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Workers Compensation Issues

Workplace Violence Assessment and Response

Mark Walls , Kimberly George | September 7, 2018

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Workplace violence is a daily threat to workers in many industries. Aside from mass shootings, which grab headlines, more than 2 million workers are victims of violence every year. The issue is a challenge for employers striving to maintain a safe working environment for their employees.

By understanding the scope of the problem, the underlying reasons for violence, and the types of violence that threaten specific industries and workplaces, organizations can make a significant impact on reducing incidents against their workers.

During a recent Out Front Ideas with Kimberly and Mark webinar, we had the following two prominent experts join us to discuss this very challenging issue.

  • Bub Durand, practice leader of medical group support services for Kaiser Permanente's Northern California region
  • George Vergolias, Psy.D., vice president and medical director for R3 Continuum

Scope of the Problem

The Occupational Safety and Health Administration defines violence as any act or threat of physical violence, harassment, intimidation, or other threatening, disruptive behavior that occurs at the work site. That includes everything from threats and verbal abuse to physical assaults and even homicide.

Many employers, however, are wary of even discussing the issue out of concern people will view their particular companies as being overly violent. In fact, several potential speakers in retail and other industries we approached to join our panel declined for this very reason.

Despite their reluctance, we know that the workplace has increasingly become the site of violence, especially in certain industries.

Health Care

Health care is the industry that generates more attention than any other with regard to violence—and with good reason. The most-recent government statistics show there are 7.8 cases of serious violence per 10,000 employees, which far exceeds any other industry. The fact is that number is likely much lower than the reality.

Many healthcare facilities, especially in high-risk areas, such as emergency departments and level I trauma centers, are routinely the sites of violent outbursts. Patients and/or their families attack providers all too frequently. Many of these workers have come to believe violence is just part of the job. Unfortunately, those in a position to change this often foster that culture. We may soon see an increase in the numbers of incidents reported, due to mandates for increased reporting, especially in California.


Mass shootings at schools have been getting lots of attention. However, what's not talked about is the fact that schools are increasingly the site of daily violence or threats by students against teachers and staff.

For example, one of the nation's largest school districts reported a 10 percent increase in violence-related claims in the past 5 years. With incurred losses of $19 million, these represented 15 percent of the total claims and 12 percent of the system's incurred losses. The numbers do not include many of the threats and harassment incidents, which often go unreported.

One reason for the increased number of violent incidents reported in schools may be the increased awareness of the issue and the potential for remedies, both legal and/or administrative. Another is the implementation of zero-tolerance policies that require or strongly recommend reporting. One more is the increase in kids acting on their emotions, more so than they did in past years.

Overall, workplaces have seen an uptick in homicide rates in recent years, even though the rate in the general population has decreased. Some experts speculate that may be due to increased stressors facing workers, such as financial pressures.

Social media may play a role in increased violence in the workplace because it seems to empower some people to act in ways they normally would not. This sometimes spills over into real-world, face-to-face situations.

On a positive note, efforts to reduce violence in the workplace are paying off. While homicides among government employees increased by 30 percent from 2003 to 2013, the rate decreased by 30 percent in the private sector.

Types of Violence

Developing violence-prevention programs requires knowing the type(s) of violence to determine the best approach. For example, gender may be part of the equation. Men are more likely to be killed at work during robberies, especially in retail establishments, while women are more likely to be victims of domestic violence.

Domestic violence is one category that is often not adequately addressed in the workplace. Many employers believe that, since the potential perpetrator is not an employee, he is not a threat to the workplace. Statistically, it is a very real problem that should be considered and included in violence prevention plans.

In fact, violence can be initiated internally or externally. It may be started by an employee within the company or externally by a customer, former employee, vendor, or someone connected with an employee.

There are also emotional versus predatory incidents of violence. Knowing what drives each incident category is important to help prevent it.

  • Emotional violence generally occurs as a reaction to a threat or fear. An example would be two boys ready to duke it out in school. Neither actually wants to fight, but they also do not want to be humiliated, so they pretend they are ready. Diffusing this situation can be done by intervening and stopping both of them equally.
  • Predatory violence involves forethought, rather than being reactionary. A sniper is an example of predatory violence. Preventing these situations is much more complex.

Temporary States versus Emotional Traits

Some attacks occur because the person is temporarily in a highly emotional state. It could be an emotional reaction, a psychotic episode, or a drug-induced state. A permanent trait, on the other hand, means the person has a personality factor that is driving him to act in a demeaning or abusive manner. Those traits are more consistent and predictable over time.

An example of someone in a temporary state would be a father who has just been told that his wife was killed and his child is in surgery following an auto accident, and he speaks very little English. His inability to fully communicate, and his efforts to see his son in the emergency room, could easily lead to a violent outburst. Security personnel might be inclined to handcuff the man, per protocol. However, such a situation can be diffused by understanding why he is acting the way he is and getting a language interpreter to speak with him calmly.

It is important to understand the context of the violence and not assign permanent traits to someone who is only in a temporary state. That can sometimes be tricky, especially if a zero-tolerance policy is in effect and mandates that security personnel handcuffs any violent perpetrator.

If someone is acting out in hostility, especially if it is atypical behavior for that person, asking questions can help prevent an incident. This can be especially effective in the case of students at school, pulling the person aside to find out what is driving his or her actions is often effective.

Assessing the Risk

There are many ways to determine the types and levels of risk to an organization.

  • Traditional assessment. One approach includes a traditional security risk assessment of the grounds, the physical security environment, and the security practices and policies, using specific metrics and historical performance of law enforcement and risks in the local community as factors.
  • High-risk area assessment. As Mr. Durand explained, a new California law addressing workplace violence in health care has led Kaiser Permanente to conduct additional assessments of its facilities. One involves looking at high-risk areas, such as emergency rooms. The type of risks present there could include family members worried about patients who have been brought in, or patients left waiting because their injuries are not life-threatening and they become impatient and agitated. These assessments look at the safety and physical security practices along with engineering controls.
  • Administrative and workplace controls. These focus on ways to distinguish employees from visitors. Kaiser Permanente, for example, requires workers to wear ID security badges from the waist up.
  • Employees' knowledge. Part of assessing risk is to determine whether staff members know what to do at the first sign of a threat; do they know the security code to call and what to expect as a response? Employees also are assessed to make sure they understand that they may sometimes have to call in outside law enforcement and must know how to do that.
  • Physical layouts. A patient who presents a danger to himself and is brought in involuntarily needs to be placed in a safe room. The assessment would look for any dangerous objects in the area the person could use to injure himself. Staff members are quizzed to ensure that they understand what needs to be removed from such an area.
  • Remote worker assessment. Many healthcare or hospice workers go to an offsite home or other location. Since the risks are often unknown in those environments, employees need to understand what to do. For example, the worker could ask whether there are any firearms in the home.

It is also important to assess both safety and security because they are different. Security would include a door in a particular location of the facility that serves as an exit, so visitors cannot enter. However, a worker who props the door open, even briefly, defeats the purpose. Employers need to promote a culture of safety within their organizations, as well as enhancing security.


The best workplace violence policies mean nothing if people are not trained regarding them. Employees need to clearly understand what to do in a given situation. Ongoing training should be conducted at least annually and with any new hires. Employees should be given competence testing regularly. Staff members need to be clear on the expectations of security personnel, or they increase their own risk of becoming victims of violence. Proper training also improves legal defensibility.

An important point to emphasize in training is to examine the threats to each particular worksite and each specific area of a worksite. While the same policy may apply, there may be different priorities depending on the risks and the employees. A one-size-fits-all approach should be avoided.

It is also important for the trainer to understand what the policy says before starting the training. A zero-tolerance policy is different from others. Unfortunately, some companies seek training before a policy is fully developed.

In addition to training staff on policies, management must adhere to it. Otherwise, they risk creating a toxic work environment if someone reports a concern that is ignored.

The trainer needs an adequate amount of time to perform effective training. It is imperative to make sure employees fully understand the policies and procedures.

Threat Responses

There are a variety of ways for employees to mitigate violent threats in the workplace.

  • Be aware. Be aware of the surroundings. Recognizing how the worker is feeling and how the other person is feeling is important. The other person is likely feeling agitated, so the worker must be able to stay composed.
  • Understand/do not judge. Where possible, engaging the person can prevent a violent incident. Workers can try to find something they like or have in common with the person.
  • Explain the consequences and alternatives. Angry people are not thinking clearly. Nor are they thinking about how it will impact their lives or families. Calmly explaining the ramifications can help.
  • Change the tone of voice. Speaking calmly to an agitated person may help reduce his or her anxiety.
  • Avoid provoking. Telling the person to "just calm down" could make him or her angrier.

The goal is to help redirect the person so that they slow down and begin to think more clearly.

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