2023 HSR&D/QUERI National Conference

1024 — Coping with Disruptive Patients During the COVID-19 Pandemic and Beyond: Perspectives of Primary Care Employees

Lead/Presenter: Shay Cannedy,  COIN - Los Angeles
All Authors: Cannedy SL (VA Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP)), McCoy M (CSHIIP, Greater Los Angeles VA) Oishi K (CSHIIP, Greater Los Angeles VA) Hamilton AB (CSHIIP, Greater Los Angeles VA and Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine) Olmos-Ochoa, TT (CSHIIP, Greater Los Angeles VA)

Patient aggression toward healthcare workers is a prevalent problem that has negative implications for employee well-being and health system outcomes. The impact of patient aggression on primary care employees is underexplored, yet imperative to address, given high rates of burnout and turnover further exacerbated by the COVID-19 pandemic. We explored clinician and non-clinician staff’s perceptions of patient aggression in women’s health primary care at the Veterans Health Administration (VA) to identify the coping strategies staff have devised in response to aggressive patient behavior.

We conducted semi-structured interviews with 24 VA women’s health primary care employees recruited from clinics that had experienced staff turnover. Informed by the Job Demands-Resources model, we used rapid qualitative analysis to create interview summaries that were analyzed to generate top level codes cross-validated by project team members. We used ATLAS.ti to organize our coding, guided by content analysis principles. After coding, the team identified and refined general themes, including the theme of disruptive patient behavior experiences that emerged in interviews. The lead author identified and compiled themes and sub-themes related to patient aggression and coping strategies, as well as associated quotes from transcripts. Resulting themes and quotes were reviewed and validated by two members of the project team.

Participants reported experiences with verbal and physical aggression (e.g., related to COVID-19 screening procedures and mask mandates: “Anger…sometimes can get exhausting. Especially this year, especially with COVID. I find that can be really challenging.”). Disruptive patient behavior was emotionally draining and employees perceived a general lack of consequences for low level patient aggression. Participants used a variety of coping strategies in response to patient aggression before, during, and after negative interactions. Support from team members emerged as a dominant coping mechanism (e.g., huddling with team members to plan for an upcoming visit such as having social workers present), as did rapport-building and communicating with patients (e.g., acknowledging a patient’s frustration and explaining the purpose of Covid mask policies).

Patient aggression can negatively impact the work experiences of primary care employees. VA women’s health primary care staff have devised multiple strategies to cope with these interactions. However, the ability to effectively prevent and manage patient aggression is limited by the lack of meaningful repercussions for aggression at the organizational level, which has important implications for employee well-being and retention. Retention of women’s health employees in VA is critical to ensuring health equity given the need for a highly specialized workforce to address the complex health needs of women Veterans.

Peer-support from colleagues, supportive leadership, strong interpersonal skills, and having clear expectations for appropriate patient-employee behavior with meaningful repercussions may aid employees’ ability to cope with patient aggression and promote employee retention. Understanding how to address patient aggression can help healthcare systems prepare for future public health crises like COVID-19 that impact how staff interact with patients.