IDEWE study: 4 in 10 healthcare workers experience aggression from patients or visitors

“Aggression affects employees’ psychosocial wellbeing”, says Sofie Vandenbroeck, Head of Knowledge, Information and Research at IDEWE. “They feel less safe, less engaged and are more likely to distance themselves from their work. In the longer term, this also increases the risk of absenteeism, which in turn puts additional pressure on the remaining colleagues. That is why we are raising awareness of this issue and emphasising the importance of prevention, particularly in the already tight healthcare labour market.”

Combination of factors 

The figures show that aggression in the healthcare sector primarily comes from external sources. In total, 38% of healthcare workers experience external violence at least occasionally. Sofie Vandenbroeck: “Particularly in general hospital departments, you are often dealing with people in stressful and uncertain situations, sometimes facing very bad news. On top of that, there are often long and unclear waiting times, which some interpret as a lack of attention or care. This creates an explosive combination of factors.”

In other settings – such as residential care centres, psychiatric institutions or youth care facilities – you are more likely to encounter aggression linked to an underlying condition, where aggressive behaviour is a symptom. “This can be seen, for example, in geriatric wards, psychiatric departments or emergency services, where staff are often confronted with substance use. It is therefore not surprising that aggression rates in healthcare are higher than in other sectors. At the same time, nearly 40% is very high, and we believe it can be improved.”

Meanwhile, healthcare workers often deal with high workloads and emotionally demanding conditions, which can also lead to tensions between colleagues. “A slightly higher level of internal aggression is not unexpected here either, but the goal should be to bring that 7.5% down significantly. Especially since support from colleagues is a crucial buffer when dealing with external aggression.”

Different forms of aggression

Aggression occurs in different forms, both externally and internally. In cases of external aggression, 32% of healthcare workers experience verbal aggression at least occasionally, followed by threats of physical aggression (26%) and physical aggression, such as hitting or pushing (17%). A similar pattern can be seen in internal aggression, with 5% reporting verbal aggression, 3% threats and 2% physical incidents.

“It is not surprising that verbal and psychological aggression occur most frequently”, says Sofie Vandenbroeck. “Physical aggression is often accompanied by verbal abuse. Because these forms are less visible than physical incidents, they are sometimes underestimated, even though they have a significant impact on how employees experience their work. Moreover, repeated smaller incidents can build up over time, increasing the strain on employees until it – seemingly all of a sudden – becomes unsustainable.”

What can you do about aggression in the workplace?

Both employers and employees can take concrete steps to prevent aggression and deal with it effectively. In healthcare, aggression often builds up gradually due to uncertainty, frustration and time pressure, although in some situations, such as pathological aggression, it can also occur suddenly. De-escalation starts with remaining calm. That may sound simple, but it is often the most difficult part, as people tend to react instinctively. That is why it is important for healthcare workers to learn how to manage their own reactions, so they can remain professional and prevent situations from escalating. Aïsha Butseraen, Prevention Advisor for Psychosocial Aspects shares a number of practical tips:

• Ensure clarity and predictability

  “When patients or family members are left waiting without clear information, frustration can quickly build. Inconsistent rules can also create confusion and increase the risk of aggression. That is why good alignment within teams is essential. At the same time, healthcare professionals often work under high pressure — something patients are not always aware of. Clear communication is therefore key, especially when things change: what seems obvious internally is often not so for patients. And often, it’s the small human gestures that matter most. A simple look or a few words showing “we haven’t forgotten you” can already make a big difference.”

• Acknowledge emotions before providing information

  “In emotionally charged situations, explanations alone often have the opposite effect. Always start by acknowledging the person’s feelings and showing empathy – ‘I understand this is frustrating’ – to first reduce tension and then create space for a more substantive conversation. Avoid falling into the ‘routine trap’: the more delivering bad news becomes part of your daily routine, the greater the risk that it comes across as impersonal and lacking empathy to those receiving it.”

• Stay calm and set clear boundaries

  “De-escalation does not mean allowing everything. By staying calm and clearly indicating what is and is not acceptable, you maintain control without escalating the situation further.”

• Invest in training tailored to the healthcare context

  “De-escalation takes practice. Staff need to learn how to handle emotional reactions from patients and their families, communicate under pressure and quickly assess when a situation is at risk of escalating. It is also important to repeat this training regularly.”

• Address issues early within the team

  “Create a culture where any form of inappropriate behaviour between colleagues can be easily reported and discussed. The clearer the boundaries and the sooner underlying tensions are addressed, the lower the risk of a culture where colleagues take out their frustrations on each other. This also helps prevent a vicious cycle in which internal and external aggression reinforce each other.”

• Be aware of your surroundings and ensure safety

  “Always make sure you have a way out of a situation. This starts with where you position yourself in a room or consultation space and knowing where alarm buttons are and which procedures to follow. Also make sure new colleagues are properly informed, so everyone knows how to act if a situation escalates.”

• Make clear agreements within the team

  “Agree in advance how you will support each other when tensions rise or when intervention is needed. Regularly discuss, evaluate and practise these agreements. Smaller incidents also deserve attention, as this helps prevent boundaries from becoming blurred and behaviour from being normalised.”

• Acknowledge the impact and seek support

  “Take time to reflect on how an incident affects you and speak up about it. Aggression can have a real impact, and that does not reflect on your competence. Actively seek support within your organisation, from colleagues, supervisors, confidential counsellors or aftercare teams.”
   

^{* The data are based on results from IDEWE’s surveys among employees in the healthcare sector in the context of psychosocial wellbeing (RAPSi – risk analysis of psychosocial aspects). The results reflect self-reported experiences that occur ‘at least occasionally’. The study was conducted by IDEWE among 3,473 respondents in 2025, representative of the Belgian working population.}