Healthcare Employees in Psychiatric Healthcare Settings. American Psychiatric Association (2025). 2025. Jose A. Arriola Vigo MD MPH, Erick H. Cheung MD, Suliman El-Amin MD, et al.
8. Nonfatal Violence Involving Days Away From Work Following California’s 2017 Workplace Violence Prevention in Health Care Safety Standard. American Journal of Public Health. 2022. Doucette ML, Surber SJ, Bulzacchelli MT, Dal Santo BC, Crifasi CK.
9. R3 Report 42: Workplace Violence Prevention in Behavioral Health Care and Human Services. Joint Commission (2023). 2023. The Joint Commission.
10. Workplace Violence in Healthcare Settings: A Scoping Review of Guidelines and Systematic Reviews. Trauma, Violence & Abuse. Fricke J, Siddique SM, Douma C, et al.