Understanding Workplace Violence in Healthcare: Insights from an Eight-Year Case Study in a Swiss Hospital Network.

BACKGROUND

Workplace violence against healthcare workers is a growing concern worldwide, with consequences for staff well-being, care quality, and patient safety. However, longitudinal evidence from hospital networks remains limited, and few studies have used statistical process control-informed visual methods to monitor trends over time. This study examined whether reported aggression trends showed distinct temporal patterns across a Swiss public hospital network and whether such patterns could generate hypotheses regarding potentially associated organizational and contextual factors.

METHODS

We conducted a retrospective observational study of reported aggressions toward healthcare staff across the Ente Ospedaliero Cantonale (EOC), the public hospital network of southern Switzerland, over an eight-year period (2017-2024). Data were extracted from the network's internal quality and occupational safety reporting platform. Two standardized indicators were calculated annually for each hospital: aggressions per 1,000 inpatient days and aggressions per 1,000 discharges. Individual control charts with boundaries at ± 1, ±2, and ±3 standard deviations were used to examine temporal patterns, complemented by exploratory simple linear regression to estimate overall linear trends across the full network, the network excluding Locarno Hospital (ODL), and ODL alone.

RESULTS

Across the network, reported aggressions showed an overall upward pattern, with the highest levels recorded in 2024. When standardized by inpatient activity and discharges, both indicators showed increasing trajectories at network level. In contrast, at ODL aggression rates increased from 2018 to 2021, followed by consecutive annual decreases through 2024. Aggressions per 1,000 inpatient days decreased from 1.32 in 2021 to 0.78 in 2024. This temporal pattern differed from the continuing upward pattern observed across the rest of the network. Exploratory linear regression over the full 2017-2024 period did not show statistically significant overall linear trends at ODL. Most reported incidents in 2022-2024 were perpetrated by patients, nursing staff were the most affected professional group, and geriatric units accounted for the largest proportion of reports.

CONCLUSIONS

This study extends previous single-hospital evidence by adopting a network-level perspective, a longer observation period, and statistical process control-informed visual methods. The findings suggest that aggression trends may not be uniform across comparable hospital settings. Although causal inference is not possible, the distinct temporal pattern observed at ODL generates hypotheses regarding organizational and contextual factors potentially associated with differences in workplace violence trajectories and warrants further investigation. Continuous monitoring using standardized indicators may support organizational learning, benchmarking, and targeted prevention.