SINGAPORE — The Tripartite Workgroup, consisting of representatives from the Ministry of Health, the National Trades Union Congress, and the Singapore Health Services, has completed an extensive engagement with over 3,000 healthcare workers and more than 1,500 members of the public, through surveys and focus group discussions.

The engagement findings revealed that more than two in three healthcare workers said they had witnessed or personally experienced abuse or harassment in the past year.

Half of them, or a third of all healthcare workers, witnessed or experienced abuse or harassment at least once a week. Frontline healthcare workers such as pharmacists, patient service associates, and nurses are more likely to experience abuse and harassment.

The most common forms of abuse and harassment are shouting, threats by patients and/or caregivers to file complaints or take legal action against the healthcare workers, and demeaning comments.

On average, healthcare workers reported that abuse or harassment they witnessed or experienced came from patients / clients most of the time (41%), followed by caregivers / visitors (28%), colleagues / peers (18%) and supervisors / managers (13%)

Healthcare workers experiencing abuse and harassment sometimes rationalize these as being part of their job. Healthcare workers often empathize with patients’ circumstances and do not take action against them.

Among incidents of abuse and harassment recounted by healthcare workers, only a small proportion were officially reported to the institution (24%) or to the Police (4%), as healthcare workers often had to recount incidents of abuse or harassment to multiple supervisors, which could be emotionally challenging.

Filling up incident reports outside of working hours added to their workload, while taking time off for interviews at police stations disrupted their schedules. Moreover, there was uncertainty among healthcare workers regarding what constituted abuse or harassment, leading to situations where incidents were not reported, or supervisors failed to take action due to lack of clarity on legal thresholds and advice.

Furthermore, healthcare workers are concerned about how reporting abuse and harassment will be perceived by their supervisors and colleagues, and some are worried about losing their jobs.

As a result, abuse and harassment are often under-reported.

Standardized zero-tolerance policy

In response to these findings, the Workgroup recommends adopting a standardized zero-tolerance policy against the abuse and harassment of healthcare workers in any form, using a three-pronged framework of Protect, Prevent, and Promote.

The framework includes measures such as protecting healthcare workers who face abuse and harassment, preventing situations that lead to abuse and harassment, and promoting positive relationships between healthcare workers and patients/caregivers.

To protect healthcare workers from abuse and harassment and build a supportive culture where they feel safe to work and confident to report abuse and harassment, the Workgroup suggests establishing a clear and common definition of abuse and harassment, which includes any inappropriate behavior or communication that causes a healthcare worker to experience distress, harassment, threat, or discrimination, regardless of intention.

Additionally, an effective reporting and escalation protocol and a supportive culture of reporting are crucial, along with clear consequences that are implemented and enforced.

The Workgroup also recommends that institutions train their staff to prevent potential abusive situations by equipping them with the skills and knowledge to manage and de-escalate challenging situations and deterring potential offenders through the enforcement of consequences.

The public healthcare sector will lead by example, and the public healthcare institutions have agreed to strengthen their existing processes and implement this standardized zero-tolerance policy.

Private healthcare institutions and community care organizations will be encouraged to refer to the parameters of this policy when it is ready and adapt it to their processes and operating models where feasible.

The Ministry of Health Holdings will launch a national public education campaign in the second half of 2023 to promote positive relationships of trust and respect between healthcare workers, patients, and their caregivers.

“Support their recommendations fully”, Health Minister

Minister for Health, Mr Ong Ye Kung, expressed his support for the Workgroup’s recommendations, stating that abusive behaviour towards healthcare workers is not acceptable.

Speaking at the Ng Teng Fong centre for Healthcare Innovation on Friday, Mr Ong noted that while many healthcare workers find ways to cope, it is wearying and demoralizing to experience this on a regular basis.

He called for the implementation of these recommendations to create a safe and conducive working environment for healthcare workers to carry out their duties effectively.

Mr Ong noted that the Ministry of Health will be working closely with public healthcare institutions to implement the recommendations made by the Tripartite Workgroup to Prevent Abuse and Harassment of Healthcare Workers.

The details of the recommendations will be translated into practices on the ground, with operating guidelines to be published once ready.

“Healthcare workers deserve to be treated with respect, like anyone else. We are grateful to those who have stood up for them and expressed appreciation and understanding,” said Mr Ong.

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