In recent decades, workplace violence against medical staff in China has been reported to be widespread and has negatively impacted medical service delivery. The present study aimed to contribute to the prevention of workplace violence against medical staff in China. Guided by a socio-ecological model, the present study’s objectives included: identifying patterns and risk factors, identifying key risk factors and their interplay for workplace violence against medical staff, and developing a preliminary framework for violence prevention intervention in China.

This sequential mixed-methods study took place over five years, from late 2015 to early 2021, and consisted of three phases. In Phase One, 97 publicly available Chinese healthcare violent incidents were collected and analysed. Content analysis was used to understand patterns and risk factors of violence. In Phase Two, 22 purposively sampled key stakeholders in China were interviewed to examine the violence risk factors and investigate the interplays of risk factors to inform the development of violence prevention framework. In Phase Three, findings from Phases One and Two, as well as literature, were synthesised to suggest that misunderstandings during the medical encounter could result in unpleasant communication between service users and medical staff, causing service users’ negative perception and mistrust, and at times, violence. Many of the problems identified among service users and medical staff at the individual level could be linked to problems in hospital management (organisation level) which, in turn, were rooted in community and health policies (community and societal level). Intervention strategies were then derived from triangulating findings from Phases One and Two and the literature review.

The provisional framework provides an approach to highlight and address risks at the individual, organisational, and the external community and national policy levels, systematically and comprehensively, emphasising collaborating and coordinating intervention efforts. Opportunities are identified for hospital management to play a pivotal role in enabling and facilitating positive communication and positive service user experience during the medical encounter by providing the necessary resources focusing on medical staff’s wellbeing and empowerment. Hospital senior management was found to have low awareness of such a need, thereby indicating the need for policy and regulatory efforts to further guide hospitals’ senior management to implement strategic health and safety management to take care of medical staff’s wellbeing to improve medical staff’s performance.

Furthermore, interplays of factors indicate that intervention at the community and policy levels is required to effectively and fundamentally address problems manifested on individual service users and medical staff, so that positive communication between service users and medical staff, and service users’ positive experience are made possible. Specifically, promoting health literacy through health education among the public, and continuing health reforms, especially reforms in human resource management of medical professionals, reforms in how medical staff are paid, and improving laws and regulations concerning protection against risks carried in medical services provision to enable trust and effective communication between service users and medical staff, are identified as necessary to address risk factors of workplace violence.