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OBJECTIVE: Workplace violence (WPV) is an important issue in prehospital care, especially for emergency medical technicians ( EMTs) who are at increased risk of physical violence due to the nature of their work. This study aimed to shed light on the specific factors that contribute to the underlying causes of physical WPV in the prehospital context through direct experience and insight into the work of EMTs. METHODS: Sequential explanatory mixed methods were applied in five western provinces of Iran from 2022 to 2023. In total, 358 EMTs that met the criteria for the quantitative phase were selected using a multi-stage clustering method. In the quantitative phase, the researchers used a questionnaire on workplace violence in the healthcare sector. Based on the results of the quantitative phase, 21 technicians who had experienced physical violence in the past 12 months were invited for in-depth interviews in the qualitative phase. RESULTS: The average age of the EMTs was 33.96 ± 6.86 years, with an average work experience of 10.57 ± 6.80 years. More than half (53.6%) of the staff worked 24-hour shifts. In addition, most EMTs were located in urban bases (50.3%), and 78 (21.8%) reported having experienced physical violence. No significant correlations were found between the demographic characteristics of the technicians and the frequency of physical violence, except base location in the last 6 months. The qualitative study also created one theme (the complexity of WPV in the prehospital setting), four categories, and ten subcategories. CONCLUSION: The study's results emphasize the need for comprehensive WPV factors in the prehospital setting. These factors can lead to identifying and improving strategies such as organizational support, improving communication and collaboration between responders, and training in de-escalation techniques. In addition, it is crucial to address the root causes of WPV such as poverty and lack of education in the community to create a safer and more supportive environment for patients and staff.

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BACKGROUND: Workplace violence is a global public health issue and a major occupational hazard cross borders and environments. Nurses are the primary victims of workplace violence due to their frontline roles and continuous interactions. OBJECTIVE: The present study aimed to investigate the status of workplace violence, turnover intention, compassion fatigue, and psychological resilience among Chinese nurses, and explore the mediating role of compassion fatigue and the moderating role of psychological resilience on relationship between workplace violence and turnover intention among Chinese nurses. METHOD: A cross-sectional study was conducted among a convenience sample of clinical registered nurses from public hospitals in Changsha, Hunan, China. Data was collected through an online questionnaire, which included a demographic information form, the Workplace Violence Scale (WVS), the Turnover Intention Questionnaire (TIQ), the Compassion Fatigue Scale (CF-CN), and the Connor-Davidson Resilience Scale (CD-RISC). Descriptive statistics and correlation analysis were employed to examine the relationships among the main variables. A moderated mediation analysis was further conducted using the PROCESS macro for SPSS (Model 4 and Model 8) to examine the mediating role of compassion fatigue and the moderating role of psychological resilience. RESULT: The present survey recruited a convenience sample of 1,141 clinical registered nurses, who reported experiencing multiple types of workplace violence during the past year. Correlation analysis revealed significant positive correlations between workplace violence and turnover intention (r = 0.466, P < 0.01) as well as compassion fatigue (r = 0.452, P < 0.01), while negative correlation between workplace violence and psychological resilience (r=-0.414, P < 0.01). Moderated mediation analysis revealed that compassion fatigue mediated, while psychological resilience moderated, the positive relationship between workplace violence and turnover intention (all P < 0.05). CONCLUSION: This study underscores the mediating effect of compassion fatigue and the moderating role of psychological resilience in the relationship between workplace violence and turnover intention among Chinese nurses. Future efforts should be undertaken to develop effective preventive measures and intervention strategies at individual, organizational, and national levels to mitigate workplace violence and foster supportive work environment. CLINICAL TRIAL NUMBER: Not applicable.

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OBJECTIVE: To measure the 1 year cumulative incidence of and analyse the risk factors associated with workplace violence directed towards the ambulance service in a Swedish region. DESIGN: Prospective cohort study. SETTING: The ambulance services in Örebro County Council (Sweden) contain approximately 300 000 inhabitants. PARTICIPANTS: All ambulance missions during the period of 12 months (n=28 640) were assessed. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was workplace violence together with the associated risk factors. RESULTS: The 1 year cumulative incidence of workplace violence within the ambulance service was 0.7%. Non-physical violence was most common. There was an increased odds for violence when the patient was under the influence of alcohol or drugs or suffering from mental illness. There was an association between the dispatch categories intoxication, unconsciousness or mental health problems and workplace violence against ambulance personnel. The offenders were mostly men aged 18-29 and workplace violence was more likely to occur in public places. CONCLUSIONS: The 1 year cumulative incidence of workplace violence within the regional ambulance service was low in comparison to that of previous research. The overall regression model had low explanatory power, indicating that the phenomenon is complex and that additional variables need to be taken into account when trying to predict when workplace violence will occur. Additional research is needed to fully understand why workplace violence within the ambulance service occurs and how to mitigate such situations.

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BACKGROUND: Medical staff are regularly confronted with workplace violence (WPV), which poses a threat to the safety of both staff and patients. Structured de-escalation training (DET) for Emergency Department (ED) staff has been shown to positively affect the reporting of WPV incidents and possibly reduce its impact. This study aimed to describe the development of incidence rates, causes, means, targets, locations, responses, and the time of WPV events. Additionally, it explored the effect of the staff trained in DET on the objective and subjective severity of the respective WPV events. METHODS: In a retrospective, single-center cohort study, we analyzed ten years of WPV events using the data of Staff Observation Aggression Scale-Revised (SOAS-R) score (ranging from 0 to 22) in a tertiary ED from 2014 to 2023. The events were documented by ED staff and stored in the electronic health record (EHR). RESULTS: Between 2014 and 2023, 160 staff members recorded 859 incidents, noting an average perceived severity of 5.78 (SD = 2.65) and SOAS-R score of 11.18 (SD = 4.21). Trends showed a non-significant rise in incident rates per 10,000 patients over time. The WPV events were most frequently reported by nursing staff, and the cause of the aggression was most often not discernible (n = 353, 54.56%). In total, n = 273 (31.78%) of the WPV events were categorized as severe, and the most frequent target of the aggressive behavior was the staff. WPV events occurred most frequently in the traumatology section and the detoxification rooms. While the majority of events could be addressed with verbal interventions, more forceful interventions were performed significantly more often for higher severity WPV events. More WPV events occurred during off-hours and were of a significantly higher objective and subjective severity. Overall, the presence of staff with completed DET led to significantly higher SOAS-R scores and higher perceived severity. CONCLUSION: The findings underline the relevance of WPV events in the high-risk environment of an ED. The analyzed data suggest that DET significantly fostered the awareness of WPV. While most events can be addressed with verbal interventions, WPV remains a concern that needs to be addressed through organizational measures and further research.

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Workplace violence (WPV) has become a crisis for health care workers, with a significant increase in violent events taking place in health care settings across the nation. Health care organizations should develop a comprehensive WPV program that includes recognition, management, and reporting of all types of WPV. A large health care system developed strategies and a program to address WPV. The health care system believes that a safe and respectful work environment is foundational to the goal of zero preventable harm. The "Safety in the Workplace" initiative was designed to raise awareness of concerning behaviors and to offer tools and resources for identifying, responding to, and reporting incidents of violence, aggression, or disruptive behaviors of WPV. During a 6-month pilot of a WPV bundle, there was a 44% reduction in physical violence reports and a 44% reduction in reported incidents of WPV. From June 2020 to June 2021, there was a 10% decrease in WPV overall.

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BACKGROUND: Violence against healthcare workers is a pervasive, yet in many cases, under-reported problem. This is due to various factors, including lack of time, support and a universal understanding of what constitutes a reportable event. This study explored facilitators and barriers to reporting workplace violence among emergency department nurses. METHODS: In this descriptive, qualitative study, researchers conducted open-ended interviews with emergency nurses considered to be "high-" and "non-reporters" of violent events and analyzed for themes. RESULTS: Participants cited consistent factors associated with less reporting, factors associated with more reporting and effectiveness of existing safety measures. CONCLUSIONS: To encourage the reporting of violent events, frequently cited barriers and facilitators should be addressed. Strategies such as integrating reporting mechanisms into the health record, creating nuanced definitions of reportable events, and consistent education with positive feedback can promote reporting by staff. These efforts should be combined with prevention strategies to ensure we are collecting correct data about the success or failure of these programs.

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BACKGROUND: Workplace violence (WPV) is highly prevalent in the health sector and remains a major occupational issue causing significant harm, ranging from bodily and psychological harm to death. Female healthcare workers (HCWs) are at high risk of WPV. OBJECTIVES: Identify risk factors of WPV among different professional categories of female HCWs. DATA SOURCES: PubMed, EMBASE and Web of Science, along with their references lists January 2010 and March 2022. ELIGIBILITY CRITERIA: English language observational studies focusing on WPV among HCWs evaluating the risk factors, impacts and consequences of WPV in female HCWs. METHOD: Risk of bias was assessed for all studies by Joanna Briggs Institute critical appraisal checklists. We estimated the pooled prevalence of WPV and the associated 95% CI using a random-effects meta-analysis model. We then described the associated factors and effects of WPV. RESULTS: 28 reviewed studies (24 quantitative, 4 qualitative and 1 mixed-method) from 20 countries were selected. From the available results of 16 studies, the pooled prevalence of WPV was estimated at 45.0% (95% CI 32% to 58%). Types of violence included verbal abuse, verbal threats, physical assaults, sexual harassment, mobbing, bullying and discrimination. Perpetrators were patients, patients' relatives, colleagues and supervisors. Nurses were the most studied HCWs category. WPV was found to affect both mental and physical health. Age, marital status, lower occupational position, substance abuse, shorter work experience and low support at work were the main socio-demographic and organisational factors associated with higher risk of WPV. CONCLUSION: WPV prevalence is high among female HCWs, warranting a multilevel intervention approach to address and mitigate its impact. This approach should include targeted policies and individual-level strategies to create a safer work environment and prevent adverse effects on both HCWs and the broader healthcare system. Further research is needed to better document WPV in categories of HCWs other than nurses. PROSPERO REGISTRATION NUMBER: CRD42022329574.

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BACKGROUND: Workplace violence (WPV) can have adverse psychological, physical, and emotional effects on emergency department (ED) personnel. Adaptive strategies can help them better adapt to WPV. The study aimed to explore ED personnel's experiences with adaptive strategies used in the face of WPV. METHODS: In this qualitative study, 22 ED personnel (nurses, doctors, services patient care assistants, and security guards) were selected using purposive sampling from Urmia city hospitals. Deep semi-structured individual face-to-face interviews were used to collect data. After recording and implementing interviews, conventional content analysis was used to extract concepts. RESULTS: Data analysis led to extracting an overarching theme of "mastering the situation and avoiding harm." Two categories that supported the main theme were: "effort to avoid violence" and "effort to escape suffering." The seven subcategories supported main categories included "managing patients and companions, "self-control," "seeking support, "emotional discharge," "thought diversion, "tendency to spirituality," and "seeking medical assistance." CONCLUSION: Given the experiences of ED personnel regarding strategies used, health managers and policymakers are recommended to develop and implement comprehensive programs to reduce violence and empower nurses before and after dealing with violence. The following programs will help: developing and implementing guidelines such as zero-tolerance WPV policy, criminalizing violence against personnel and punishing perpetrators; holding classes related to communication skills, self-control skills, and deviant thinking skills for ED personnel; raising public awareness of the prevailing conditions in the emergency through mass media, and counseling and treating violent ED personnel.

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BACKGROUND: Colleague violence experiences of students negatively affect their vocational education in the short term and their desire to stay in the profession in the long term. This study aims to determine the levels of colleague violence experienced by nursing students and the affecting factors in Türkiye. METHODS: This study was conducted with second-, third-, and fourth-year nursing students (N = 703) from three state universities in three different provinces in Turkey. The data were collected using the "Student Information Form" and "The Scale of Exposure to Colleague Violence" with an online questionnaire. Descriptive statistics, the Independent Samples t-test, and the ANOVA test were employed for data analysis. RESULTS: students' total mean score on the scale was 46.72 ± 21.30. The "exposure to verbal/psychological violence" and "effect of violence on physical and mental health" subscales were 21.62 ± 10.09 and 25.10 ± 12.02, respectively. The most common reaction to the violence they were exposed to was "remain silent" (34.7%). CONCLUSIONS: nursing students were exposed to moderate levels of verbal/psychological colleague violence, and students' physical and mental health were moderately affected by this violence. Most students remained silent as a response to colleague violence. This study contributed to the emergence of factors that affect and are related to colleagues' violence. The results highlighted the need for programs that educate people about colleague violence and what should be done.

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AIM: To describe and compare the prevalence of assaults and aggressive patient behavior among frontline staff in behavioral health (BH), medical-surgical (MS), and emergency department (ED) settings and examine the impact on staff health, work stress, work engagement, and intent to leave their position. BACKGROUND: Patient verbal and physical assaults have significant staff consequences, including decreased work productivity, increased burnout, job dissatisfaction, absenteeism, turnover, and intentions to leave. METHODS: Using a descriptive cross-sectional design, data were collected from a sample of 432 frontline staff working in ED, BH, and MS settings across 3 healthcare systems. RESULTS: The majority of frontline staff (74%) reported experiencing verbal aggression often/frequently, significantly impacting their mental health, work engagement, stress levels, and intent to leave. All 3 specialty groups reported a significant increase in verbal/psychological assaults and physical assaults since the pandemic's onset. CONCLUSION: The COVID-19 pandemic had a significant impact on assaultive/aggressive behaviors. Nurse leaders must strategize on methods to decrease the normalization of violence against healthcare workers and support research aimed at evidence-based interventions to reduce such incidences of violence and ensure the well-being of healthcare workers.

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INTRODUCTION: Workplace violence is a pervasive, perpetual, and underreported problem in the emergency department. Nurses experience devastating physical and psychological consequences owing to workplace violence exposure. Understanding workplace violence is challenging due to nurse underreporting. Improvement in capturing workplace violence cases can help drive data-informed, sustainable solutions to workplace violence prevention. The purpose of this project was to better capture the full extent of workplace violence in the emergency department through enhanced nurse workplace violence reporting. METHODS: In collaboration with emergency nurses and management, the project team used a multi-interventional approach and designed a feasible electronic reporting instrument to capture workplace violence events in real time by reducing nurse reporting barriers. Participating nurses accessed the instrument by scanning a quick-response code with their mobile phones. This code was strategically located on wall flyers and individual name badge stickers. Data were collected using Qualtrics software and analyzed using SPSS Statistics, which summarized the descriptive statistics. RESULTS: Two months after implementation, the electronic reporting instrument recorded 94 quick response code scans and 59 workplace violence reports, resulting in a 1080% increase in ED workplace violence reporting compared with the 2 months prior to implementation. The 59 workplace violence reports comprised 78% registered nurses, 19% emergency medical technicians, and 3% other health care workers. Workplace violence events were most frequent from 12:01 pm to 6:00 pm in treatment rooms (37%), triage (29%), waiting room (19%), behavioral health section (15%), and hallway (12%). DISCUSSION: A multi-interventional approach, coupled with a feasible, readily available electronic reporting instrument, enhanced ED workplace violence reporting and facilitated a better capture of ED workplace violence. Although nurse underreporting is still likely occurring, an emergence of workplace violence data trends can provide data-driven solutions in workplace violence prevention. Continued efforts to reduce the barriers that inhibit reporting are needed to foster a safe and supportive culture surrounding workplace violence reporting.

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OBJECTIVES: Approximately 81% of traumatic brain injury cases are considered to be mild (mTBI), but few studies have reviewed mTBI caused by workplace violence (WPV). This study aimed to (1) determine the incidence of mTBI secondary to WPV in a statewide workers' compensation system using International Classification of Disease codes and (2) analyse and compare factors associated with return-to-work outcomes between WPV mTBI cases versus other mechanisms. METHODS: Using a retrospective cohort of claims data from the California Workers' Compensation Information System during 2015-2019, cases with a return-to-work date were classified as WPV if the injury description contained keywords such as assault, gunpoint, harassed, intimidated, punch, threat, robbery, violent or verbal abuse. RESULTS: Of the 14 089 mTBI claims analysed in this study, 11.2% were caused by WPV. When comparing WPV to non-WPV claims, the variables with statistically significant (p≤0.001) differences were age, income, industry and job class. There were no significant differences between groups for leave duration. In a linear mixed model, the variable of interest (WPV) was not associated with recovery duration after adjusting for other factors. CONCLUSION: To our knowledge, this is the first study to examine WPV mTBI claims in the USA. The findings suggest that the public administration, education and healthcare and social services industries are at higher risk for WPV mTBI. WPV and job class were the only modifiable factors in the model and therefore should be the focus of additional research.

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BACKGROUND: In a working environment that is predominantly male, very tough physically, with a difficult working environment, occupational exposures and working, verbal and physical aggression can be more frequent than in other sectors. Fishing, merchant shipping and yachting are all sectors where fitness to sail is reassessed every year by doctors in the Seafarers' Health Service. Seafarers are increasingly reporting insulting, violent or sexist behaviour. The main types of abuse seen on board can be verbal and/or physical aggression, humiliation, whether in private or in front of others. Sexual harassment of women is a very worrying subject. MATERIALS AND METHODS: It was a retrospective observational study which is part of the professional monitoring of seafarers. The target population was adult seafarers coming for a fitness to sail visit. The group was recruited from seafarers aged over 18 who were being monitored by one of the seafarers' health services (or local centres). The inclusion period was 4 months between January and April 2023. All the information was collected using a self-questionnaire developed from the questionnaires of the Surveillance Médicale des Expositions des Salariés au Risques Professionnels (SUMER) for health status, job satisfaction and the European mini-module, verbal and physical aggression and psychological violence at work (based on the Leymann questionnaire), sexual violence and aggression based on the sexual harassment questionnaire and the PCLS-5 scale validated and translated into French to assess post-traumatic stress. The population studied was therefore 788 sailors. RESULTS: The study population was predominantly male (82.3%). The average age was 41.4 years (standard deviation = 11.7). 46.7% of seafarers estimate being in very good health. During the past 12 months, overall, 24.5% of seafarers disclaimed having been victim in work-related context of a verbal aggression, with a significant difference according to the gender (21.1% for men and 41.0% for women). During the last 12 months, overall, 3.2% of seafarers have been victim in work-related context of a physical aggression (2.6% for men and 5.8% for women, NS), whereas 10.9% of seafarers reported hostile behaviour at present. Twenty per cent of seafarers reported sexual harassment in the last 12 months. During the entire working life of seafarers, 65.5% of women and 38.2% of men reported sexual harassment, and 38.8% of seafarers stated that they had experienced at least one traumatic event in the last 12 months. DISCUSSION: A quarter of seafarers say they have been the victim of verbal or physical aggression at work in the last twelve months. These figures are high, and higher than those of the global survey on violence and harassment at work carried out by the International Labour Organization. One of the most alarming results of our study is the overexposure of women working in the maritime industry to the risk of physical, verbal or sexual assault of any kind. Indeed, in all the questions concerning the experience of verbal and physical aggression, the number of women victims is twice as high as that of their male colleagues, and this difference is statistically significant. As far as prevention is concerned, it seems that an effort is needed in terms of information, since only one seafarer in two knows the procedure to follow in the event of aggression within their shipyard. Communication between shipowners and seafarers needs to be stepped up to ensure that everyone is familiar with the procedures.

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OBJECTIVES: Despite the critical value of healthcare workers (HCWs) demonstrated during the COVID-19 pandemic, there remains a noted global surge in violence against this population. The present meta-analysis aimed to gather data on the prevalence of workplace violence (WPV) against HCWs and to determine if there is any difference based on gender. STUDY DESIGN: This was a systematic review and meta-analysis. METHODS: A thorough search of PubMed/MEDLINE, Lilacs, and Cochrane Collaboration databases was conducted from the start of the COVID-19 pandemic until March 8, 2023. Two authors independently carried out screening, data extraction, and quality assessment, followed by statistical analysis using random-effects meta-analysis and subgroup analysis to assess heterogeneity. RESULTS: We included 22 studies with 44,357 participants, of which 79.37% were women. The analysis revealed an overall prevalence of WPV similar in both women (51.86%, 95% confidence interval [CI]: 41.39-62.33) and men (51.45%, 95% CI: 40.95-61.95). There were considerable differences in gender-based WPV across geographic regions. Aggressions tend to be higher toward men in Asia (odds ratio [OR] 0.79, 95% CI 0.74-0.85, P < 0.001). Conversely, in Latin America, WPV prevalence was higher in women (OR 1.20, 95% CI 1.01-1.4, P = 0.035). HCWs from low- middle-income-level countries suffered a higher incidence of violence irrespective of gender compared with high- and upper-middle-income countries (72.36% vs 47.35%). CONCLUSIONS: Our data indicate that more than half of HCWs experienced WPV during the COVID-19 pandemic. In addition, women and HCWs in low-middle-income countries were notably vulnerable to WPV. A deeper understanding of the nuances behind violence against HCWs will help to facilitate tailored strategies for different demographical contexts. REGISTRATION: PROSPERO ID: CRD42023403970.

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BACKGROUND: Many people experience forms of gender-based violence and harassment (GBVH) in the context of their work. This includes a wide range of experiences, from subtle expressions of hostility to physical assault, that can also be of a sexual nature (e.g., sexual harassment or assault). This systematic review aimed to summarize findings about the prospective associations of work-related GBVH with people's health and occupational situation. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Scopus, Web of Science, MEDLINE and PsycINFO were searched for prospective studies in English from 1990 to May 24, 2023. Studies were included if they concerned a working population, exposure to any form of GBVH in the work context, and a health outcome or manifest occupational outcome. Quality was assessed with a modified version of the Cochrane 'Tool to Assess Risk of Bias in Cohort Studies', and studies assessed as low quality were excluded from the narrative synthesis. For the narrative synthesis, we grouped the results by similar exposures and outcomes and reported the strength and statistical significance of the associations. RESULTS: Of the 1 937 screened records, 29 studies were included in the narrative synthesis. Studies were mainly conducted in the USA and northern Europe and investigated exposure to sexual violence or harassment (SVH). Only two included studies investigated non-sexual kinds of GBVH. Consistently, studies showed associations of work-related SVH with poor mental health and there were indications of an association with hazardous substance use. There was no consistent evidence for an association of SVH with subsequent sickness absence, and there were too few studies concerning physical health and occupational outcomes to synthesize the results. CONCLUSIONS: There is consistent evidence of work-related SVH as a risk factor for subsequent poor mental health. There is no indication that the health consequences of SVH differ between women and men, although women are more often affected. There is a need for conceptual consistency, the consideration of non-sexual behaviors and prospective studies that test clear hypotheses about the temporal sequence of events.

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Introduction: Among clinical healthcare personnel, nurses face the highest proportion of workplace violence, which has a significant impact on their physical and mental well-being as well as their personal and professional lives. However, little is known about the effects of workplace violence on inexperienced breastfeeding nurses and their experiences during and after breastfeeding when they return to work. This study aimed to explore the experiences of inexperienced breastfeeding nurses who encountered workplace violence and its resulting impacts. Methods: This study employed a descriptive qualitative design. Semi-structured in-depth interviews were conducted with 20 nurses working in various positions and departments at three tertiary hospitals. Purposive and maximum variation sampling techniques were employed. The interview data were analyzed using Colaizzi's method, and the research findings were reported according to Consolidated Criteria for Reporting Qualitative Studies (COREQ)standards. Results: Inferences regarding workplace violence and risks for inexperienced breastfeeding nurses included physical labor (such as lifting heavy objects and performing cardiopulmonary resuscitation), conflicts, inadequate job skills, role confusion, occupational exposure risks, patient violence, and pressure from older adults. An inductive thematic investigation revealed the "Challenges faced during breastfeeding," "Conflicting professional and family roles," "Out of balance," and "Coping strategies." Conclusion: Inexperienced breastfeeding nurses experience several negative consequences due to workplace violence. Therefore, it is essential to plan and implement preventive strategies and management programs that specifically target workplace violence among inexperienced breastfeeding nurses.

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BACKGROUND: Workplace violence (WPV) is a complex global challenge in healthcare that can only be addressed through a quality improvement initiative composed of a complex intervention. However, multiple WPV-specific quality indicators are required to effectively monitor WPV and demonstrate an intervention's impact. This study aims to determine a set of quality indicators capable of effectively monitoring WPV in healthcare. METHODS: This study used a modified Delphi process to systematically arrive at an expert consensus on relevant WPV quality indicators at a large, multisite academic health science centre in Toronto, Canada. The expert panel consisted of 30 stakeholders from the University Health Network (UHN) and its affiliates. Relevant literature-based quality indicators which had been identified through a rapid review were categorised according to the Donabedian model and presented to experts for two consecutive Delphi rounds. RESULTS: 87 distinct quality indicators identified through the rapid review process were assessed by our expert panel. The surveys received an average response rate of 83.1% in the first round and 96.7% in the second round. From the initial set of 87 quality indicators, our expert panel arrived at a consensus on 17 indicators including 7 structure, 6 process and 4 outcome indicators. A WPV dashboard was created to provide real-time data on each of these indicators. CONCLUSIONS: Using a modified Delphi methodology, a set of quality indicators validated by expert opinion was identified measuring WPV specific to UHN. The indicators identified in this study were found to be operationalisable at UHN and will provide longitudinal quality monitoring. They will inform data visualisation and dissemination tools which will impact organisational decision-making in real time.

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