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2019 HSR&D/QUERI National Conference Abstract

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4141 — Understanding VHA Staff Experiences with Patient Harassment

Lead/Presenter: Karen Dyer,  Center for the Study of Healthcare Innovation, Implementation & Policy
All Authors: Relyea MR (VA Connecticut Healthcare System; Yale School of Medicine), Dyer, KE (VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy), Klap, R (VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy; VA Women's Health Research Network, VA Greater Los Angeles Healthcare System) Yano, EM (VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy; VA Women's Health Research Network, VA Greater Los Angeles Healthcare System; Women's Health Services, Office of Patient Care Services)

Objectives:
The harassment of staff by patients (i.e., patient harassment) is a common problem in hospitals and is associated with healthcare staff burnout, increased medical errors, decreased patient care, and decreased staff retention. Although a recent survey at one VHA facility indicated that VHA staff often experience patient harassment, VHA lacks information on the scope and types of inappropriate comments and behavior that staff receive, information that is necessary to understand harassment and inform intervention. The objective of this study is to determine the frequency and forms of patient harassment that VHA staff experience.

Methods:
We used retrospective survey data from an evaluation of women's health patient aligned care teams at 12 VHA medical centers. The survey asked VHA staff how often they had experienced inappropriate or unwanted comments or behavior from patients in the prior year and asked staff to describe their experiences in an open-ended response. We used descriptive statistics to assess the frequency of harassment. Two qualitative researchers used inductive content analysis to identify the types of harassment that staff described in the open-ended responses. Coding continued until reaching theme saturation.

Results:
Overall, 248 VHA staff provided feedback on their harassment experiences. The majority of staff reported experiencing patient harassment, with a higher percentage of women experiencing harassment than men. Staff reported experiencing multiple types of patient harassment, including sexual and gender harassment and inappropriate displays of anger (e.g., yelling, slamming objects, threats, degrading comments). Common sources of patients' anger involved frustration over wanting to be seen faster or immediately upon walking in, difficulty navigating VHA or the Choice program, and being refused desired procedures, services, or medication, particularly opioid pain medications.

Implications:
The prevalence of patient harassment among VHA staff is comparable to other studies of healthcare providers. Reducing patient harassment will require efforts to prevent and respond to sexual and gender harassment, improve timeliness and care coordination, assist patients with the discontinuation of opioids, and educate patients on appropriate behavior at VHA.

Impacts:
Multipronged efforts to reduce sources of patients' frustrations with care and address harassing behaviors are warranted to improve both staff and patient outcomes.