A systems analysis of work-related violence in hospitals: Stakeholders, contributory factors, and leverage points

•Work-related violence (WRV) in hospitals is a growing problem worldwide.•The issue is highly complex and requires a systems thinking approach.•We developed an ActorMap, AcciMap and PreventiMaps to examine WRV in hospitals in New South Wales, Australia.•The findings show a complex and diverse set of stakeholders and contributory factors.•Nine target areas are proposed as the most suitable for intervention. Work-related violence in hospitals is a growing problem that has significant personal, societal, and economic costs and adversely impacts the quality of patient care. The complex and multi-factorial nature of the issue is such that it is extremely difficult to understand and manage, and interventions have had varying levels of success. Systems thinking and associated analysis methods are useful when attempting to understand and respond to complex issues; however, they have not previously been applied to work-related violence in hospital settings. This study involved the application of three systems thinking methods in conjunction with healthcare stakeholders to analyse the problem of work-related violence in hospital settings in New South Wales, Australia. The ActorMap method was used to identify the stakeholders who share the responsibility for the issue and the AcciMap method was used to identify the contributory factors which interact to create work-related violence incidents. PreventiMaps were then developed to show where interventions could be used to better prevent or mitigate work-related violence. The findings show a complex and diverse set of contributory factors beyond patients and healthcare workers and suggest that fundamental system reform is required. Nine key areas of hospital practice are proposed as the most suitable targets for intervention moving forward.