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
The prevalence of these behaviors in healthcare is startling:
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:
Indirect Safety Effects:
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:
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:
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:
2. Professional Communication
Develop standardized communication frameworks that reduce the likelihood of misinterpretation and conflict:
3. Emotional Intelligence
Enhance staff ability to recognize and manage emotions during challenging interactions:
4. Boundary Setting
Teach clear methods for establishing and maintaining professional boundaries:
Creating Accountability
Effectively addressing lateral violence requires clear accountability at multiple levels:
Individual Accountability
Each team member must understand:
Leadership Accountability
Leaders at all levels must:
Organizational Accountability
The institution as a whole must:
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:
Community Hospital Example
A mid-sized community hospital implemented a comprehensive lateral violence prevention program that resulted in:
Implementation Roadmap
For organizations looking to address lateral violence as a safety issue, consider this phased approach:
Phase 1: Assessment
Phase 2: Infrastructure Development
Phase 3: Skill Building
Phase 4: Cultural Integration
Phase 5: Continuous Improvement
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.