SINGAPORE — A significant number of healthcare workers have long silently endured abuse from patients and visitors but a new framework aims to empower them to speak up.
The framework, unveiled on Wednesday (Dec 13), also provides protocols for institutions to take action, including the denial of treatment to abusers who do not need urgent medical care.
Set to be fully implemented by June next year, the framework has been developed by a tripartite workgroup comprising representatives of the Ministry of Health (MOH), healthcare workers union, public healthcare clusters, community care partners and private healthcare providers.
MOH said that the framework empowers healthcare institutions to take action against abusers or perpetrators of harassment. The ministry will review the facts of the case if the perpetrator raises a complaint.
“If an abuse has indeed taken place and healthcare workers have behaved professionally and reasonably, MOH will stand by the decisions of the healthcare institutions,” it added.
“This would enable healthcare institutions to make decisions knowing that so long as they have not done anything wrong, they have the backing of their management and MOH.”
WHY IT MATTERS
The plight of healthcare workers was in the spotlight during the Covid-19 pandemic, when the healthcare system was inundated with heavy caseloads.
More recently, in October, a woman was sentenced to jail and a fine for being abusive while receiving treatment at the Singapore General Hospital (SGH).
Speaking to the media on Wednesday, Health Minister Ong Ye Kung said that while the nation has transitioned to the green level of the Disease Outbreak Response System Condition, healthcare workers have remained very busy.
He said that the great majority of patients and their next-of-kin are “very understanding” and respectful, but all it takes is a small minority who are frustrated and angry to “prick the morale” of healthcare workers.
“So I think we really need to protect our healthcare workers against abuse, lift up their morale, support their morale, because that’s the best way to help them serve the great majority of Singaporeans and our patients,” he added.
Studies by the tripartite workgroup released earlier this year found less than a quarter — 24 per cent — of healthcare workers report abuse if they face such a situation.
Mr Ong was asked by TODAY how the framework can help such workers who keep such abuse to themselves.
He said that while he salutes the workers who “have been trained to really stomach everything and to be professional no matter what”, he said that keeping mum would do emotional harm to the workers themselves.
“Better to correct the situation, tackle it at its roots, and not let the abuse become something that we expect healthcare workers to tolerate.”
The lack of clarity over what constituted abuse, along with shortcomings in the reporting process and negative perceptions within the industry over reporting such incidents, deterred healthcare workers from making reports, the studies in March had found.
The framework aims to provide this clarity and sets out the steps that can be taken by healthcare workers and the institutions they work for to offer more protection against such abuse.
WHAT THE FRAMEWORK ENTAILS
The framework covers three main areas: A common definition of abuse and harassment, a standardised protocol for healthcare institutions and a list of follow-up actions against perpetrators.
COMMON DEFINITION
The framework defines abuse and harassment as words, communication, actions or behaviour that are inappropriate, threatening or insulting; that cause a healthcare worker to feel intimidated, alarmed or distressed; and/or hinders the healthcare worker in carrying out his or her duties.
The definition is to guide how public healthcare institutions identify, and subsequently prevent and manage such incidents in a consistent manner, MOH said.
STANDARDISED PROTOCOL
The framework states that workers have the right to take immediate action to protect themselves and others from harm. This includes:
Telling the perpetrator firmly to stop the abusive behaviourActivating security personnelAs a last resort, administrating restraint to perpetrators to prevent them from causing harm
The framework also lays out guidelines for reporting incidents of abuse and how to manage the incident afterwards:
1.Internal reporting:
Workers should report all incidents of abuse and harassmentEach public healthcare institution will have an employee protection function to oversee such incidents involving staff membersHealthcare institutions should foster a supportive culture and ensure the process is not burdensome, repetitive or intimidating
2. Reporting to the police:
Victims are encouraged to call the police if they have sustained physical injury or receive threatsHealthcare institutions should consider providing relief such as time off to attend police interviews
Healthcare institutions will also offer support for staff who are victims of abuse and harassment, including but not limited to medical treatment, time off or the reassignment of duties and mental health support.
3. Follow-up actions
The framework states that regardless of police proceedings and outcomes, healthcare institutions can take concurrent and appropriate actions against perpetrators, as long as they do not compromise the clinical care needed by a patient.
The actions that the institutions can take are:
Issue warnings, either verbal or written, to the perpetratorsRemove abusive next-of-kin and visitors from the premises of the institution, disengage with them in communications, and bar them from visiting patients in the hospital for a period of time, if necessaryRefuse unreasonable requests from perpetrators, such as requests for services outside of healthcare workersʼ job scopeDischarge abusive patients if they do not require urgent medical careDocument the behaviour of repeat perpetrators in their medical records so that healthcare workers may take appropriate precautions and prevent further abuse and harassment in the future.
The framework is expected to be rolled out across public hospitals and healthcare institutions by June next year.
On Wednesday, Mr Ong said that there was “no doubt” that when a case of abuse is reported, many alleged perpetrators would “swear innocence”, claiming that the healthcare workers are at fault instead.
The minister gave an assurance that MOH will look through all the facts of any given case.
“If we can really ascertain that it is the healthcare worker that is unprofessional, of course there’s organisational discipline actions will be followed up with,” he said.
“But should we review the facts and find that healthcare workers have been professional and this is a clear case of abuse, we will stand by healthcare workers,” he said.
WHAT HEALTHCARE INSTITUTIONS AND WORKER SAY
Public healthcare groups welcomed the move and the support it signals for healthcare workers.
Mr Joe Sim, group chief executive officer-designate for National Healthcare Group, said that the “very strong” and “unequivocal” move by MOH to stand behind healthcare workers is the biggest difference offered by the framework compared to existing measures.
“That actually helps a lot to remove the ambiguity that sometimes is perceived,” he said.
Mr Sim added that he knows of some staff members who were afraid of supposed repercussions when the management offered to help them deal with cases of abuse.
“But I think with the framework and clear guidelines, clear definition, and also the protocols and all that, it helps a lot to clarify things.”
Ms Cynnthia Chitrah C Chandra, a senior staff nurse working in SGH’s emergency department, recalls an abusive patient who would frequently come by the hospital’s emergency department whenever he was intoxicated.
While she and her colleagues would be professional and do their best to speak to him nicely, “he would calm down for a while, and become abusive again”.
“He will start to damage things around him. For example, if we give him a urinal bottle, he would urinate inside it and start pouring the content outside the cubicle,” she said.
The patient would also threaten to slap her or her colleagues, Ms Cynnthia said. She added that they would escalate the matter if the situation got out of hand.
Asked how the new framework might help her, the healthcare worker with six years’ experience, said that it protects both the staff members and patients.
“They (the patients) will know what is expected of them also. If there are long waiting hours, I think they will know how to behave and treat everyone with respect,” she said.
She hopes that the framework will help foster better understanding among patients and their next-of-kin by bringing attention to what healthcare workers “go through on a daily basis”.
“Everyone gets frustrated, but you know, we will know how to treat each other with respect.”