Workplace violence (WPV) including incivility, bullying, verbal abuse, physical threats, and physical assaults can result is serious adverse consequences for workers. WPV has been extensively studied among workers in hospitals and nursing homes, yet no studies have examined WPV among the 2.5 million workers employed in the 221,000 outpatient physician clinics (NAICS 621111) in the U.S. These workers manage and provide more than 1 billion patient care visits annually. In 2010, the Bureau of Labor Statistics reported a rate of 0.9/10,000 WPV events in these clinics, which suggests that the risk of WPV is low. However, the majority (75%) of these clinics are exempt from OSHA reporting requirements due to their small size (<11 employees). Studies outside the U.S. have reported estimates for patient-perpetrated violence (Type II Violence) against clinic workers including verbal abuse (42%-99%), physical threats (27%-39%), and physical assaults (3%-27%). These estimates are on par, if not higher, than those reported for hospital workers, as well as some factors that both hospital and clinic workers have attributed to WPV events including patient drug seeking and mental illness. While similarities exist, the type of care that clinic workers provide, and the environment where they provide it, is very different from hospitals and other healthcare settings. Historically, outpatient physician clinics have been small, physician owned establishments, which may have made them previously hard to access from a research standpoint. In recent years, more than half of U.S. independently owned physician clinics have been purchased by large healthcare systems. We propose to take advantage of this shift by studying the scope of WPV (Types I through IV) among 3,600 workers in 197 physician clinics that are part of two healthcare systems in Houston, TX. We will conduct a three-year, cross-sectional study in which we will employ a mixed- methods approach including worker and clinic level surveys, focus groups, clinic walk-through surveys, geo- information system (GIS) analyses to study WPV and WPV prevention efforts at the worker, clinic, clinic system, and community levels. More specifically, we aim to: 1) examine the 12-month prevalence and associated risk factors of WPV at the worker and clinic level; 2) examine where workers report these events, if they are in line with the reporting systems that clinics have in place to capture these events, and how clinics and clinic systems use these data to inform WPV prevention efforts; 3) describe the WPV prevention policies and procedures used in these clinics, and examine the coordination of WPV prevention efforts between clinics and clinic system owners; 4) using GIS methodology, we will examine factors within the communities where these clinics are located and their associations with WPV, including demographic, economic activity and crime. This study is aligned with NORA's Healthcare and Social Assistance Strategic Goals as they pertain to identifying risk factors for WPV. This study is the first to be conducted among physician clinic workers in the U.S., which is long overdue.

Public Health Relevance

No studies have examined the risk of workplace violence (WPV) among workers in the 221,000 physician clinics in the U.S., or how they manage violent events. Our study will be first to examine the prevalence of WPV and associated risk factors at the worker, clinic, clinic system and community levels.

National Institute of Health (NIH)
National Institute for Occupational Safety and Health (NIOSH)
Research Project (R01)
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Safety and Occupational Health Study Section (SOH)
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Chiou, Sharon
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University of Texas Health Science Center Houston
Public Health & Prev Medicine
Schools of Public Health
United States
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