How Underreporting Masks the True Cost of Workplace Violence in Healthcare

Workplace violence in healthcare costs $18.27 billion annually, according to recent research by the American Hospital Association, but this figure may represent only a fraction of the true economic and human cost. Recent research from the University of Michigan estimates that workplace violence incidents could actually be up to three times higher, suggesting the real economic impact could be much greater when accounting for significant numbers of unreported incidents leading to cascading effects throughout the healthcare system.

The Persistent Reality of Underreporting

The statistics surrounding workplace violence reporting in healthcare reveal that little has changed since a 2015 study that found only 12% of incidents were reported. Current research paints an equally troubling picture of underreporting in the healthcare industry.

A University of Michigan study published in 2023 found that over the course of a year, 39% of healthcare workers experienced violence from patients and families (including physical assaults, threats of physical harm, and verbal abuse), but only 19% of events were reported.

Another study conducted in Texas in 2024, surveyed over 550 nurses providing direct patient care and found that 46% of nurses chose not to report their most recent workplace violence incident to their employer. Even more concerning, over half stated their reason for not reporting was because they did not expect anything to change in the long term. Similarly, the Hennepin Healthcare Survey found that only 47% of nurses report violent incidents to their employers, citing time constraints, insufficient staffing, and inaction from management.

Why Healthcare Workers Continue to Stay Silent

Despite growing attention to workplace violence in healthcare, studies continue to identify multiple factors contributing to widespread underreporting. One of the most consistent and disturbing findings from recent research is the relentless perception among staff that organizational efforts, while improving, have not yet fully addressed workplace violence in an effective and lasting way. Staff continue to report a lack of support and follow up around reporting workplace violence.

This concern presents an important opportunity for healthcare leaders to address the cultural and systemic challenges that discourage reporting. By building on the progress already made, organizations can create meaningful and lasting improvements that not only shift staff perceptions, but also reinforce their commitment to cultivating a safe, transparent, and supportive environment.

Organizational Missteps Fuel Endemic Perceptions

When healthcare workers do choose to report an incident, their personal experiences after reporting, often validate their initial skepticism about the reporting process. A 2024 American College of Emergency Physicians (ACEP) survey revealed alarming statistics about organizational responses to reported incidents:

• 68% of respondents felt their organizations did not handle their report appropriately

• 50% said nothing was done at all following their report

• Only 23% saw a behavioral flag added to a patient's chart as a precaution for others

In addition, the 2024 National Nurses United Survey found that:

• 45% of nurses said their employer ignored reports of workplace violence

• 29% said their employer reprimanded or blamed the employee who reported the incident

These studies reveal dangerous patterns that continue to shape negative staff perceptions. When reports are not properly handled or follow up actions are not communicated, it undermines trust in the overall system and creates a culture of resentment. Furthermore, when nearly one in three healthcare workers report they faced reprimand or blame from their employers, it creates a powerful disincentive for future reporting. This blame-the-victim mindset continues to silence staff and sends a clear message about the risks of speaking up.

When reporting is seen as futile, it discourages future reporting, ultimately putting staff safety at greater risk. Even if organizations do take appropriate follow up actions—such as investigating root causes, setting up behavioral contracts, or adjusting patient care expectations—failure to communicate these actions to reporting staff can leave employees feeling unsupported and reinforce the perception that reporting incidents is not worthwhile, since they remain unaware of any changes or improvement

Breaking the Cycle: A Path Forward

Healthcare leaders today are confronted with extraordinary challenges: reduced staffing levels, workforce burnout, competing organizational priorities, and, in many cases, the absence of a designated leader for workplace violence prevention. These pressures help explain why efforts to address workplace violence may appear fragmented or lack sustained momentum.

But addressing this underreporting crisis requires more than policy updates—it demands a fundamental shift in organizational culture and a systematic approach to understanding and addressing workplace violence risks.

This evidence underscores the critical importance of leadership engagement. By working collectively to identify root causes and close gaps in the process, leaders are uniquely positioned to drive meaningful change from within.

The Foundation: Comprehensive Assessment

The first step in rebuilding staff confidence lies in conducting thorough, honest assessments of current workplace violence risks and organizational responses. Comprehensive current state assessments should examine not just incident frequency, but also organizational culture, reporting barriers, staff perceptions, and systemic risk factors that contribute to violence. When healthcare workers see employers taking concrete steps to understand the true scope of the problem, it signals genuine commitment to long-term change. Equally important is the involvement of healthcare staff in ongoing assessments. Including the voice of staff demonstrates that leadership recognizes the complexity of workplace violence issues and is serious about addressing root causes that have persisted for years.

Identifying and Addressing Systemic Gaps

Once organizations understand their current state, a gap analysis becomes crucial for identifying specific deficiencies in policies, procedures, training, and support systems. Recent research indicates that many organizations share similarly persistent challenges across their institutions, which highlights the important need for organizations to understand and address fundamental gaps in their current approach.

A thorough gap analysis helps organizations prioritize improvements and develop targeted action plans that address the specific factors contributing to underreporting in their facility. When staff see concrete plans to address identified deficiencies—and evidence that these plans are being implemented—it begins to rebuild confidence that reporting will lead to meaningful change.

Staff-Centered Policy Development

Traditional top-down policy development fails to incorporate the real concerns and experiences of frontline healthcare workers, as evidenced by the underreporting rates. A more effective approach involves developing workplace violence prevention policies and response procedures that are informed by staff input and designed around their actual experiences and needs.

Staff-centered policies should address not only incident response but also the organizational culture that influences reporting decisions. This includes clear protections against retaliation, transparent investigation processes, and guaranteed follow-up actions that demonstrate the organization's commitment to preventing future incidents. Most importantly, these policies must include accountability measures that ensure consistent implementation.

Creating Accountability Through Documentation

Well-developed playbooks that outline specific organizational initiatives and responses to different types of workplace violence, help ensure consistent, appropriate procedures that staff can trust. 

These operational guides should include clear specific roles and responsibilities, timelines for follow up, measurable outcomes that demonstrate organizational accountability, and regular evaluation processes to ensure effectiveness. When healthcare workers understand what to expect after reporting an incident - and see those procedures consistently followed - it empowers them to speak up for safety and strengthens their confidence in the reporting system.

The Cascading Effects of Systematic Change

When healthcare workers see their organizations investing in comprehensive risk assessments and implementing evidence-based responses, they gain confidence that reporting their incidents leads to real change. This trust fuels greater transparency, providing the organization with stronger data to drive continuous improvements, creating a powerful cycle that protects both staff and patients. The goal of healthcare leaders should be to create organizational cultures and systems that promote transparency, support staff who speak up, and demonstrate through consistent and sustained actions that employee safety and wellbeing is prioritized not only in principle, but in daily practice.

About David Brake

DAVID is the Co-founder and CEO of OPTICS for Healthcare, an AI-first company dedicated to creating safer healthcare environments for staff, patients, and the public. The OPTICS platform was designed to revolutionize how healthcare organizations approach facility assessments, enabling them to conduct comprehensive current-state evaluations, generate detailed gap analyses, and develop customized workplace violence policies and action-specific operational playbooks.

About Kim Urbanek

KIM is a leading Workplace Violence Prevention expert with over 26 years of healthcare, security, and emergency management  experience. Kim is a nationally sought-after speaker, a #1 best-selling author, and a recognized healthcare consultant. Kim is the Co-founder and Chief of Innovation and Practice of OPTICS for Healthcare, an AI driven workplace violence risk assessment and mitigation tool, designed to reduce violence and improve operations at healthcare organizations.