Workplace violence response in emergency departments after an organizational improvement cycle: a second-cycle qualitative study of healthcare provider perspectives
Abstract
Abstract Background: Emergency departments (EDs) carry a disproportionate share of healthcare workplace violence (WPV). A first cycle of qualitative interviews at a multi-site Canadian academic health centre described violence as normalized and organizational responses as fragmented, and informed a quality improvement programme. What frontline staff experience once such a programme is underway has rarely been examined. This second cycle asked how healthcare providers describe WPV prevention and response systems after organizational efforts to address them. Methods: Twenty-two healthcare providers at two urban EDs of a multi-site academic health centre in Toronto, Canada, took part in semi-structured interviews in October 2023. Interviews covered experiences of violence, security response, training and preparedness, incident reporting and follow-up, environmental safety, and psychological impact. Analysis followed the six-phase thematic framework of Kiger and Varpio. A candidate framework was generated across three independent analytic runs, in which a generative artificial intelligence tool was used as an aid, and was then subjected to human verification and analysis, including in-depth review of four transcripts and manual qualitative analysis across all 22 transcripts. Reporting follows COREQ. Results: Seven themes were established: security as conditional protection; the professionalization deficit between Code White and Code Blue; the accountability vacuum; lost…
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