A comparative study of experiences of violence in Malaysian and English hospitals

This PhD thesis compared incidents of violence in two Malaysian hospitals and two English hospitals. Using a model of workplace violence, the aims of the thesis were to explore and compare six constructs: extrinsic, intrinsic, triggers, experiences, moderators, and consequences of workplace violence as perceived by Malaysian and English hospital staff. This study used data on experiences of violence gathered in 2005 for incidences in hospitals that occurred up to one year before the survey. The 2004 data from the Incident Report database (IRD) of the English hospitals was also used. Two instruments were developed for this thesis. First was the General Violence Victimization Questionnaire (GVQ), an instrument to identify the types, prevalence, nature, consequences, post-incident support, and reporting trends of violence in hospitals. The second instrument was the Violence Victimization Semi-structured Interview (VicQ) which explored factors leading to the violent incident, the violent incident itself, and psycho-social issues relating to the violent incident. Both instruments were translated into the Malay language for use in Malaysia. 227 people participated in the quantitative survey: 162 people from the Malaysian Government Hospitals (MGH) and 115 people from the National Health Service (NHS). A total of 25 people volunteered to be interviewed as part of the qualitative aspect of the study: 15 from the MGH and 10 from the NHS. Six categories of violence were compared: verbal, nonverbal, threat, physical, sexual, and psychologically-based. A total of 4118 violent incidents (1402 in MGH and 2716 in NHS) were reported. The most common type of violence was psychologically-based violence in the MGH and verbal violence in the NHS. Both samples perceived that the major source of workplace violence was from patients and involved one male perpetrator. There were differences between the two samples indicative of cultural differences. Of those interviewed, the Malaysian participants perceived that offenders were intrinsically motivated to offend. The English participants perceived that offenders had either intrinsic or extrinsic motivation for perpetuating violence. Differences were noted for substance abuse and customer relations as triggers of organisational violence. Comparisons of moderators were different for the two country samples. Comparisons of consequences were not significantly different. Comparisons across several demographic variables (gender, age, and occupational groupings were not significant between the two country samples with regards to workplace violence victimisation. However, a comparison of length of service was found to be significant. The final path model differed from the original model of workplace violence. Additional findings include a difference between the established definition and participants‘ definition of workplace violence, a lack of anti-violence policies in Malaysian hospitals, under reporting, and unforeseen direct and direct relationships among the six constructs.