Wicked problem of violence in healthcare

A James Cook University researcher says the problem of violence in healthcare is extremely difficult and needs a commitment from government all the way down to frontline staff if it is going to be solved.

Alycia Jacob is a PhD student and the lead author of a study on the problem. She says research suggests more than six out of every 10 healthcare workers globally have experienced violence at work – and that is probably a conservative figure.

“One problem with conducting this research is healthcare workplace culture and the expectation that ‘minor’ aggression and violence is a part of the job – which impacts on the willingness of healthcare workers to report violent incidents.

“Despite specific campaigns against violence in healthcare settings such as those in Australia and the UK, we still see generally that rates of violence against healthcare workers have not decreased internationally over the past 35 years,” said Ms Jacob.

She said violence in any form can be challenging to manage but in health care, with vulnerable patients and regularly occurring emotionally fraught situations, it is particularly volatile and challenging.

“The complex nature of violence arising in health-care settings has many of the hallmarks of what academics call a ‘wicked’ problem. Wicked problems cannot be solved using pure science, and require complex, multi-faceted solutions,” said Ms Jacob.

She said a review has been conducted into interventions for reducing violence in health care, analysing the effectiveness of organisational strategies. These include bundled interventions and specific diverse interventions, such as music therapy, humour, structured risk assessments and cultural change programmes.

The review found that while many interventions have been trialled, few were tested using high quality methods and there was little evidence of violence reduction.

“Because healthcare is a complex system it’s important to acknowledge the need to consider broader systematic factors, rather than micromanaging individual or group behaviours. This may include moving the responsibility of violence prevention away from individual workers,” said Ms Jacob.

She said thinking about violence in health care in this way illustrates the need for multi-faceted approaches to violence prevention, including a better understanding of those perpetrating violence and the impact on health-care professionals and systems.

“The complexity of violence in health care can only be managed through a coordinated, multilayered approach that incorporates not only individual healthcare workers but also healthcare management and governmental policy. It won’t be easy or quick, but it needs to be done.”

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