Reframing and addressing horizontal violence as a workplace quality improvement concern.

AIM: To reframe horizontal violence as a quality improvement concern.

BACKGROUND: Although the number of studies exploring horizontal violence has increased, evidence supporting the effectiveness of current interventions is weak and the problem persists. Often framed as an individual or interpersonal issue, horizontal violence has been recognized as a complex phenomenon that can only be understood through an examination of social, individual and organizational factors. As such, interventions to address horizontal violence must be applied systemically and address contributions from all sources.

DESIGN: This is a discussion paper.

DATA SOURCES: This discussion is based on results of a study of nurses' perceptions of horizontal violence and review of the literature.

IMPLICATIONS FOR NURSING: Context is recognized as a contributing factor in human behavior, yet often overlooked in interventions to address horizontal violence. Moving the focus away from the individual and investigating systems contributions to horizontal violence using existing quality improvement frameworks is suggested.

CONCLUSION: To date, efforts to address horizontal violence have not been proven effective. There is a call for a wider application and investigation of interventions. This reframing provides the system level application suggested and would address a broader range of factors contributing to the perpetuation of the phenomenon.