Gender-related violence and harassment in healthcare: A booklet on interventions

Abstract

Workplace violence (WPV) and gender-based violence and harassment (GBVH) are persistent and pervasive challenges in healthcare systems worldwide, representing critical threats to workers’ safety, well-being, and retention. Effective, evidence-based interventions are therefore critical to preventing violence, strengthening organisational responses, and fostering safer, more equitable healthcare environments. The main purpose of this booklet is to synthesise selected evidence-based strategies for the prevention and intervention of WPV and GBVH in healthcare settings, and to provide informed recommendations to guide the development and implementation of strategies that have demonstrated effectiveness in addressing the problem, serving as a guide to good practices. Hence, this work is directed at hospital administrators, occupational health services, policymakers, union representatives, and other groups or individuals interested in WPV and GBVH in healthcare settings. This booklet is structured into five interconnected sections that provide a broader overview of WPV and GBVH in healthcare settings: introduction, methods, results, reflexive synthesis with practical recommendations, and conclusions. The introductory section conceptualises WPV and GBVH in healthcare settings and outlines the purpose and objectives of this document. The second section offers a methodological overview of the data sources, search strategy, eligibility criteria, and study selection. To accomplish its purpose, structured searches were conducted and contributions from experts on the field were solicited to collect and select case studies of interest, respecting the following criteria: (1) prevention or intervention programme with an pre- or quasi-experimental design, (2) relevance to GBVH, (3) heterogeneity of perpetrators and victims, (4) gap-filling potential given what is known from published research, (5) novelty or innovative approach to the phenomenon, and (6) practical applicability. The results section is divided into a general overview of findings, a level of implementation (individual and organisational), a gender analysis, and a deeper analysis section. The 17 analysed case studies show an overemphasis on individual-level educational interventions, mainly directed at healthcare workers (as victims), leaving aside patients and their relatives, who are the majority of perpetrators. These interventions particularly focus on training and educational programmes aimed at improving workers’ awareness, communication skills and capacity to respond to violent incidents. While these approaches are valuable in mitigating the adverse consequences of WPV, they are insufficient on their own to effectively prevent violent incidents. The potential role of bystanders in interrupting and de-escalating violent situations remains largely overlooked. Furthermore, many interventions disproportionately target nurses and nursing students, suggesting the underrepresentation of other healthcare professionals. The results also highlight the importance of recognising the gendered and cultural dimensions of WPV and harassment, which remain insufficiently integrated in existing interventions. There is also a lack of long-term assessment of improvements reported shortly after interventions. Although less reported, organisational-level interventions demonstrate strong potential. In particular, systemic interventions that use novel technological and digital solutions to address underreporting at the organisational level, improve surveillance systems, and foster a perception of safety at work. Integrating artificial intelligence (AI) and implementing protocols that hold perpetrators responsible based on their actions, role, clinical conditions and the gender aspect of violence should be addressed. The complex phenomena of WPV and GBVH, shaped by multiple determinants, call for a careful reflection on these findings to provide several practical recommendations for the promotion of safer and healthier workplaces in healthcare, which should be taken together in multi-level interventions, considering individual, interpersonal, organisational, socio, and intercultural levels in an integrative and coherent way. Therefore, practical recommendations can be summarised as follows:  Promote implementation of multi-level interventions  Expand interventions to all healthcare professional groups and relevant actors  Strengthen reporting, monitoring, and surveillance systems  Integrate gender-sensitive approaches  Increase intercultural literacy in healthcare  Implement long-term evaluations to assess sustained impact.