Expert Recommendations for Designing Reporting Systems to Address Patient-Perpetrated Sexual Harassment in Healthcare Settings

Abstract

Background

Patient-perpetrated sexual harassment toward staff and patients is prevalent in Veterans Affairs and other healthcare settings. However, many healthcare facilities do not have adequate systems for reporting patient-perpetrated harassment, and there is limited evidence to guide administrators in developing them.

Objective

To identify expert recommendations for designing effective systems for reporting patient-perpetrated sexual harassment of staff and patients in Veterans Affairs and other healthcare settings.

Design

We conducted qualitative interviews with subject matter experts in sexual harassment prevention and intervention during 2019.

Participants

We used snowball sampling to recruit subject matter experts. Participants included researchers, clinicians, and administrators from Veterans Affairs/other healthcare, academic, military, and non-profit settings (n = 33).

Approach

We interviewed participants via telephone using a semi-structured guide and analyzed interview data using a constant comparative approach.

Key Results

Expert recommendations for designing reporting systems to address patient-perpetrated sexual harassment focused on fostering trust, encouraging reporting, and deterring harassment. Recommendations included the following: (1) promote a climate in which harassment is not tolerated; (2) take proportional, corrective actions in response to reports; (3) minimize adverse outcomes for reporting parties; (4) facilitate and simplify reporting processes; and (5) hold the reporting system accountable. Specific strategies related to each recommendation were also identified.

Conclusions

This qualitative study generated initial recommendations to guide healthcare administrators and policy makers in assessing, developing, and improving systems for reporting patient-perpetrated sexual harassment toward staff and other patients. Results indicate that proactive, careful design and ongoing evaluation are essential for ensuring that reporting systems have their intended effects and mitigating the risks of inadequate systems. Additional research is needed to evaluate strategies that effectively address patient-perpetrated harassment while balancing patients’ clinical needs.

BACKGROUND

A recent study found that 97% of women and 77% of men physicians at a Veterans Affairs (VA) Medical Center experienced sexual harassment by patients.¹ Other findings suggest high prevalence of patient-perpetrated sexual harassment toward providers in academic medical facilities^2,3. Common incidents include unwanted sexual advances, suggestive or offensive nonverbal behaviors, interactions conveying hostile or degrading gender-based attitudes, and denigration of providers’ professional competence or role. Experiences of patient-perpetrated harassment are associated with reduced provider productivity, advancement, retention, mental health, and sense of safety at work.^3–5

Patient-perpetrated sexual harassment directed toward other patients has received less research attention than harassment of staff. One exception is a survey of 12 VA Medical Centers, which found that 25% of women Veteran regular VA users experienced harassment from men Veterans on VA grounds.⁶ Women who experienced harassment were more likely to delay or miss needed care. There are no studies that directly compare prevalence of harassment at VA and non-VA healthcare facilities, but qualitative evidence suggests that several characteristics may contribute to elevated rates of patient-perpetrated sexual harassment toward women staff and/or women patients at VA. These include a male-majority patient population, influence of negative military gender norms, an inability to deny care to disruptive patients, and an organizational climate that communicates tolerance for harassment.^7–10

Best practices in organizational strategies for reducing sexual harassment include clear and consistent policies and procedures for reporting, addressing, and remediating harassment incidents.^4,11 Well-designed reporting systems can improve perceptions of organizational climate related to harassment, provide infrastructure for implementation of evidence-based anti-harassment programs (e.g., bystander interventions), and track harassment incidents over time.^12–14 However, recent evidence suggests that many VA and academic healthcare facilities lack clear policies and procedures for reporting patient-perpetrated sexual harassment.^9,15

Several factors contribute to this lack of clear procedures. Antidiscrimination procedures mandated by the Equal Employment Opportunity Commission focus on workplace harassment between colleagues, and systems for managing disruptive patient behavior often focus on “severe” incidents such as threats or physical violence, leaving a gap in guidance for reporting patient-perpetrated sexual harassment.^9,16,17 Additionally, developing specialized procedures for reporting and addressing patient-sexual perpetrated harassment may be complicated by potential clinical, logistical, and ethical challenges. These include fears that reporting patient-perpetrated harassment will reduce patient satisfaction, disrupt clinical care, or damage the therapeutic relationship; uncertainty about how to implement corrective actions for patients or address harassment when the perpetrator’s identity is unknown (e.g., catcalling in common areas); and concerns that reporting systems can have unintended detrimental impacts on individuals making reports (hereafter “reporting parties”). ^4,9,18–21

The 2020 Deborah Sampson Act mandates VA facilities to establish clear systems through which staff and patients can report patient-perpetrated harassment,²² and recent editorials call for similar interventions in other healthcare settings.^23,24 However, there is limited evidence to assist healthcare administrators and policy makers in designing systems that encourage reporting, hold perpetrators accountable, and minimize adverse outcomes for reporting parties.⁴ The goal of this study was to generate expert recommendations for designing effective systems for reporting patient-perpetrated sexual harassment of staff and patients in VA and other healthcare settings.

Methods

Study data comes from a larger project to identify strategies for reducing patient-perpetrated sexual harassment of women staff and patients at VA. The larger project consisted of two parts: (1) interviewing subject matter experts in sexual harassment prevention and intervention to identify potential interventions and procedures for addressing harassment and (2) conducting deliberation groups with VA staff to identify VA-specific recommendations for addressing harassment. This study uses data from the subject matter expert interviews (part 1).

We used a snowball sampling approach to identify participants. We recruited initial participants by contacting experts on VA patient policies; contributors to the National Academies of Sciences, Engineering, and Medicine (NASEM) landmark report on sexual harassment;⁴ and authors of recent articles on harassment in healthcare settings. At the end of each interview, we asked participants to provide additional names of individuals with relevant expertise. To draw from fields with established literatures on sexual harassment, we included experts from military, academic, and non-profit organizations in addition to VA and other healthcare facilities in our sample. Table 1 provides information about participants’ current positions, areas of expertise, and gender.

Table 1.

Subject Matter Expert Participant Characteristics

Characteristic	N (%)a
Primary position
University faculty (e.g., medicine, psychology, public health)	12 (36)
Non-faculty researcher (e.g., consultant)	5 (15)
Clinician (e.g., physician, psychologist)	9 (27)
Policy maker/administrator	3 (9)
Other	4 (12)
Main area of sexual harassment/assault expertise
Healthcare settings (non-VA)	7 (21)
VA settings	6 (18)
Military settings	3 (9)
Educational settings	5 (15)
Public/street harassment	2 (6)
Other/general settings	10 (30)
Gender
Female	27 (82)
Male	6 (18)

^aN = 33 participants; two participants participated in two of the 31 interviews.

Three members of the research team with doctoral-level training (KD, RK, JM) conducted semi-structured telephone interviews in 2019. We developed an initial interview guide based on previous work related to sexual harassment of women staff and patients at VA and iteratively refined it based on our findings from early interviews (see Appendix). We added specific questions about reporting to the guide after completing approximately half of the interviews and noting that many participants offered suggestions related to reporting systems in their descriptions of interventions to address harassment. The interview questions related to reporting included the following: Based on the work you have done, what might a reporting system for harassment by patients look like? What might be important to keep in mind when designing a reporting system for harassment by patients? At the beginning of each interview, we provided a definition of public sexual harassment (i.e., unwanted interactions between strangers in public places) and clarified that we were interested in addressing patient-perpetrated harassment toward staff and patients. Interviews lasted approximately 45–60 min and were audio recorded. The VA Greater Los Angeles Institutional Review Board determined that the interviews constituted non-human subjects research. However, we followed protocols for ethical conduct of research projects, including securing participants’ verbal consent for recording during interviews.

We imported interview transcripts into ATLAS.ti (v8) for data management and analysis. Before formal coding, three research team members (KD, KF, KO) summarized major topics in each transcript to inform codebook and theme development.²⁵ During this step, we determined that 31 interviews (out of 40) contained information about reporting; these 31 interviews constitute the analytic sample. Next, two team members (KF, KO) completed initial coding using the constant comparative method.²⁶ Finally, the first author (KF) completed focused coding, organizing coded passages by topic to facilitate identification of overarching themes. Throughout the analytic process, the coders and other research team members discussed theme development and coding discrepancies until they reached consensus.^26,27

RESULTS

We identified five overarching recommendations (themes) and ten strategies (subthemes) for designing reporting systems to address patient-perpetrated sexual harassment of staff and patients in VA and other healthcare settings. Table 2 presents recommendations, strategies associated with each recommendation, and illustrative quotes. Some quotes in Table 2 and the text are edited for clarity.

Table 2.

Expert-Identified Recommendations for Designing Reporting Systems to Address Patient-Perpetrated Sexual Harassment and Illustrative Quotes

Recommendation 1: Promote a Climate in which Harassment is not Tolerated.	“We have to figure out a way that they can report [patient-perpetrated harassment] and have something done about it…start shifting that culture to where people are realizing it is inappropriate and it won’t be tolerated.” [28]
1a. Complement systems with holistic anti-harassment interventions.	“You have to alter the culture because most people are not going to want to deal with [reporting]…” [19].
Recommendation 2: Take Corrective Actions in Response to Reports.	“The other thing is obviously having policies and sanctions and having those implemented because people need to see that there are consequences.” [8].
2a. Focus on stopping harassing behavior.	“[Reporting parties] want [perpetrators] to get whatever necessary training is needed and have some kind of intervention that means the behavior will stop and they will not ever do it to anyone else…” [31]
2b. Attend to facility hotspots.	“The system would need to include a lot about…where and when it happened. Because the tracking might be less about the individual and more about finding the trouble spots and then trying to figure out from there what’s going on.” [30]
Recommendation 3: Minimize Adverse Outcomes for Reporting Parties.	“There’s research that shows that formal investigation processes can be traumatizing, or more traumatizing perhaps, than the original sexual harassment experience.” [10]
3a. Permit anonymous reporting.	“There probably needs to be some anonymity around it to encourage the reporting.” [37]
3b. Offer validation and support.	“It would be important to…give women an opportunity to vent what happened to them and talk about it…” [23]
3c. Give reporting parties control over the process.	“We want to give agency to people who’ve been abused and have recourse available. What I don’t want to do is find ways that take things out of their control…” [27]
3d. Follow up about outcomes.	“There’s got to be follow up as well. And I think that needs to be communicated to the person that makes the report, ‘okay, here are the steps that happen next.’” [28]
Recommendation 4: Facilitate Reporting Processes.	“[Reporting] would have to be easy.” [23]
4a. Offer multiple modalities for filing reports.	“Offering people various ways to report that feel comfortable to them.” [32]
4b. Make policies clear and accessible.	"…it would be important, obviously, for the information to be well-disseminated…” [28]
Recommendation 5: Hold the System Accountable.	“Whatever reporting system is in place then, of course, would have to be tested so that it’s one that actually works…” [35]
5a. Interpret reporting trends with caution.	“When I see an increase in reporting…I think that’s empowerment.” [19]

N interviews = 31. Themes are not mutually exclusive.

Recommendation 1. Ensure That Reporting Systems Promote an Organizational Climate In Which Harassment Is Not Tolerated

Experts stated that harassment reporting systems have a critical influence on organizational climate, or shared perceptions about the extent to which an organization tolerates harassment. Well-designed systems improve climate by signaling that the organization is addressing harassment:

And I do know that having a reporting process in place can…make it look like an institution is taking it seriously [12].

However, poorly designed systems create a “chilly climate” of tolerance for harassment and “reduce people coming forward across the board” [31]. Further, “just having a reporting mechanism in place” is not an “easy solution” for addressing harassment [12, 27]. Instead, facilities should complement reporting systems with comprehensive anti-harassment interventions grounded in a holistic approach to change (Strategy 1a: Complement systems with holistic anti-harassment interventions):

When a system not only trains it, teaches it, and from the bottom up everybody lives by the same rules, there's accountability…And [the reporting system] abides by taking the complaint seriously, encouraging people to come forward, having accountability, and supporting [the reporting party], then you have a change of culture… [34].

Recommendation 2: Take Proportional, Corrective Actions in Response to Harassment Reports

Experts stated that effective reporting systems contain mechanisms for taking corrective actions in response to reports. Corrective actions send a message “that [harassment] is not acceptable and [the system] will respond in some way” [24], thereby reducing harassment and increasing trust in the system. Experts noted that corrective actions should be proportional to the misconduct, and offered examples such as educating patients, flagging patient charts, sending warning notifications to patients, and transferring care to another provider. Corrective actions should focus on stopping the harassing behavior rather than punishing the perpetrator, in accordance with reporting party preferences (Strategy 2a: Focus on stopping harassing behavior):

…I think surprising to some people is [reporting parties] don’t want to get the person in trouble. They just want them to stop assaulting [33].

Some experts acknowledged that correcting patient-perpetrated harassment at VA creates unique challenges, since VA facilities “don’t even necessarily have that authority over a patient” [22], legally cannot deny patients care, and must continue to provide quality service:

How do we [implement corrective actions] in a way that still provides good care to Veterans and is respectful…but that clearly demonstrates that the behavior was inappropriate… To be honest, I don’t have a clear answer about what those consequences would look like… [28].

Additionally, it may not be feasible to implement individual corrective actions when the perpetrator is unknown to the reporting party (e.g., catcalling in common areas). In these cases, experts suggested using incident data to inform facility-level corrective actions, which may include adjusting physical layouts, installing cameras, or implementing trainings in harassment “hotspots” (Strategy 2b: Attend to facility hotspots):

…The fact that this is happening to me in a particular location gives the point of intervention…maybe having additional oversight in the areas where it’s happening and doing more to train the people in that space on how to do bystander intervention… [31].

Recommendation 3: Minimize Adverse Outcomes for Harassment Reporting Parties

Although some experts stated that reporting harassment can empower individuals, most agreed that the reporting process is often harmful. Reporting parties may fear retaliation from perpetrators, peers, or colleagues:

The fear of retaliation is real. No one wants to be labeled a complainer or a victim [17].

Further, inadequate institutional responses to reports may cause “betrayal trauma, which is systematic and very intense and difficult to heal from because it keeps getting reinforced” [34]. Concerns about betrayal trauma may be especially salient for VA facilities, given that many Veteran patients and staff have histories of military trauma:

Many times, when women report MST [Military Sexual Trauma], they’re not supported when they’re in the military. So, I think we would have to be very cautious about those issues… [30].

Experts identified several strategies for reducing harm to reporting parties. First, they suggested that facilities allow anonymous reporting (Strategy 3a: Permit anonymous reporting), citing examples of anonymous reporting systems such as ihollaback, Callisto, and the Department of Defense Safe helpline (see Table 3). However, one expert noted that facilities should ensure that allowing anonymity for reporting parties does not infringe on the rights of accused parties:

…the accused at some point would probably want to know who was accusing them, and so people have to figure out how to balance the rights of the parties in whatever process they set up to make it completely fair [40].

Table 3.

Expert-Identified Example Systems for Reporting Sexual Harassment

System [expert ID]	Description	Website
Callisto [17]	Anonymous online platform where students can create a time-stamped record of sexual assault or harassment experiences, report electronically to their school, or opt to send the record to their school if another student reports the same perpetrator.	http://www.mycallisto.org
ihollaback [23]	Mobile app where individuals can publicly and anonymously document experiences of harassment by pinning locations and sharing brief descriptions of incidents.	http://www.ihollaback.org
Department of Defense (DoD) Safe hotline [31]	Secure, confidential, anonymous, 24/7 support services for DoD members affected by sexual assault. Provides crisis intervention, referral to local resources, information about reporting options, and self-care plans. Modalities include telephone, text, online chat, and mobile app.	https://www.sapr.mil/dod-safe-helpline
Astronomy Allies [20]	Group of vetted volunteers who provide confidential support and reporting resources to individuals who experience harassment during academic conferences. Allies can be identified in-person by their red buttons or contacted via phone, twitter, or email.	http://www.astronomyallies.com

Second, experts stated that facilities should respond to reports by “validating the experience and reaching out to the person and allowing them to explain, this is what happened, making sure that they feel heard…” [28] (Strategy 3b: Offer validation and support). To offer additional support, facilities may provide education about the reporting process and referrals to resources (e.g., VA Employee Assistance Program). Third, facilities should give reporting parties control over the reporting process where possible to avoid compounding feelings of powerlessness associated with the harassment experience (Strategy 3c: Give reporting parties control over the process):

So, are there multiple ways for people to report, can they do it formally/informally, how are they empowered during the process, do they get to have some say in how things move forward? [31].

Finally, facilities should follow up with reporting parties about the outcome of their report to demonstrate that the report was valued and taken seriously (Strategy 3d: Follow up about outcomes):

Because the worst thing is you report it and you never know if they actually looked into it or if it was believed…Will this help the next person? [04].

Recommendation 4: Facilitate and Simplify Harassment Reporting Processes

Experts stated that facilities should encourage reporting by facilitating and simplifying reporting processes. They suggested offering multiple mechanisms for filing reports (Strategy 4a: Offer multiple modalities for filing reports), although suggested mechanisms varied. For example, some experts preferred voice-to-voice options (e.g., in-person, telephone), while others favored impersonal options (e.g., voicemail, online, email, app) or a combination of both:

It would be important for it to be an actual person on the other line that receives the report as opposed to like a voicemail or something like that. I can imagine that maybe there’s an option to go straight to the voicemail if they don’t feel comfortable speaking with a person… [28].

Additionally, experts suggested offering facility-specific, informal options (e.g., modeled after Astronomy Allies, see Table 3) to accommodate individuals who are uncomfortable filing formal reports. Experts agreed that anyone (e.g., patients, staff, and visitors; targets, witnesses, and individuals who hear about harassment) should be allowed to report harassment. Some noted that patients and staff may require different reporting mechanisms but did not elaborate on specific differences.

To further facilitate reporting, organizational policies and procedures related to harassment should be written in clear language, well-disseminated, easily accessible, and publicly available (Strategy 4b: Make policies clear and accessible). One expert illustrated how failure to follow these guidelines can deter reporting:

[Reporting policies are] often in 28-page documents, in the middle. Some of them are behind firewalls…If the work environment is where you’re being harassed, you’re not going to want to [look for policies] where everyone can see what you’re typing [04].

Recommendation 5: Hold the Reporting System Accountable

Finally, experts recommended that facilities “make sure there’s some kind of evaluation and accountability built into that reporting process. That there’s actual transparency…” [12]. Facilities should collect data on the number and type of reports made and corrective actions taken, and “make [findings] available to the community…to counter that organizational tolerance [for harassment] view” [10]. However, some experts underscored the need for caution when interpreting reporting trends, stating that an increase in reports may signal that individuals feel more comfortable with reporting rather than an increase in harassment prevalence (Strategy 5a: Interpret reporting trends with caution):

…you don’t want to say, ‘oh, the intervention made things worse’…when it actually made things better. But the way you’re measuring it and the way people are able to report or discuss it are different [18].

DISCUSSION

Reporting systems are a key component of harassment prevention and intervention efforts.¹¹ However, there is limited evidence to assist healthcare administrators and policy makers in assessing, developing, or improving systems for reporting patient-perpetrated sexual harassment toward staff or other patients. This study generated expert recommendations to guide design of reporting systems to address patient-perpetrated sexual harassment toward staff and patients, including the following: (1) ensuring that systems promote an organizational climate in which harassment is not tolerated; (2) taking corrective actions in response to reports; (3) minimizing adverse outcomes for reporting parties; (4) facilitating reporting; and (5) holding the reporting system accountable.

This study’s central finding is that careful design and ongoing evaluation are essential for ensuring that reporting systems have their intended effects. Expert-identified recommendations, strategies, and example reporting systems presented in this article can assist healthcare administrators and policy makers in creating organizational contexts that foster trust, encourage reporting, and deter harassment. Additionally, they offer guidance for mitigating some of the substantial risks of inadequate systems, including harm to reporting parties, communication of tolerance for harassment, and, ultimately, increased harassment prevalence.^4,20,21,28 Our findings align with previous work underscoring the importance of proactive and intentional reporting system design and regular monitoring and calibration.^4,29

Results suggest that reporting systems are most effective when implemented as part of comprehensive, multifaceted anti-harassment efforts. Evidence across settings indicates that underreporting remains pervasive,^30–32 and studies from healthcare settings suggest that providers are reluctant to report disruptive patient behavior.^19,33,34 Although the experts in this study offered strategies for reducing common barriers to reporting (e.g., fear of retaliation; unclear policies and procedures; beliefs that reporting is futile), additional interventions such as education, social marketing, and bystander training are needed both to encourage reporting and to offer alternative approaches to preventing and addressing harassment. Grounding anti-harassment efforts in trauma-informed principles and organizational practices^35,36 can help healthcare administrators and policy makers to prioritize safety and reduce unintended consequences for staff and patients.

Results highlight gaps in existing evidence related to reporting, addressing, and remediating patient-perpetrated harassment in healthcare settings. Findings offer some healthcare-specific design considerations (e.g., corrective actions for patients; addressing public harassment), but do not address other concerns (e.g., balancing corrective actions with provision of compassionate care; tailoring reporting mechanisms to staff versus patient reporting parties). These gaps align with findings from previous work and indicate a need for partnership between researchers, subject matter experts, healthcare administrators and policy makers, and technology and design professionals to develop and test harassment reporting strategies that are responsive to the needs of patient care contexts.^5,15 Additional work is also needed to translate the relatively broad, cross-setting recommendations from this analysis into facility-specific procedural instructions for reporting system implementation. Healthcare administrators and systems designers should conduct needs assessments to determine how best to integrate and tailor recommendations based on existing procedural infrastructure and facility characteristics. The development and expansion of harassment reporting systems in VA and other healthcare facilities will offer valuable opportunities for advancing this work.

LIMITATIONS AND FUTURE DIRECTIONS

Several limitations should be considered when interpreting results. First, this analysis was part of a larger study covering a range of topics related to addressing patient-perpetrated sexual harassment of staff and patients. Therefore, allocated time and participant expertise related to reporting systems varied by interview. Second, we did not consistently ask questions about reporting in our initial interviews, potentially limiting relevant discussion. Third, we did not routinely ask experts to differentiate between recommendations pertaining to staff versus patient reporting parties and therefore our ability to identify staff- and patient-specific reporting party needs (e.g., related to selecting reporting points of contact and disseminating information about reporting mechanisms) was limited. Future work involving input from patients and providers with high levels of patient interaction (e.g., nurses, physical therapists, pharmacists) can explore strategies for tailoring systems to staff versus patient reporting parties. Finally, although most findings have cross-setting implications for reporting system design, some (e.g., recommendations related to addressing public harassment or considering patient histories of military trauma) may have limited application to non-VA healthcare settings.

In addition to the future research directions identified previously, more work is needed to examine reporting system design considerations related to legal and ethical issues, mandatory versus voluntary reporting, informal reporting options, anonymity and confidentiality, balancing the rights of reporting and accused parties, and ensuring that system processes and outcomes do not discriminate against members of marginalized groups.^4,29,37–39 Future studies may also explore how evidence from other types of healthcare reporting systems (e.g., those for reporting medical errors) and harassment reporting systems in non-healthcare settings (e.g., educational and military institutions) can inform harassment reporting system design in healthcare facilities.^32,40–42 Finally, more research is needed to examine how this study’s findings apply to reporting and addressing patient-perpetrated bias that targets race/ethnicity, sexual orientation, gender identity, and other social identity characteristics.^43,44

CONCLUSIONS

Addressing patient-perpetrated harassment is critical for ensuring that VA and other healthcare facilities offer safe, inclusive, respectful environments of care for patients and staff. This study generated initial guidance and laid a foundation for more focused efforts to fill gaps in policies and procedures for reporting patient-perpetrated sexual harassment of staff and patients in healthcare settings. Healthcare administrators and system designers can promote an organizational climate in which harassment is not tolerated by taking corrective actions in response to reports, ensuring that systems are accessible and sensitive to the needs of reporting parties, and demonstrating internal accountability. Additional work is needed to build evidence for strategies that effectively address patient-perpetrated harassment while balancing patients’ clinical needs.

Appendix

Addressing gender-based harassment of women at VA facilities: subject matter expert core interview questions

[Note. Interviews were semi-structured and tailored to the participant’s expertise. Therefore, not all questions below were asked during every interview, and additional questions/prompts were asked where appropriate.]

1. We are familiar with your work on [briefly describe]. Please briefly share with us your history of doing research/work on the topic of harassment.

2. One of the challenges we have heard from patients and staff relates to defining harassment. What is your approach to defining what is, and is not, harassment?

3. We are particularly interested in harassment that occurs in medical settings, toward either patients or staff. [If not known/stated above] Have you done any work on (or are you familiar with work on) harassment in medical settings? Please describe.

4. Are you aware of any policies or procedures that have been used in medical settings to address sexual harassment? If yes, please describe.

5. One of the aspects that we’re trying to learn more about is reporting- having a mechanism for people to report being harassed. What might a reporting system for harassment by patients look like? What might be important to keep in mind when designing a reporting system for harassment by patients?

6. We’ve been asking mostly about harassment in medical settings, but we’re also curious about any promising interventions or approaches that have been used to address harassment outside of medical settings. Are you aware of such interventions or approaches?

7. Are you aware of any evidence-based or promising interventions that don’t specifically address public harassment that you think could be applied to this problem? [If asked for examples: bullying, IPV, incivility]. If yes, please describe the intervention and how it is used, and why it might work to address harassment. Is there anything that would need to be considered to adapt this to healthcare settings?

8. What else do you think we should keep in mind as we consider interventions to address harassment at VA?

9. Is there anyone else that you think we should talk to about this issue?

Funding Information

This work was financially supported by a VA HSR&D pilot grant (PPO 18-112; PI: Klap). Dr. Fenwick was funded by the VA Office of Academic Affiliations through the Health Services Research fellowship program (TPH 65-000-15). Dr. Yano was funded by a VA HSR&D Senior Research Career Scientist Award (RCS 05-195). Dr. Hamilton was funded by a VA HSR&D Senior Research Career Scientist Award (RCS 21-135). External editorial review of an earlier version of this article was funded by the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CIN 13–417).

Declarations

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The views expressed in this article are the authors’ own and do not necessarily represent the views of the Department of Veterans Affairs or the U. S. government.