Last week, the U. S. Department of Labor, Occupational Safety and Health Administration (“OSHA”) issued an updated version of its publication, “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers” (the “Guidelines”). This technical assistance manual was first issued in 1996 and then revised in 2004. The Guidelines are identified by the agency as representing industry best practices based on feedback from stakeholders, and they provide many helpful insights and recommendations for developing policies, procedures and programs for reducing or eliminating incidents of workplace violence in health care and social service workplace settings.

It should be stressed that these Guidelines continue to be voluntary in nature. They are not standards or regulations nor do they create any new legal obligations under the Occupational Safety and Health Act of 1970.¹ However, the Guidelines do incorporate some of the latest thinking on the subject of workplace violence—prevention, response and recovery—targeted at the realities and risk factors specific to health care and social services settings.

Covered Workplaces

The health care Guidelines focus on five specific work settings:

  1. hospitals;
  2. residential treatment facilities;
  3. non-residential treatment facilities/services;
  4. community care; and
  5. home heath care/service.

Risk Factors and Impact

The Guidelines also provide a compelling (and disturbing) summary of the disproportionate impact of workplace violence on health care and social service workers, including statistics reflecting that between 1993 and 2009 health care workers experienced workplace violence at a rate that was fully 20 percent higher than experienced by all other American workers. The Guidelines then identify and discuss risk factors incident to conditions that are specific to the health care environment, including: patient-, client- and setting-related risk factors and organizational risk factors.

Development of a Workplace Violence Program

Health care employers will be especially interested in the Guidelines’ information relating to how organizations can design, implement and maintain effective violence prevention programs. Recommended program components are identified as:

  1. Management commitment;
  2. Worksite analysis;
  3. Hazard prevention and control;
  4. Safety and health training; and
  5. Recordkeeping and program evaluation.

The Guidelines analyze and make substantive recommendations as to each of these program components in order to identify effective, targeted approaches for developing and implementing policy in each of the areas.

Response to Violent Incidents

The Guidelines recognize that while prevention is their primary goal, it will not be possible to eliminate violence in all situations and settings. Therefore, the Guidelines’ recommendations also focus on how health care organizations can respond effectively in the event of a violent incident, shorten the seriousness and duration of the incident and facilitate organizational recovery. Recommended program components incorporate post-incident investigation and analysis (nature and causes of the incident and evaluation of the effectiveness of the organization’s response) and also incorporate ongoing analysis of the effectiveness of program policies and procedures, an important step intended to fine tune and increase the effectiveness of the employer’s efforts over time.


The Guidelines also stress the importance of workplace violence training from the basic training needs of all workers to the more specialized training needs of managers/supervisors and security/crisis management personnel to the even more specialized training of those security and crisis management personnel who are likely to be first responders in the event of a violent incident.

Recordkeeping and Program Evaluation

The Guidelines stress the importance of recordkeeping to the effectiveness of the program. OSHA recordkeeping documents and requirements are identified, as are industry best practices for documenting threats and violent events, organizational responses and outcomes. Eleven components of an effective program evaluation effort are identified and described. 

Forms and Checklists

The Guidelines also contain recommended forms and checklists for use in training and program development as well as in documenting/responding to actual violent events.


The Guidelines end with an extensive bibliography of publications relating to the prevention of, response to and recovery from incidents of violence at work.


The updated “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers” should be a good starting point for any health care employer interested in policy and program development in this area.