Workplace violence is a common experience among health care workers, and is considered as an emerging issue to be addressed in various global healthcare contexts . In several health settings, workplace violence is considered a major occupational and health hazard which requires early prevention or mitigation [2, 3]. The World Health Organization defines workplace violence as the “intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development, or deprivation” . Currently, workplace violence is considered as a public health problem [5, 6]. In most cases, workplace violence involved physical attacks, verbal abuse and initiation of mental stress. Reports on workplace violence has included several health care workers such as nurses [7,8,9,10,11], emergency medical technicians , and physicians [5, 13, 14]. In Saudi Arabia, there is a lack of policy which promotes the protection health care workers from workplace violence which is instigated by patients.
According to the WHO, workplace violence can involve physical and psychological violence, both of which leads to decline in workplace productivity and health care quality . In addition, workplace violence has been reported to be related to job burnout, job dissatisfaction, and turnover intention . It was reported that in the health care settings, the most common types of violence reported include verbal abuse, threatening behaviors, physical assaults, and sexual harassment . In either case, violence against health care workers leads to a negative effect on both physical and psychological well-being in various health settings .
The most common setting of physical and psychological violence is the hospital [9, 15,16,17]. In various studies, the perpetrators of workplace violence included patients and visitors [15, 17, 18], and other workers [17, 19]. Some of the most common instigating causes of workplace violence include failure to meet patient expectations [5, 7] and deficient staff number  which lead to patient aggression. While it is expected that patient dissatisfaction should encourage feedback towards the improvement of health care services in the emergency department, there is also a possibility that the stressful environment in the health setting may initiate incidence of workplace violence.
In Saudi Arabia, initial efforts in assessing the incidence of workplace violence have been documented among health care workers. Violence towards health care workers have been documented among nurses in the emergency department in Riyadh , with most cases associated with verbal abuse while physical abuse was relatively uncommon. Violence against health care workers situated in primary care centers in Al Khobar, Eastern Province has also been documented , with most cases attributed to verbal violence and intimidation. However, the incidence of workplace violence among physicians working in the emergency department in Taif City, Saudi Arabia is still undocumented. In another study, it was reported that the most common form of workplace violence in the emergency department of certain hospitals in Saudi Arabia were related to verbal attacks  and the most susceptible health care professionals were physicians. In the study of , it was revealed that nurses in Saudi Arabia who experienced workplace violence did not report the incidence due to fear for negative consequences and feelings of uselessness.
With the pervasiveness of workplace violence, the manner how the issue on physical and verbal violence was resolved between health care professionals and the perpetrators was often remarked to be unsatisfactory . The dismal effort towards protecting health care professionals against violence in the workplace may compromise the well-being of health care professionals, leading to poor performance and consequent work dissatisfaction. In Saudi Arabia, issues on work and may require further investigation to promote the well-being of the health care worker and the patient.
Hence, this study sought to investigate the incidence of physical and verbal violence in selected hospitals in Taif City, Saudi Arabia, and the interventions done by the physicians to mitigate workplace violence. In addition, associations between the incidence of violence and interventions done with the type of physicians, and type of physicians and years of experience in the emergency medicine department were also investigated. The results of the study can serve as a guide to the development of relevant hospital policies which can address workplace violence in the emergency department of hospitals in Taif City, Saudi Arabia. The study’s aim to determine the types of workplace violence and types of perpetrators in the workplace can provide context-specific policies that can address not only the concerns of residents and physicians, but other health care workers as well. Furthermore, the information gathered on the current intervention utilized by physicians in the emergency department of hospitals to address the incidence of verbal and physical violence can also be utilized to draft additional guidelines on national policies which protects the rights of health care professionals.
Subjects and methods
This study utilized a cross-sectional research design using an adapted research instrument, duly adapted for online data gathering. Physician respondents who work in the emergency department were recruited from Taif City, Saudi Arabia. The inclusion criteria of respondents included: a) currently employed physician in a hospital in Taif city, b) male or female, c) works in morning, afternoon or night shifts, and d) willing to participate in the study. For the exclusion criteria, any respondent who refused to sign the informed consent prior to answering the research instrument, or who are unable to answer the test due to any health condition, or those who have other conditions which might influence their performance on the test were excluded from the study. All respondents who did not have any internet access and expressed withdrawal from answering the questionnaire were also excluded from the analysis of data.
This study gathered data using the WHO Questionnaire on Violence against Health Care Workers. The research instrument is divided into three parts. The first part obtained the sociodemographic data of the physicians while the second part determined the respondents’ experiences with violence in the workplace. The third part identified the factors which may lead to violence and strategies for the prevention of violence in workplace, as perceived by the respondents.
The study was approved by the Institutional Ethics Committee of the Directorate of Health Affairs in Taif, Saudi Ministry of Health (MOH), Research Protocol # HAP-02-T067. Anonymity was ensured by assigning a code for each respondent. All files were secured in a single document to ensure confidentiality of information. Using systematic sampling, a total of 120 residents and physicians were recruited and 96 residents and physicians who received an online link to an electronic version of the research instrument completely answered all questions, which is equivalent to 80% response rate. All respondents were physicians who had worked in the emergency department. The invitation to answer the questionnaire was sent to the respondents’ email, after seeking permission from the hospitals to obtain their email addresses. Participation to the study was voluntary and complied with the set guidelines by the ethical approval committee and indicated voluntary participation by answering the “Yes” option in the electronic form.
The data obtained were entered into Microsoft Excel. Quantitative analysis was conducted by summarizing data into frequency and percentage. Chi square (χ2) analysis was performed to determine association of variables using SPSS 27.0 (NY, Armonk). Fisher Exact test was utilized in cases where chi square statistics was not appropriate. Bonferroni adjustment was used as post hoc test for associations which were statistically significant. Statistical significance was evaluated at α = 0.05. All p values less than 0.05 were considered statistically significant.