National Council on Compensation Insurance analyzes the uptick in workplace violence, driving factors and the industries most affected.
By Matt Schutz (from left), Valeria Lara and Mike Lambesis, members of the Actuarial & Economic Services team at the National Council on Compensation Insurance.
Workplace violence spans a wide range of behaviors, from threats and verbal abuse to physical assault and homicide.
Although the issue persists across industries, the National Council on Compensation Insurance’s recent three-part research paper series on workplace violence found that assault cases are most heavily concentrated in the health care and social assistance sector, as defined by the North American Industry Classification System.
When health care occupations are combined, they account for the largest overall share of violence-by-others cases, underscoring the central role of patient-facing health care work in the national violence-by-others burden. In fact, the number of annual nonfatal violence-by-others cases within this sector is 10 times the next largest, retail trade; frequent, direct interaction with patients and clients elevates exposure relative to other sectors.
According to the most recent US Bureau of Labor Statistics assault case data, workplace assaults overall have shown an upward trend: They increased at an annualized rate of 5.3% per year from 2011 through 2021-22, outpacing the nationwide aggravated assault rate over the same period. Similarly, the assault share of all Days Away From Work (DAFW) cases in health care and social assistance doubled from 4.8% in 2011 to 9.6% in 2019.
The COVID-19 pandemic was an exception to this trend. Assault shares fell sharply in 2020 and 2021-22, not because assaults declined, but because in 2020 the number of cases of individuals too ill to work more than quadrupled across all industries from the prior year, with respiratory illnesses accounting for 78% of the total. Assault shares, meaning the percentage of DAFW cases attributable to assaults, declined not because the number of assaults decreased, but because the number of other types of DAFW cases increased.
The overall workplace violence trend in health care is driven in part by frequent, direct interactions with patients. Hospitals and nursing/residential care facilities together account for 75.1% of all violence-by-others cases in the sector. General medical and surgical hospitals alone account for 30.5% of the sector total, making them the single largest contributor by count.
At the same time, the highest rates are concentrated in behavioral-health and residential-care settings rather than in general acute care: Psychiatric and substance abuse hospitals post a rate of 138.8 cases per 10,000 full-time equivalent (FTE) workers, while residential intellectual and developmental disability, mental health and substance abuse facilities post a rate of 60.9.
Fatalities tell a different story from assaults, particularly in the health care industry. First, homicides have remained essentially flat over time, in contrast to both national homicide levels and the steady growth in nonfatal assaults.
The cases that do occur are concentrated in a narrow set of job environments — public-facing roles, cash-handling settings, lone-worker situations, and enforcement duties — which is why sales, food service, transportation and protective-service occupations account for most workplace homicides.
Workplace homicides are also predominantly committed by criminal assailants with no prior work relationship to the victim, rather than being due to escalations of routine workplace interactions like a patient attacking their health care provider.
Women and men participate in the labor force in roughly equal numbers, yet women account for a disproportionate share of assault cases and experience assault rates nearly three times higher than men. Much of this disparity reflects sector composition because women are heavily represented in health care and social assistance. In contrast, about 83% of workplace homicide victims are men. Protective-service and transportation roles — two groups with some of the highest exposure to robbery, enforcement duties, late-night, or public-facing work — are more than three-quarters men, and this concentration helps explain why men account for most workplace homicide victims.
Workplace violence can be an occupational hazard, particularly in sectors such as health care, retail, protective services and education. Federal agencies recommend a layered approach: a comprehensive written prevention program, worksite risk assessments, environmental and engineering controls, administrative controls, and employee training, all monitored and updated over time.
With a century-long legacy, the National Safety Council is a global center for safety expertise. Let's work together to align resources. We look forward to learning about ways we can join efforts to expand safety everywhere!
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