Giusti Emanuele M, Veronesi Giovanni, Forest Hannah, Ghelli Monica, Persechino Benedetta, Borchini Rossana, Magnavita Nicola, Ferrario Marco Mario
EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers Compensations Authority (INAIL), Roma, Italy.
BMC Public Health. 2024 Dec 4;24(1):3371. doi: 10.1186/s12889-024-20898-8.
About one-third of workers identify organisational factors as contributors to workplace violence (WPV), but the associations between these factors and WPV have primarily been explored retrospectively and with measures of perceived organisational constraints, hence providing limited information for prevention. Therefore, we assessed whether objectively measured ward-level indicators of turnover, downsizing, overtime, and night shifts are associated with the occurrence of WPV and whether these associations vary by ward type.
We conducted an ecological study at a university hospital in northern Italy from 2016 to 2022, using wards as statistical unit (average: 230 wards per year). Active surveillance of WPV was based on an in-hospital incident reporting procedure, updated in November 2021 based on Health Regional Administration guidelines; 2021 was therefore excluded as a transition year. Individual-level administrative data were used to compute ward-level yearly indicators of turnover, downsizing, overtime and night shifts per active worker. Using generalised linear models, we estimated rate ratios (RRs) for yearly WPV counts per 1 SD increase in the indicators, controlling for study period, ward type (emergency department [ED], psychiatric ward, other) and ward sociodemographic composition.
A total of 337 WPV episodes occurred in the 1381 ward-year observations. The WPV rates per 100 active workers per year increased from 1.40 (95%CI: 1.23-1.60) during 2016-2020 to 3.48 (2.90-4.17) in 2022. Higher turnover (RR, 95%CI: 1.47, 1.23-1.75) and downsizing (1.12, 1.00-1.24) were associated with a greater occurrence of WPV across all wards; these associations were consistent across the study periods. In wards with night shift scheduling, turnover (1.64, 1.40-1.92), downsizing (1.21, 1.04-1.40) and the mean number of night shifts (2.50, 1.37-4.56) were associated with WPV. The association between night shifts and WPV was greater in psychiatric wards (RR = 8.73; interaction p-value = 0.02), whereas the role of downsizing was greater in EDs (RR = 1.42, interaction p-value = 0.09) and the role of turnover was greater in the other wards (RR = 1.34, interaction p-value = 0.16).
Work organisational factors are associated with the occurrence of WPV episodes against healthcare workers. Ward type-tailored priorities should be given to minimising turnover and downsizing and promoting a fairer allocation of night shifts to decrease WPV occurrence.
约三分之一的工作人员认为组织因素是工作场所暴力（WPV）的促成因素，但这些因素与WPV之间的关联主要是通过回顾性研究以及感知到的组织限制措施来探索的，因此为预防工作提供的信息有限。因此，我们评估了客观测量的病房层面的人员流动、裁员、加班和夜班指标是否与WPV的发生相关，以及这些关联是否因病房类型而异。
我们于2016年至2022年在意大利北部的一家大学医院进行了一项生态研究，以病房作为统计单位（每年平均230个病房）。对WPV的主动监测基于医院内部事件报告程序，该程序于2021年11月根据地区卫生管理指南进行了更新；因此，2021年作为过渡年被排除。使用个体层面的行政数据来计算每个在职员工的病房层面年度人员流动、裁员、加班和夜班指标。使用广义线性模型，我们估计了指标每增加1个标准差时每年WPV计数的率比（RRs），并控制了研究期间、病房类型（急诊科[ED]、精神科病房、其他）和病房社会人口构成。
在1381个病房年观察中，共发生了337起WPV事件。每年每100名在职员工的WPV发生率从2016 - 2020年期间的1.40（95%CI：1.23 - 1.60）增加到2022年的3.48（2.90 - 4.17）。更高的人员流动率（RR，95%CI：1.47，1.23 - 1.75）和裁员率（1.12，1.00 - 1.24）与所有病房中WPV的更频繁发生相关；这些关联在研究期间是一致的。在安排了夜班的病房中，人员流动率（1.64，1.40 - 1.92）、裁员率（1.21，1.04 - 1.40）和夜班平均次数（2.50，1.37 - 4.56）与WPV相关。夜班与WPV之间的关联在精神科病房中更强（RR = 8.73；交互作用p值 = 0.02），而裁员在急诊科中的作用更强（RR = 1.42，交互作用p值 = 0.09），人员流动在其他病房中的作用更强（RR = 1.34，交互作用p值 = 0.16）。
工作组织因素与针对医护人员的WPV事件的发生相关。应根据病房类型制定优先事项，以尽量减少人员流动和裁员，并促进更公平地分配夜班，以减少WPV的发生。
