Contributing Factors

The Joint Commission has acknowledged that "intimidating and disruptive behaviors" among co-workers in healthcare settings can adversely affect patient care and safety. These behaviors include "verbal outbursts and physical threats as well as passive activities such as refusing to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities."

The Joint Commission describes root causes for worker-on-worker violence:

"Systemic factors stem from the unique health care cultural environment, which is marked by pressures that include increased productivity demands, cost containment requirements, embedded hierarchies, and fear of or stress from litigation. These pressures can be further exacerbated by changes to or differences in the authority, autonomy, empowerment, and roles or values of professionals on the health care team … as well as by the continual flux of daily changes in shifts, rotations, and interdepartmental support staff. This dynamic creates challenges for inter-professional communication and for the development of trust among team members" (Joint Commission, 2008).