When most healthcare organizations discuss safety, the conversation typically revolves around physical hazards—needle sticks, patient falls, medication errors, and other tangible risks that can be counted, measured, and tracked. These physical risks are essential to address, but they represent only part of the safety equation.
The less visible threats—sharp words, emotional attacks, and verbal aggression—can be just as damaging to both patients and healthcare workers. Words can also be gateway behaviors to physical violence, i.e., reliable indicators of imminent threats or “antecedents” to physical assaults; therefore, learning how to recognize, respond, and set limits on disrespectful and threatening language keeps people safer.
As we observe National Safety Month this June, it's time to expand our definition of safety to include protection from psychological and verbal harm. This broader perspective isn't just about being nice—it's about recognizing the full spectrum of safety threats that impact healthcare outcomes, staff retention, and organizational performance.
The Hidden Epidemic of Verbal Violence
The statistics on physical violence in healthcare are well-documented—healthcare workers suffer workplace violence at rates significantly higher than other industries. What receives less attention, however, is the
These incidents are frequently dismissed as "just part of the job" or classified as customer service challenges rather than safety issues. This miscategorization has serious consequences.
The Real Impact of Verbal Aggression
Verbal and emotional harm isn't merely unpleasant—it carries measurable costs:
For Healthcare Workers:
For Patients:
For Organizations:
Recognizing the Warning Signs
At Vistelar, our conflict management training emphasizes recognizing the early indicators of potential verbal or emotional harm, i.e., what we call "gateway behaviors." These include:
Proxemic Indicators:
Verbal Indicators:
Paraverbal Indicators:
Non-verbal Indicators:
Note: Certain cognitive disorders can appear as aggressive or disrespectful, e.g., refusing eye contact, difficulty with personal space, and excessive emotionality. Training to recognize and address cognitive challenges is also crucial training for healthcare workers.
The Cycle of Violence
Gateway behaviors are best understood this way: Verbal disrespect unchecked leads to threatening – threatening unchecked leads to physical violence. Although it is a common perception on the part of victims, physical assaults almost never come “out of the blue.” People will usually tell us several times they are going to strike out before they attack; however, most potential victims aren't listening and fail to recognize or respect these warning signs.
By training staff to recognize these early warning signs, interventions can occur before situations escalate to more severe verbal or physical aggression. By properly and effectively addressing the early forms of violence, such as sarcasm and implied threats, physical violence can be prevented and the tone for more cooperative and safer communication can be established.
Integrating Psychological Safety into Safety Systems
Expanding safety systems to include psychological and verbal protection requires systematic changes:
1. Update reporting mechanisms
What gets measured gets managed. Ensure incident reporting systems explicitly include categories for verbal aggression and emotional harm.
2. Develop verbal safety protocols
Just as we have protocols for needle sticks or falls, create clear procedures for responding to verbal aggression:
3. Establish clear behavioral expectations
Create and communicate standards for acceptable behavior from all parties:
4. Train intervention skills
Equip all staff with the skills to:
5. Create recovery processes
Develop protocols to support recovery after verbal incidents:
Building a Comprehensive Safety Culture
The most effective approach integrates psychological safety into the existing safety culture:
Leadership Commitment
Leaders must explicitly include verbal and emotional safety in their safety messaging and priorities. This means addressing inappropriate behavior consistently, regardless of who exhibits it—patients, visitors, or staff members.
Policy Integration
Rather than creating separate policies for "customer service issues" and "safety issues," integrate verbal
Environmental Design
Consider how physical environments might increase or decrease psychological safety:
Proactive Prevention
Implement preventive measures:
The Path Forward
Expanding our definition of safety to include protection from psychological and verbal harm isn't about creating a conflict-free environment—healthcare will always involve difficult conversations and emotionally charged situations. Rather, it's about acknowledging that verbal and emotional harm are legitimate safety concerns that deserve the same systematic attention as physical risks.
This National Safety Month, consider how your organization might take concrete steps to address the full spectrum of safety. By protecting staff and patients from both sharp objects and sharp words, we create environments where healing can truly flourish.