Healthcare organizations routinely apply rigorous prevention protocols to predictable harms such as wrong-site surgery and hospital-acquired infections, yet violence against nurses—equally foreseeable and recurring—is often treated as an unavoidable operational reality rather than a systems failure. While wrong-site surgery triggers 'never event' protocols, root-cause analysis, and accountability mechanisms, assaults on nurses are frequently dismissed as 'part of the job,' despite their predictable nature and serious consequences for staff.
EPIC Webinars has launched an Authority Briefing showing how different assumptions create two parallel safety standards operating within the same organization. One standard treats predictable harm as evidence that systems require redesign.
The other acknowledges predictable harm while accepting that current operational realities may prevent meaningful change. Violence may begin with the behaviour of an individual patient, but normalization begins with the organization's response after that behaviour has occurred repeatedly.
More information is available at https://epicwebinars.com/authority-briefing-predictable-harm
The World Health Organization reports that between 8% and 38% of health workers experience physical violence during their careers, with up to 62% encountering overall workplace violence and nurses among those most at risk. A 2017 survey by the Canadian Federation of Nurses Unions found that 61% of nurses had experienced violence in the previous month, and two-thirds considered leaving their jobs as a result. These statistics underscore that violence is not exceptional but predictable and recurring, demanding the same systematic response healthcare systems apply to other known harms.
Recent Canadian legislative amendments, including Bill C-3 and Bill 88, have sought to strengthen protections. Bill C-3 makes assault against a healthcare worker an aggravating sentencing factor, while Bill 88 increases maximum employer fines for safety failures. However, courts have historically been reluctant to impose such sanctions, and enforcement remains inconsistent. Governance and systemic prevention measures—not legislative penalties alone—are needed to shift from reactive to proactive approaches that treat violence as a systems failure amenable to organizational learning and redesign.
The Authority Briefing asks healthcare leaders and administrators to change the purpose of organizational reviews in the face of workplace violence. Instead of asking why the assault occurred, healthcare leaders should begin by asking when the situation first became predictably unsafe. Those are two fundamentally different questions.
By extending the governance discipline already accepted in domains such as medication errors and pressure injuries, the briefing advocates treating violence as a systems failure rather than an inherent cost of care.
The framework within the Authority Briefing outlines five steps: define violence as a sentinel safety issue, investigate contributing factors such as staffing levels and environmental design, build preventive controls including alarms and team response protocols, monitor trends rather than treating incidents as isolated episodes, and hold leadership accountable for timely corrective action. These measures parallel proven approaches to surgical safety and infection prevention, demonstrating that the principle is sound and implementable when organizations commit to applying the same rigor to workforce safety that they routinely apply to patient outcomes.
The Authority Briefing is not to provide definitive answers, but to encourage attention to the concept of organizational acceptance of predictable harm. Using this framework it asks that the absence of an immediate solution should not end the discussion about what ultimately requires improvement. Every act of workplace violence cannot be prevented. Despite excellent clinical assessment, appropriate interventions, and compassionate care, aggression will still sometimes occur.
The important question to answer is whether organizations should continue accepting repeated exposure to foreseeable harm once the circumstances producing that harm have become clearly understood. Predictable harm should trigger organizational learning, not acceptance—a principle that must apply equally whether the harmed party is the patient or the clinician providing care.
For more details, visit https://epicwebinars.com/