In harm’s way: workplace aggression in Australian clinical medical practice

Abstract

There is only a very limited literature on workplace aggression in medical practice settings, especially in Australia. The aim of the Workplace Aggression in Australian Clinical Medical Practice study was to determine the extent of workplace aggression experienced by medical clinicians, identify key risk and protective factors for this aggression and its impact, both personally and professionally, and ascertain what efforts are required to prevent or minimise the likelihood and consequences of aggression exposure in medical practice settings. Cross-sectional survey responses were obtained from a sample of over 9400 General Practitioners (GPs) and GP Registrars, Specialists, Hospital Non Specialists and Specialists in Training. More than 70% of clinicians reported experiencing verbal or written aggression and almost a third reported experiencing physical aggression from one or more sources in the previous year overall. Patients were the most common source of aggression (51-80%), followed by aggression from patients’ relatives or carers (40-70%), co-workers (15-45%) and others external to the workplace (18-22%). Non-physical aggression was 1.5 to four times more prevalent than physical aggression. Clinicians also reported on the presence of 12 aggression prevention and minimisation actions in their main workplace. The point-prevalence was greater than 60% only for policies, protocols and/or procedures for aggression prevention and minimisation (65.6%), incident reporting and follow-up systems (68.2%), patient and public access restrictions (61.8%) and building security systems (69.9%). For nine actions, the point-prevalence was greatest for Hospital Non Specialists and Specialists in Training, those clinicians most exposed to workplace aggression. In multiple logistic regression modelling, expressed as odds ratios (OR), age (OR=0.97-0.98) and external control orientation (OR=1.07-1.26) were consistently associated with workplace aggression from all sources. Also associated with workplace aggression in most models were weekly hours worked (OR=1.01-1.02), and clinicians reporting a poor support network of other doctors like them (OR=1.13-1.43), that the hours they worked are unpredictable (OR=1.17-1.60), that their patients have unrealistic expectations about how they can be helped (OR=1.25-1.99), and that the majority of their patients have complex health and social problems (OR=1.23-1.78). In fully adjusted, multiple logistic regression models, workplace aggression from internal and external sources was found to be associated with intrinsic job satisfaction (internal OR=0.59; external OR =0.75), satisfaction with life in general (internal OR=0.67; external OR=0.87), self-rated health (internal OR=0.86; external OR=0.83) and intentions to leave patient care in the next 5 years (internal OR=1.20; external OR=1.16). Only external aggression was associated with intentions to reduce clinical workload within 5 years (OR=1.13) and only internal aggression was associated with intentions to leave medicine entirely within 5 years (OR=1.20). The thesis has addressed important gaps in the research evidence base on the extent and impact of workplace aggression experienced by Australian clinical medical practitioners, extending beyond the scope of existing studies. Workplace aggression is a major occupational health and safety concern, and a significant public health issue. The threat that it presents to the personal and professional integrity of medical clinicians may have much broader ramifications, including compromising community access to safe, high quality medical care. Drawing on the results of this and other studies, key legislative, policy and accreditation reforms have been recommended to support efforts to prevent and minimise workplace aggression in medical and other health service settings. Importantly, however, there remains a need for further research, including longitudinal studies to investigate potential causal relations between workplace aggression and known associated factors, and to obtain a better understanding of clinician experiences of workplace aggression and the subsequent impact on workforce participation decisions and patient care.