Workplace Safety and Health: Additional Efforts Needed to Help Protect Health Care Workers from Workplace Violence
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.
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.
Recommendations for Executive Action
|Department of Labor||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.||
In June 2016, OSHA provided a three-day training to regional workplace violence coordinators, inspectors, and solicitors on procedures to assess complaints, conduct inspections and develop workplace violence citations. In January 2017, OSHA published a revised directive on Enforcement Procedures and Scheduling for Occupational Exposure to Workplace Violence. The revised directive provides OSHA inspectors additional information, such as a new decision-making flow chart that inspectors can use to review a workplace violence complaint and determine whether an inspection should be conducted as well as a timeline with specific steps that should be taken to develop a citation within the required 6-month statutory time frame. The information in the updated directive will help inspectors collect the information needed to cite employers following inspections involving workplace violence if they are warranted.
|Department of Labor||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.||
In January 2017, OSHA added procedures to its directive on Enforcement Procedures and Scheduling for Occupational Exposure to Workplace Violence on how OSHA inspectors should follow up on workplace violence-related hazard alert letters. Specifically, OSHA updated the procedures to direct inspectors to specify a timeframe for when employers must respond to the hazard alert letter and inform the employer that OSHA will follow up with an inspection or investigation within a year, depending on the employer's response.
|Department of Labor||
Priority Rec.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.
According to OSHA officials, the agency completed a study of 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. As of April 2021, OSHA officials reported that the study was under review for submission to a peer-reviewed journal. The agency also published enforcement procedures to help OSHA field offices conduct inspections related to workplace violence. In addition, in December 2016, OSHA published a Request for Information (RFI) on Preventing Workplace Violence in Healthcare and Social Assistance to help identify workplace violence prevention requirements that could be effective and economical if a regulation were to be developed. In 2020, OSHA had evaluated the information it received in response to the RFI, gathered information on best practices in certain industries, and completed its review of the submissions in response to the RFI. In August 2022, DOL officials said the agency has been delayed in developing regulatory options due to the COVID-19 pandemic. As of February 2023, OSHA had initiated a small business panel to obtain additional input from potentially affected small businesses. The final report with the panel's recommendations should be complete by the end of April 2023. To fully implement this recommendation, the agency should complete its process of obtaining input on regulatory options and finalize its determination on whether additional actions are needed.