Workplace Safety and Health:
Additional Efforts Needed to Help Protect Health Care Workers from Workplace Violence
GAO-16-11: Published: Mar 17, 2016. Publicly Released: Apr 14, 2016.
What GAO Found
According to data from three federal datasets GAO reviewed, workers in health care facilities experience substantially higher estimated rates of nonfatal injury due to workplace violence compared to workers overall. However, the full extent of the problem and its associated costs are unknown. For example, in 2013, the most recent year that data were available, private-sector health care workers in in-patient facilities, such as hospitals, experienced workplace violence-related injuries requiring days off from work at an estimated rate at least five times higher than the rate for private-sector workers overall, according to data from the Department of Labor (DOL). The number of nonfatal workplace violence cases in health care facilities ranged from an estimated 22,250 to 80,710 cases for 2011, the most recent year that data were available from all three federal datasets that GAO reviewed. The most common types of reported assaults were hitting, kicking, and beating. The full extent of the problem and associated costs is unknown, however, because according to related studies GAO reviewed, health care workers may not always report such incidents, and there is limited research on the issue, among other reasons.
DOL's Occupational Safety and Health Administration (OSHA) increased its education and enforcement efforts to help employers address workplace violence in health care facilities, but GAO identified three areas for improvement in accordance with federal internal control standards.
Provide inspectors additional information on developing citations . OSHA has not issued a standard that requires employers to implement workplace violence prevention programs, but the agency issued voluntary guidelines and may cite employers for hazards identified during inspections—including violence in health care facilities—under the general duty clause of the Occupational Safety and Health Act of 1970. OSHA increased its yearly workplace violence inspections of health care employers from 11 in 2010 to 86 in 2014. OSHA issued general duty clause citations in about 5 percent of workplace violence inspections of health care employers. However, OSHA regional office staff said developing support to address the criteria for these citations is challenging and staff from 5 of OSHA's 10 regions said additional information, such as specific examples of issues that have been cited, is needed. Without such additional information, inspectors may continue to experience difficulties in addressing the challenges they reported facing.
Follow up on hazard alert letters . When the criteria for a citation are not met, inspectors may issue warnings, known as hazard alert letters. However, employers are not required to take corrective action in response to them, and OSHA does not require inspectors to follow up to see if employers have taken corrective actions. As a result, OSHA does not know whether identified hazards have been addressed and hazards may persist.
Assess the results of its efforts to determine whether additional action, such as development of a standard, may be needed . OSHA has not fully assessed the results of its efforts to address workplace violence in health care facilities. Without assessing these results, OSHA will not be in a position to know whether its efforts are effective or if additional action may be needed to address this hazard.
Why GAO Did This Study
Workplace violence is a serious concern for the approximately 15 million health care workers in the United States. OSHA is the federal agency responsible for protecting the safety and health of the nation's workers, although states may assume responsibility under an OSHA-approved plan. OSHA does not require employers to implement workplace violence prevention programs, but it provides voluntary guidelines and may cite employers for failing to provide a workplace free from recognized serious hazards. GAO was asked to review efforts by OSHA to address workplace violence in health care.
GAO examined the degree to which workplace violence occurs in health care facilities and OSHA's efforts to address such violence.
GAO analyzed federal data on workplace violence incidents, reviewed information from the nine states GAO identified with workplace violence prevention requirements for health care employers, conducted a literature review, and interviewed OSHA and state officials.
What GAO Recommends
GAO recommends that OSHA provide additional information to assist inspectors in developing citations, develop a policy for following up on hazard alert letters concerning workplace violence hazards in health care facilities, and assess its current efforts. OSHA agreed with GAO's recommendations and stated that it would take action to address them.
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Recommendations for Executive Action
Comments: According to OSHA officials, in fiscal year 2016, the agency will provide additional training to regional workplace violence coordinators and some inspectors on best practices for assessing a complaint, conducting inspections, and developing workplace violence citations. In addition, the agency is revising its directive on Enforcement Procedures for Investigating or Inspecting Workplace Violence Incidents. The revised directive is expected to be completed by the fall of 2016 and will include additional guidance on developing workplace violence citations. We will close this recommendation when OSHA conducts the additional training and issues the revised directive.
Recommendation: To help reduce the risk of violence against health care workers, the Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health to provide additional information to assist inspectors in developing general duty clause citations in cases involving workplace violence.
Agency Affected: Department of Labor
Comments: According to OSHA officials, the agency is the process of revising its directive on Enforcement Procedures for Investigating or Inspecting Workplace Violence Incidents and will include procedures for following up on all workplace violence-related hazard alert letters in the revised directive. OSHA plans to complete the revisions by fall of 2016. We will close this recommendation when OSHA issues the revised directive.
Recommendation: To help reduce the risk of violence against health care workers, the Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health to establish a policy that outlines a process for following up on health care workplace violence-related hazard alert letters.
Agency Affected: Department of Labor
Comments: According to OSHA officials, the agency has a study underway as of October 2106 that will review OSHA's workplace violence enforcement cases in health care to better understand the obstacles OSHA compliance officers encountered during these investigations and identify factors which led to citations. OSHA expects the final report to be completed in June 2017, which will help its compliance officers develop citations in workplace violence cases. In addition, in December 2016, OSHA published a Request for Information on Preventing Workplace Violence in Healthcare and Social Assistance (RFI), which will help the agency identify workplace violence prevention requirements that could be effective and economical if a regulation were to be developed. To fully implement this recommendation, DOL should complete its ongoing study to better understand the obstacles OSHA compliance officers encountered during these investigations and identify factors that led to citations; and analyze the input received from the RFI to determine whether regulatory action is needed.
Recommendation: To help determine whether current efforts are effective or if additional action may be needed, such as development of a workplace violence prevention standard for health care employers, the Secretary of Labor should direct the Assistant Secretary for Occupational Safety and Health to develop and implement cost-effective ways to assess the results of the agency's efforts to address workplace violence.
Agency Affected: Department of Labor