Violence in health care: institutional strategies to cope with the phenomenon.

Violence permeates every aspect of society, including the health care organization. Appropriate health care organizational response to the phenomenon of violence requires recognition that the emergence of violence is associated with patient, staff, situational, and environmental variables, and it is predictable in most instances. Effective management of violent patients requires comprehensive organizational policies, procedures, and protocols, combined with periodic staff training and retraining. Health care organizations and their personnel need to be knowledgeable about pre-assaultive clinical symptomatology, modification of staff behaviors and environmental factors with the goal of reducing the potential for violence, therapeutic interventions during both pre-assaultive and violent phases of patient behavior, and quality assurance and risk management issues implicit in managing violent patients.