When healthcare organizations assess workplace safety risks, their focus typically lands on patient-to-staff violence, environmental hazards, or procedural errors. Yet one of the most pervasive safety threats often goes unaddressed in traditional safety initiatives: lateral violence—the disrespect, hostility, and aggression that occurs between colleagues.
As we observe National Safety Month this June, it's time to bring this silent safety risk into the spotlight and recognize that interpersonal conflict among staff isn't just an HR issue—it's a legitimate safety concern that deserves the same systematic tracking and intervention as other workplace hazards.
Understanding Lateral Violence in Healthcare
Lateral violence encompasses a range of behaviors that occur between colleagues at similar hierarchical
levels. In healthcare settings, these behaviors may include:
- Verbal abuse (harsh criticism, humiliation, blame)
- Exclusion or isolation (withholding information, excluding from activities)
- Undermining (questioning competence, setting up for failure)
- Passive-aggressive behaviors (eye-rolling, sighing, gossiping)
- Withholding assistance or resources
- Taking credit for others' work
- Excessive scrutiny or micromanagement
The prevalence of these behaviors in healthcare is startling:
- Studies suggest that between 46-100% of nurses have experienced some form of lateral violence during their careers
- Medical residents report rates of harassment from colleagues as high as 45%
- Support staff, including administrative personnel and environmental services workers, often report even higher rates of disrespect from other staff members
The Safety Implications of Lateral Violence
While lateral violence is sometimes dismissed as "personality conflicts" or "workplace politics," its impact on safety is profound and measurable:
Direct Safety Impacts:
- Communication breakdowns that lead to medical errors
- Delayed response to patient needs due to dysfunctional teamwork
- Failure to report safety concerns for fear of retaliation
- Decreased situational awareness when staff are distracted by conflict
- Increased medication errors associated with workplace stress
Indirect Safety Effects:
- Higher staff turnover leading to knowledge gaps and inconsistent care
- Increased absenteeism creating staffing shortages
- Reduced reporting of near-misses and safety concerns
- Compromised teamwork during emergencies
- Cognitive burden that reduces decision-making capacity
When lateral violence goes unchecked, it creates what safety experts call a "normalized deviation"—harmful behaviors become accepted as part of the culture, making it increasingly difficult to maintain safe practices.
Why Traditional Approaches Fall Short
Most healthcare organizations have policies against lateral violence or workplace bullying, yet these behaviors persist. Several factors contribute to this disconnect:
Siloed Responsibility
Lateral violence is typically treated as an HR issue rather than a safety concern, creating artificial divisions in what should be an integrated approach to workplace wellbeing.
Inadequate Metrics
While organizations track physical injuries, medication errors, and patient falls, few systematically measure interpersonal conflict metrics or include them in safety dashboards.
Focus on Individuals, Not Systems
Interventions often target specific "problem employees" rather than addressing the systemic and cultural factors that enable lateral violence.
Lack of Skill Development
Many organizations provide awareness training about lateral violence but fail to equip staff with the specific skills needed to address it effectively.
Hierarchical Protection
In some organizations, high-status individuals may be implicitly exempt from behavioral standards that apply to others, undermining efforts to create a consistent culture.
Integrating Lateral Violence into Safety Systems
To effectively address lateral violence as a safety issue, healthcare organizations must integrate it into their existing safety infrastructure:
1. Include in Safety Reporting Systems
Expand incident reporting systems to explicitly include lateral violence categories, making these events as reportable as medication errors or patient falls.
2. Track Meaningful Metrics
Develop and monitor metrics that capture the prevalence and impact of lateral violence:
- Reported incidents of disrespectful behavior
- Staff survey data on workplace climate
- Unit-specific psychological safety scores
- Correlation between interpersonal conflict and other safety events
3. Incorporate into Root Cause Analysis
When investigating safety events, include assessment of team dynamics and communication patterns as potential contributing factors.
4. Create Intervention Protocols
Develop clear, stepwise protocols for addressing lateral violence, similar to those used for other safety concerns:
- Early intervention guidelines
- Escalation pathways
- Documentation requirements
- Follow-up procedures
5. Include in Safety Rounds
Add assessment of interpersonal dynamics to safety rounds and leadership gemba walks, making team functioning as visible as environmental hazards.
Building Skills to Address Lateral Violence
At Vistelar, our conflict management training emphasizes that addressing lateral violence requires specific skills, not just awareness or good intentions. Key skill areas include:
1. Bystander Intervention
Equip all staff with techniques to safely intervene when witnessing lateral violence:
- Distraction methods to interrupt negative interactions
- Delegation approaches to involve appropriate resources
- Direct intervention language for addressing inappropriate behavior
- Documentation procedures for reporting incidents
2. Professional Communication
Develop standardized communication frameworks that reduce the likelihood of misinterpretation and conflict:
- Structured feedback models
- Clear handoff protocols
- Conflict resolution processes
- Assertive communication techniques
3. Emotional Intelligence
Enhance staff ability to recognize and manage emotions during challenging interactions:
- Self-awareness development
- Emotion regulation techniques
- Empathy and perspective-taking skills
- Stress management approaches
4. Boundary Setting
Teach clear methods for establishing and maintaining professional boundaries:
- Verbal boundary-setting techniques
- Non-verbal communication skills
- Consistent limit-enforcement approaches
- Documentation of boundary violations
Creating Accountability
Effectively addressing lateral violence requires clear accountability at multiple levels:
Individual Accountability
Each team member must understand:
- Their responsibility to treat colleagues with respect
- Obligation to report observed lateral violence
- Personal role in maintaining a healthy work environment
- Consequences for engaging in disrespectful behavior
Leadership Accountability
Leaders at all levels must:
- Model respectful communication consistently
- Address disrespectful behavior promptly and fairly
- Implement systemic changes to prevent lateral violence
- Include team climate in performance metrics
Organizational Accountability
The institution as a whole must:
- Provide necessary resources for addressing lateral violence
- Enforce policies consistently across departments and roles
- Measure and report on lateral violence metrics
- Incorporate conflict management into strategic planning
Case Studies in Success
Organizations that have successfully integrated lateral violence into their safety frameworks have seen significant benefits:
Academic Medical Center Example
One large teaching hospital incorporated lateral violence metrics into their safety dashboard and saw:
- 35% reduction in medication errors after implementing team communication training
- 28% decrease in staff turnover on previously high-conflict units
- Significant improvement in patient satisfaction scores related to coordination of care
Community Hospital Example
A mid-sized community hospital implemented a comprehensive lateral violence prevention program that resulted in:
- 40% reduction in reported staff conflicts
- 22% decrease in absenteeism
- 15% improvement in compliance with safety protocols
- Measurable increase in error reporting, suggesting improved psychological safety
Implementation Roadmap
For organizations looking to address lateral violence as a safety issue, consider this phased approach:
Phase 1: Assessment
- Gather baseline data on lateral violence prevalence
- Identify high-risk departments or teams
- Review existing policies and procedures
- Assess current reporting mechanisms
Phase 2: Infrastructure Development
- Expand safety reporting systems to include lateral violence
- Develop intervention protocols
- Create tracking metrics
- Establish clear accountability mechanisms
Phase 3: Skill Building
- Provide comprehensive conflict management training
- Develop peer support networks
- Train leaders in addressing team dynamics
- Build intervention skills at all levels
Phase 4: Cultural Integration
- Incorporate lateral violence prevention into onboarding
- Include interpersonal metrics in performance reviews
- Recognize positive team dynamics publicly
- Share success stories and outcomes
Phase 5: Continuous Improvement
- Regularly review metrics and outcomes
- Refine approaches based on data
- Expand successful interventions
- Adapt to emerging challenges
The Path Forward
Addressing lateral violence as a safety issue rather than just a workplace culture concern represents a significant opportunity for healthcare organizations. By applying the same rigorous approaches used for other safety threats—systematic tracking, intervention protocols, skill development, and accountability mechanisms—organizations can create environments where staff are protected from both physical and interpersonal harm.
This National Safety Month, consider whether your safety tracking includes measures of lateral violence and team dysfunction. If these metrics are missing from your safety dashboard, you may be overlooking one of the most significant risks to both staff wellbeing and patient care. By bringing this silent safety risk into the light, you can create a more complete and effective approach to workplace safety.
