Mitigation of Emergency Department Workplace Violence:
Using Haddon’s Matrix to Identify Risks and Prevention Strategies
Description: The Haddon’s Matrix can be used to identify the factors that contribute to workplace
violence and corresponding mitigation strategies that can be implemented before, during and after
the event that may influence the outcomes. You can use the matrix as a debriefing tool to examine
workplace violent incidents that occur in your emergency department (ED).
Process:
Think about the characteristics of the host (nurse), agent (assailant), and environment (ED
workplace) that were present before, during and after the incident. Use Table 1 as a guide to help
identify some of the most common risk factors that contribute to workplace violence. Place the
relevant item in the appropriate cell of the Haddon Matrix. Review the results with emergency
department staff.
Benefits:
•
The Haddon Matrix can be used as an individual or unit exercise, in which several incidents can
be discussed and patterns can be recognized
•
The completed results provide a map of both incident characteristics and patterns, providing
valuable information that can help uncover opportunities to reduce ED violence
•
Identified issues can be addressed through staff training and implementation of appropriate
prevention and control strategies
Phase
Host
Agent/Vehicle
Workplace Environment
(Nurse, Security
(Assailant, Weapons)
(Structures, Cultural
Personnel)
Pre-event
(e.g., preassault)
Event
(e.g.,
during
assault)
Post-event
(e.g., postassault)
Norms, and Policies)
TABLE 1: RISK FACTORS FOR ED WORKPLACE VIOLENCE
Host
Agent/Vehicle
Workplace Environment
(Personal Characteristics)
(Patient & Visitor Behaviors)
(Physical, Social, Cultural Factors)
 Lack of recognition of
dangerous situations/patients
 Limited help-seeking
 Little or no use of deescalation skills
 Lack of confidence in handling
difficult patients
 Lingering trauma, PTSD or
history of personal violence
 Pain or other physical
symptoms; disability
 Loss of pay or reduced hours;
absenteeism
 No incident report filed
 Fear of retribution by
employer or colleagues
 Slow response of facility to
acknowledge and respond
 STAMP behaviors
 Crowded conditions
 Escalating aggression
 Patient boarding and long wait
times
 Difficulty accepting limitsetting requests
 Inadequate security
 Resistance to health care
 Inadequate safety controls
 Potential for poor patient
outcomes
 Poorly lit, isolated areas
 History of violence
 Alcohol and/or drug use
 Threatening gestures
 Verbal threats
 Access to weapons or
threatening use of weapons
 Emotional state of patient’s
family members and visitors
 Unrestricted public access
 Small exam rooms
 Staffing shortages
 No zero tolerance or safety
policies
 Workplace bullying
 Culture of tolerance
 Inadequate staff training
 Family conflict
 Lack of access to safety devices
 Lack of support from peers
 Prolonged wait times
 Attrition from nursing
workforce
 Arrest or removal from
premises
 Refusal from administrators to
report and respond to incident
 Legal prosecution
 Reduced productivity
 Impact on staff retention