From Burnout to Business Risk:
Why Hospital Violence Demands Boardroom Attention
In emergency departments across the country, the rising tide of workplace violence is reshaping the realities of care delivery. As a nursing director at a high-volume Level 1 trauma center, I’ve seen firsthand how violent incidents, once isolated, have become daily occurrences. These events affect not only the safety of healthcare workers but also the clinical performance, caregiver wellbeing, and financial sustainability of hospitals themselves.
The American Hospital Association’s 2025 report, The Burden of Violence to U.S. Hospitals, underscores the urgency with hard numbers: $18.27 billion in annual costs related to workplace and community violence. This includes medical treatment, staff turnover, lost worktime, legal exposure, infrastructure repairs, and investments in prevention.
These figures make clear what many clinicians and leaders have long experienced: workplace violence is not just a frontline challenge; it’s a systemic risk that belongs on the radar of every health system’s executive team and board.
Why This Is a C-Suite Issue
Violence drives attrition, burnout, and decreased productivity. It also imposes unplanned financial burdens in a sector already grappling with margin pressures. But its impact goes deeper. Violence erodes organizational culture, undermines trust, and hampers progress across all four pillars of the Quadruple Aim: patient experience, population health, cost efficiency, and caregiver well-being.
Boards and executive teams increasingly recognize cybersecurity and emergency preparedness as strategic priorities. Workplace violence must be treated with the same gravity because it:
- Disrupts operational continuity during volume surges or staff shortages.
- Increases reputational risk and community distrust.
- Impacts HCAHPS1 scores, staffing KPIs, and regulatory compliance.
- Creates latent liability in cases where systems are found unprepared.
Bringing Safety to the Strategy Table
To elevate workplace violence prevention from a compliance function to a strategic priority, hospitals can take several board-facing steps:
- Integrate violence prevention into enterprise risk dashboards.
Make safety metrics as visible as length of stay or readmission rates. This includes incident reporting trends, security response times, staff perception surveys, and behavioral code activations.
- Align prevention with capital and workforce planning.
Security investments, from design changes to staffing models, should be evaluated not only on cost, but also on their impact on staff retention, patient experience of care, and system resilience.
- Assign executive sponsorship and accountability.
Violence mitigation should be owned at the highest levels, with a dedicated executive sponsor reporting regularly to the CEO and/or the board's safety and quality committee.
- Benchmark and audit prevention readiness.
Just as hospitals prepare for mass casualty events, they should assess readiness to manage persistent, lower-frequency-but-higher-impact workplace violence scenarios.
- Engage frontline voices in strategy development.
Cross-functional safety councils should include clinicians, support staff, and security to ensure practical, experience-informed recommendations reach the boardroom.
From Reactive to Integrated Approaches
These board-level strategies must also translate into practical, frontline readiness. Leading hospitals are now embracing integrated approaches that shift from reactive policies to proactive prevention.
Responding effectively to workplace violence means moving beyond episodic training and ad hoc reporting. Many health systems are advancing more integrated approaches that include:
- Structured debriefing and secondary trauma support for staff in both group and individual capacities.
- Data-driven safety governance with cross-disciplinary input.
- Environmental and procedural modifications to prevent escalation.
- Community partnerships focused on violence intervention and continuity of care.
The shift is clear: addressing workplace violence is not just a matter of frontline safety, but a strategic imperative touching every aspect of hospital operations and culture.
A Shared Strategic Imperative
Hospital safety must evolve from a set of policies to a lived culture, and that culture starts with leadership. Boards set the tone, allocate resources, and determine what constitutes strategic action. A failure to address violence as a governance issue may soon become a governance failure.
In a post-pandemic healthcare environment strained by labor shortages and financial volatility, we cannot afford for safety to remain a siloed or reactive function. Elevating workplace violence prevention to a core part of strategic planning is crucial for protecting our teams, maintaining patient trust, delivering high-quality care, and ensuring the long-term viability of our institutions.
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Jen Moberg, DNP, MPA, RN, NEA-BC, Senior Advisor, CSA, brings over 28 years of experience leading complex interdisciplinary teams towards safe, high-quality care. Jen holds expertise and accomplishment with strategic planning and alignment, patient safety, workforce safety, process improvement, change management, staff engagement, and patient experience. She has led emergency preparedness initiatives and partnered closely with security for both Level 1 and Level 3 trauma centers in workplace safety.
- Hospital Consumer Assessment of Healthcare Providers and Systems
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