Violence towards health care staff and possible effects on the quality of patient care

Much of the research on violence in the health care sector has focused on t he immediate and long-term effects of patient violence on staff victims. Th ere is a lack of studies, however, examining whether individual reactions t o violent episodes, such as anger and increased fear in one's work, have an y measurable effect on staff behaviour toward their patients, and ultimatel y on the quality of patient care. The aim of the present study was to inves tigate whether an association exists between staff experiences with violenc e and patient-rated quality of patient care. A theoretical model was presen ted, suggesting that violence or threats experienced by health care staff h ave a negative effect on the quality of health care services offered, as me asured by patients. In addition, it was theorised that there would be an as sociation between staff work environment and staff reports of violence. Six questionnaire studies, three concerning hospital staff's views of their wo rk environment and three dealing with patients' perceptions of the quality of care, provided the data for evaluating the model. Work environment and q uality of care studies were carried out simultaneously at a single hospital in 1994, 1995, and again in 1997. Regression analysis was used to see whic h combination of work environment and quality of care variables would best predict a positive overall grade for quality of care from the patient persp ective. Violence entered consistently as an important predictor into each o f the three best regression equations for 1994, 1995, and 1997, respectivel y. The results of this analysis suggest that! the violence experienced by h ealth care staff is associated with lower patient ratings of the quality of care. The study indicates that violence is not merely an occupational heal th issue, but may have significant implications for the quality of care pro vided. (C) 2001 Elsevier Science Ltd. All rights reserved.