The Singaporean initiative protecting healthcare workers from abuse

A new initiative coming from Singapore is helping to prevent the abuse and harassment of healthcare workers, 62% of whom have witnessed or experienced verbal or physical abuse at work.

The initiative, delivered by Singapore’s Ministry of Health, was born out of the COVID-19 pandemic, when abuse in healthcare settings became a prominent issue worldwide.

Kam Wai Kuen, who helped design the initiative at the Singapore General Hospital, said that, before it was introduced, staff did not have a clear avenue to handle workplace abuse.

“Up to that point, if someone became violent or aggressive, we would tell a staff member, maybe call the police for the violent ones, and manage the rest ourselves as best as we could,” she said.

“There wasn’t much else we could officially do. There was this underlying narrative that, ‘that is a patient, the patient requires our care and we are here to provide it’.”

Now, hospital workers in Singapore have clear guidelines to follow and are given the right to discharge or refuse non-emergency care for certain patients who exhibit “highly unacceptable” behaviour.

“If the abuser is extremely unreasonable and cannot be dealt with, we can deny our service to them, providing it is not an emergency. We haven’t yet gone to that stage, but it’s available to us as an option, should we need it,” Kam said.

For less severe cases of abuse, the hospital can issue verbal warnings and warning letters.

Finding a balance

Kam said finding the appropriate response is about striking a balance.

“We recognise that when patients come to us, they're not at their best. We're not a hotel where everybody is there for a holiday and everybody is happy. Many people are dealing with challenging circumstances and are pushed beyond their coping abilities.

“So, we have to recognise that and set up our own systems to ensure we are fair, both to the staff and the patient, and that our responses are appropriate.”

To ensure a fair response, healthcare workers are encouraged to learn about the perpetrator’s circumstances.

“We find out everything we can - the psychosocial factors, their background, normal behaviour and medical condition, that may be pertinent to the unacceptable behaviour.”

Managing staff expectations

The framework is also helping to manage workers’ expectations around the legal consequences for perpetrators.

Kam said that, without any visibility of police processes, healthcare workers may be dissatisfied with penalties for sexual harassment. For first-time offenders, this is typically a 12- or 24-month conditional warning, prohibiting repeat offences.

However, through stronger liaison with police, they can better understand and be more optimistic about these outcomes.

“When a worker faces abuse, they want the police to haul the abuser off. But we have to educate staff and temper their expectations - because we are not the police and whatever we do is only at the hospital level.

“Now, through a lot of engagement with the police, we can at least go back to the staff and explain how the framework works – that a conditional warning is actually a good outcome, because in the past, that type of harassment might not have resulted in anything.”

The development of a Staff Protection Council, with direct involvement from senior leadership, is also helping on this front.

Kam says it gives hospitals better access to the police, enabling conversations which, previously, might not have been entertained.

“Traditionally, police would only respond to the person who made the report. Now we can say we are calling as a Staff Protection Officer and would like to know what has been done to the perpetrator, if anything at all. Then, with this information, we can go back to the staff and manage their expectations.”

Staff wellbeing

The programme also addresses the wellbeing of staff who have fallen victim to workplace aggression or violence.

The hospital developed a care network, including a mental health committee, peer support programme and staff protection programme.

“The Mental Health Committee provides training and resources and works hard to destigmatise talking about mental well-being.

“The peer support programme equips people on the ground with psychological first aid skills. It teaches them how to “be a friend” and support their peers, as well as recognise signs of distress. If they do spot something, they can act, or call upon the next tier of support, which escalates to a psychologist and psychiatrist, if necessary.”

Meanwhile, the Staff Protection Programme , which Kam helped set up, addresses the legal and psychosocial fallout of workplace aggression and violence.

Outcomes so far

Since the programme was established, reports of harassment and other forms of abuse have grown significantly. Kam believes this signals a culture where staff feel more confident to speak out.

“It is only a surrogate measure of success, but we believe the statistics reflect greater reporting rather than greater instances of abuse,” she said.

“Harassment was previously brushed off by a lot of staff. If there wasn’t an injury, people wouldn’t talk about it or take further action.

“Now, with a clear framework to follow, staff feel empowered to take action. They know they will be heard and what actions will be taken by the hospital, as well as having a clearer picture of what might happen once the case is in police hands.

“Ultimately, it has given them a voice.”

Further insight

Sharing more on the Singapore General Hospital Staff Protection Programme, Kam Wai Kuen will address the upcoming Healthcare and Workforce Safety Conference.

This year’s event will shine a spotlight on the measures hospitals are taking to address rising rates of abuse from patients.

Joining Kam on the stage are representatives from…

Learn more and register your place here.