Academic journal article Australian Health Review

Prevalence and Prevention of Workplace Aggression in Australian Clinical Medical Practice

Academic journal article Australian Health Review

Prevalence and Prevention of Workplace Aggression in Australian Clinical Medical Practice

Article excerpt

Introduction

This report describes the outcomes of a study investigating the prevalence of workplace aggression experienced by Australian doctors in clinical practice, and the implementation of aggression prevention and minimisation strategies in their place of work. Recent media reports of the murder and violent assault of medical practitioners and the ongoing problems of aggression directed towards Australian health workers have publicly highlighted the potential threat that workplace aggression poses to the provision of healthcare.1-6 Workplace aggression is a worldwide phenomenon. It has been linked to impaired physical and mental health, including longer-term trauma, and these effects can extend to witnesses of aggression towards others through the development of a 'climate of fear'.7-11

There is a growing body of international research highlighting the effects of workplace aggression in medicine, which may extend to influencing decisions about remaining in specific practice locations or in clinical practice.12-23 This may be of particular concern where there are existing challenges to the recruitment and retention of medical practitioners. Workplace aggression in medical practice is an important public health issue, extending beyond the physical and psychological consequences for individual clinicians to broader effects on the profession and, ultimately, the delivery of health services.

To date, there has been only limited research on workplace aggression in Australian medical practice. Most studies have targeted General practitioner (GP) experiences of patient aggression.24-29 Overall, ~60-70% of GPs have reported experiencing some form of aggression, with non-physical forms being the most prevalent and physical forms being relatively uncommon.25,26,30 These findings broadly reflect the outcomes of more general studies of Australian health workers that have included medical practitioners.31,32 With the exception of smallscale studies investigating medical student experiences of sexual harassment,33 harassment and stalking of plastic surgeons,34 and the workplace aggression experiences of a broader range of health professions in various care settings,31,32 there is a dearth of research addressing workplace aggression towards medical practitioners other than in general practice settings or from nonpatient sources.

The application of workplace aggression prevention and minimisation measures, such as policies and protocols, risk assessment and management, and environmental design, have also received little attention in medical literature. There is a paucity of research focussing on the implementation of aggression prevention and minimisation strategies in Australian medical practice settings, despite the initiation of several important policy responses from State governments and professional organisations.35-38 Although the limited research base may partly reflect an emerging recognition of the extent and effects of workplace aggression experienced by medical practitioners, it may also reflect the lack of provisions directly addressing workplace aggression in prevailing Occupational Health and Safety statutes.

All Australian State governments have legislative provisions addressing criminal violence, which may provide a retributive response for more extreme acts of aggression directed towards clinicians in their place of work. As highlighted in a recent Productivity Commission Report,39 however, psychosocial hazards are given considerably less attention in Occupational Health and Safety statutes than are physical hazards in the workplace, with only Queensland and Western Australia providing a code of practice on bullying, and Western Australia being the only jurisdiction to have a code that specifically addresses workplace aggression. Furthermore, there are no comprehensive data sources on the prevalence of workplace aggression in Australia, either in individual States or nationally. Although many health service organisations have wellestablished workplace incident reporting and data management systems, workplace aggression has been considered to be grossly underreported by health workers in Australia. …

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