Addressing Mistreatment of Providers by Patients and Family Members as a Patient Safety Event

Abstract

OBJECTIVE: Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment. METHODS: In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children’s hospital between 2018 and 2019. We used multivariable logistic regression to examine the effect of training on the outcomes of interest and whether this association was moderated by staff role. RESULTS: We received 309 baseline surveys from 72 faculty, 191 nurses, and 46 residents, representing 39.1%, 27.1%, and 59.7%, respectively, of eligible HCPs. Verbal threats from patients or family members were reported by 214 (69.5%) HCPs. Offensive behavior was most commonly based on provider age (85, 28.5%), gender (85, 28.5%), ethnicity or race (55, 18.5%), and appearance (43, 14.6%) but varied by role. HCPs who received training had a higher odds of reporting knowledge, self-efficacy, and experiencing offensive behavior. Incident reporting of mistreatment increased threefold after the intervention. CONCLUSIONS: We report an effective organizational approach to address mistreatment of HCPs by patients and family members. Our approach capitalizes on existing patient safety culture and systems that can be adopted by other institutions to address all forms of mistreatment, including those committed by other HCPs.

Kindness Isn’t Just about Being Nice: The Value Proposition of Kindness as Viewed through the Lens of Incivility in the Healthcare Workplace

“…Hatfield and colleagues recently documented that, at an academic medical center, verbal threats from patients or families were reported by 70% of healthcare practitioners within the previous year, with threats of physical harm or actual physical harm relayed by 23% and 12% of HCPs [ 63 ]. In another survey study at a large academic medical center, Meese and colleagues reported that approximately 10% of all clinical staff reported patient mistreatment as a major stressor, which was experienced most by nurses (19%).…”

Responding to Patients and Society in Distress

“…Similarly, a recent single-site study 10 indicated that 87% of registered nurses experienced incidents of workplace violence, of which more than 96% were patient related. Another study, 11 in 2018 and 2019, found that more than 60% of responding hospital employees had been victims of physical violence by patients, and 12% had experienced actual physical harm.…”