Workplace Violence Intervention Research Workshop, April 5–7, 2000, Washington, DC1: Background, rationale, and summary

Introduction 

The Workplace Violence Intervention Research Workshop, held on April 5–7, 2000, in Washington, DC, was an outgrowth of plans made in the fall of 1995 by the University of Iowa Injury Prevention Research Center (UI IPRC). In October 1995, the UI IPRC and the National Center for Injury Prevention and Control (NCIPC) co-sponsored the National Violence Prevention Conference in Des Moines, Iowa. Violence in the workplace was a major theme at this conference, and the National Institute for Occupational Safety and Health (NIOSH) guided development of this theme.

Through this conference and discussions with the National Advisory Committee on Occupational Safety and Health (NACOSH) and the NIOSH Board of Scientific Counselors (NIOSH BSC), the need for intervention research in workplace violence became clear. James Merchant, who directs the UI IPRC Public Policy Core, also served on both the NACOSH and NIOSH BSC. Under Dr. Merchant’s leadership, the participants developed the intervention research workshop concept and included the concept in the UI IPRC’s 5-year competitive renewal grant application.

The Workplace Violence Intervention Research Workshop’s goal was to examine issues related to violence in the workplace and to develop recommended research intervention strategies to address this burgeoning public health concern. The workshop included 37 invited participants who represent diverse occupations within industry; organized labor; municipal, state, and federal governments; and academia (see Appendix I).

To control the number and affiliation of participants, we intentionally limited attendance at the April 2000 workshop to “by invitation only.” Although we capped attendance at a workable size of approximately 35 people, we sought to strike a balance among representatives of academia, government, industry, and organized labor. We think we achieved this objective but unfortunately not without having to tell numerous interested and well-qualified individuals that we could not accommodate them at the workshop.

Below, we summarize workplace violence–related issues and recommendations identified at the workshop. The articles in this theme issue present a more thorough discussion of each topic:

The extent of the problem 

Workplace violence garners increasing attention because of growing awareness of the toll violent events have on workers and workplaces. Despite existing research, significant gaps remain in our knowledge of the causes and potential solutions. Nor do we understand the extent of violence in the workplace or the number of victims.

In 1998, the Bureau of Labor Statistics recorded more than 700 homicides in workplaces in the United States. Although this number declined from a high of 1080 in 1994, homicide remains the second leading cause of fatal occupational injuries for all workers and the leading cause of fatal occupational injuries for women. The number of nonfatal assaults is less clear. The National Crime Victimization Survey, a weighted annual survey of 46,000 households, estimates that an additional 2 million people become victims of nonfatal injuries caused by violence while at work.

Addressing this problem is complicated because workplace violence has many sources and causes. Researchers have identified four categories of workplace violence. Most incidents fall into one of these categories:

These categories can be very helpful when designing strategies to prevent workplace violence because each type of violence may require a different approach, and some workplaces may be at higher risk for certain types of violence.

How often does workplace violence occur? Working with scattered and sketchy data makes it very difficult to study what works and what doesn’t work to reduce violence in the workplace. The best data available cover fatal events. Less information is available concerning injuries from nonfatal events, economic impact on businesses affected, lost productivity, and other costs. Various surveillance systems have different ways of defining “at work,” especially when ambiguities exist, such as with commuting and travel; with volunteers or students in a workplace; or with workplaces that are also residences (i.e., farms, home offices). Other reporting sources, such as police, physicians, workers’ compensation, or employee reports, may each capture only one element: the violent incident, the injury, the lost work time, or the setting (at work), but not the whole picture—trauma resulting from violence in the workplace. Finally, many nonfatal incidents simply go unreported, in part because no coordinated surveillance system exists to collect this information.

Prevention 

Three general approaches to preventing or responding to workplace violence are (1) environmental: lighting, entrances and exits, security hardware, and other engineering controls; (2) organizational/administrative: developing programs, policies, and work practices aimed at maintaining a safe working environment; and (3) behavioral/interpersonal: training staff to anticipate, recognize, and respond to conflict and actual violence in the workplace.

We do not have adequate research into the effectiveness of any of these three approaches for all types (I–IV) of workplace violence. For example, most research to date on criminal intent (Type I) in retail settings has focused only on environmental approaches. Despite some promising initial findings, more research is needed to help businesses properly protect their employees. Very little research has been conducted on behavioral/interpersonal or organizational/administrative approaches to prevention.

The Occupational Safety and Health Administration (OSHA) has developed voluntary guidelines for preventing workplace violence, including guidelines for specific industries (i.e., late-night retail, health care and social services, and those with community workers). However, the effectiveness of some of these recommendations has not yet been scientifically evaluated. Funding is urgently needed to evaluate these guidelines.

Of most concern, very little of the existing research has been conducted using rigorous scientific methodology to evaluate interventions for any type of workplace violence. The article in this issue by Peek-Asa, Runyan, and Zwerling1 describes a comprehensive review of research to date. The authors raised a variety of methodologic concerns with a large proportion of the research, including small sample sizes, few control groups (no randomized control groups), publication without peer review, and a lack of control for confounders, among other problems. This lack of rigorous research severely limits efforts to address the problem of violence in the workplace.

Laws and regulations 

Industry 

Some employers have responded to the problem of workplace violence by implementing measures to reduce the risk to their employees. Different industries have different kinds of risks depending on a multitude of factors, including the type of business, populations served, management, employees, location of the workplace, layout of the work area, and the relationship of that business with the community.

Some employers have attempted to increase safety in a number of areas, including

In workplaces with only infrequent incidents of violence, many employers find it difficult to decide which safety measures are most appropriate. This is especially true when faced with very expensive or labor-intensive interventions. Private security services and consultants abound, but scientific information is limited on which strategies work best for the various types of workplace violence. In addition, to avoid alarming their customers or tipping off potential perpetrators, businesses are often reluctant to publicly share their security methods, making it difficult to evaluate those methods. In industries such as health care and retail, in which nonfatal assaults are more frequent, it may be easier to test intervention strategies and develop data-collection systems.

Employers are often in a difficult position when it comes to responding appropriately to workplace violence. They must avoid over-reacting, under-reacting, or reacting in a way that exacerbates the problem. In addition, businesses may face serious legal implications with some security measures. For example, some kinds of pre-employment screening may be viewed as discriminatory. However, an employer could also face a “negligent hiring” lawsuit if the employer hires an applicant with a past history of violence.

Labor 

In the past decade, representatives of organized labor have pushed for recognition of workplace violence as an occupational hazard, not just a criminal justice issue. Of particular concern is the high rate of violent incidents affecting health care workers (Type II violence). On some psychiatric units, for example, assault rates on staff are more than 100 cases per 100 workers per year. Unions representing workers in the health care industry suspect that short staffing may play a role in this problem. However, to date we have little research into this issue.

Organized labor professionals or representatives have also expressed concern about workplace violence interventions that target employee behavior. Included in this category are “worker profiling” efforts, designed to screen out employees or potential employees viewed as at risk of violent behavior, and “zero-tolerance” policies. Profiling based on personal characteristics, say its critics, cannot effectively predict potentially violent behavior and may raise discrimination issues at the expense of violence prevention. Zero-tolerance policies may be unevenly enforced and do not address some of the root causes of violence such as stress or situations that lead to conflict.

In general, labor unions favor an increase in voluntary implementation of workplace violence intervention by employers, coupled with some mandatory provisions such as state legislation or a mandatory OSHA standard. Labor also recognizes the need for more research to determine which current OSHA guidelines or other interventions are most effective in preventing violent incidents in the workplace.

Recommended workplace violence research agenda 

Workshop participants met in three breakout group sessions to identify specific areas of research needed for each of the four types of workplace violence. Table 1 summarizes the intervention research questions identified.

Table 1. Research agenda for workplace violence intervention questionslegend

	Criminal intent (Type I):
	What are people doing now?
	What factors predict employers’ choices of stretegies to prevent workplace violence?
	How do employers choose consultants?
	Are current training programs effective?
	How extensive is voluntary compliance with OSHA guidelines?
	How effective are the OSHA guidelines?
	Do industry-specific environmental, organization/administrative, and behavioral/interpersonal control strategies work in high-risk industries?
	Client/customer on employee (Type II):
	What is the relationship between staffing levels, the organization of work, and violence in the health care setting?
	How extensive is voluntary compliance with OSHA guidelines in the health care industry?
	How effective are the OSHA guidelines?
	Do industry-specific environmental, organizational/administrative, and behavioral/interpersonal control strategies work in high-risk industries?
	Worker on worker (Type III):
	What are the relationships among corporate culture, the organization of the workplace, security, and worker-on-worker violence?
	How can surveillance data on threats and violence be improved?
	Are zero-tolerance policies and profiling effective?
	Personal relationships (Type IV):
	How big is the problem? What is the impact of domestic violence on the workplace? Add work-related questions to national domestic violence surveys to improve surveillance to estimate magnitude of the problem for fatal and nonfatal injuries.
	What strategies have been employed by labor and management to address this problem? How effective have they been?
	What is the legal situation? What duties do employers have under state laws? Do legal barriers exist to early interventions?
	What is the impact of including employers (both private and public) in coordinated community response coalitions? Can businesses play a critical role in changing social norms regarding domestic violence?

legend OSHA, Occupational Safety and Health Administration

The workshop participants recommended that NIOSH take the lead in developing a national research initiative to address these workplace violence–related questions. In the course of developing this extramural research program, NIOSH should consult with the NCIPC and the National Institute of Justice for technical assistance in their respective areas. The participants also agreed that all stakeholders in coping with workplace violence needed to join together to advocate for federal funding for this national initiative. Finally, participants recommended that the results of this workshop be widely disseminated through both the publication of the workshop proceedings in a peer-reviewed journal and through a print and electronic summary, targeting policymakers and program directors.

Conclusion 

Workplace violence affects us all. Not only do victims of violence bear the toll but so do their coworkers, families, employers, and every worker at risk of violent assault—in other words, virtually all of us. However, understanding the burden of workplace violence is still in its infancy. Much research work remains undone, particularly in surveillance and intervention. Without basic information on who is most affected and which preventive measures work in what settings, we cannot move forward in addressing this problem.

With the help of the broad coalition assembled for this workshop, we have identified a number of key issues for future research. However, research funding and a much broader understanding of the scope and impact of workplace violence are urgently needed to reduce the human and financial burden of this public health problem.