He, YumeiHolroyd, EleanorKoziol-McLain, Jane2023-07-112023-07-112023-06-20BMC Health Serv Res, ISSN: 1472-6963 (Print); 1472-6963 (Online), Springer Science and Business Media LLC, 23(1), 660-. doi: 10.1186/s12913-023-09577-31472-69631472-6963http://hdl.handle.net/10292/16412BACKGROUND: Workplace violence against medical staff in China is a widespread problem that has negative impacts on medical service delivery. The study aimed to contribute to the prevention of workplace violence against medical staff in China by identifying patterns of workplace violence, key risk factors, and the interplay of risk factors that result in workplace violence. METHODS: Ninety-seven publicly reported Chinese healthcare violent incidents from late 2013 to 2017 were retrospectively collected from the internet and analysed using content analysis. A modified socio-ecological model guided analysis of the violent incidents focusing on risk. RESULTS: Physical violence, yinao, or a combination of physical and verbal violence were the typical forms of violence reported. The findings identified risk at all levels. Individual level risk factors included service users' unreasonable expectations, limited health literacy, mistrust towards medical staff, and inadequacy of medical staff's communication during the medical encounter. Organisational level risk factors under the purview of hospital management included problems with job design and service provision system, inadequacies with environmental design, security measures, and violence response mechanisms within hospitals. Societal level risk factors included lack of established medical dispute-handling mechanisms, problems in legislation, lack of trust and basic health literacy among service users. Situational level risks were contingent on risk factors on the other levels: individual, organisational, and societal. CONCLUSIONS: Interventions at individual, situational, organisational, and societal levels are needed to systematically address workplace violence against medical staff in China. Specifically, improving health literacy can empower patients, increase trust in medical staff and lead to more positive user experiences. Organizational-level interventions include improving human resource management and service delivery systems, as well as providing training on de-escalation and violence response for medical staff. Addressing risks at the societal level through legislative changes and health reforms is also necessary to ensure medical staff safety and improve medical care in China.Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.http://creativecommons.org/licenses/by/4.0/ChinaCommunicationHealthcareManagementPatient experiencePatient-centred carePhysician-patient relationsSocio-ecological modelTrustWorkplace violence42 Health SciencesPreventionClinical ResearchPatient SafetyViolence Research3.1 Primary prevention interventions to modify behaviours or promote wellbeing8 Health and social care services research3 Prevention of disease and conditions, and promotion of well-being8.1 Organisation and delivery of servicesMental health16 Peace, Justice and Strong Institutions0807 Library and Information Studies1110 Nursing1117 Public Health and Health ServicesHealth Policy & Services4203 Health services and systems4205 Nursing4206 Public healthHumansWorkplace ViolenceRetrospective StudiesMedical StaffPatientsChinaWorkplaceHumansRetrospective StudiesMedical StaffPatientsWorkplaceChinaWorkplace ViolenceJournal ArticleOpenAccess10.1186/s12913-023-09577-3