This presentation addresses the impact of workplace violence and strategically evaluates causes and makes recommendations for the same, in a hospital setting in India.
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Evaluations and Interventions to address Workplace Violence in the Healthcare Sector
1. Strategic Evaluations and Interventions to
Address Workplace Violence against
Medical Practitioners in Indian Hospitals
- Dr. Niyoti Khilare
2. BACKGROUND
WHO : 8-38% health care workers face workplace violence
Indian Medical Association (IMA) : 75% of doctors in India face workplace violence
Healthcare workers are nearly four times more likely to be injured and require time away from work
as a result of Work Place Violence than all workers in the private sector combined
WORK PLACE VIOLENCE :
The Health and Safety Executive (HSE) defines work-related violence as: Any incident in which a person
is abused, threatened or assaulted in circumstances relating to their work
Maybe Physical or Psychological
Kicks, scratches, thrashing, spitting, biting, abusive behavior, verbal threats, etc
3. IMPACT
Over 40,000 doctors on mass leave in protest against assault on a doctor who lost
his vision due to attack by patient’s relatives
4th reported major attack in one week
The medical services at about 40 hospitals in the capital city Delhi were shut down
2,000 surgeries postponed
Doctors wearing helmets to work to protect themselves, and as a sign of protest
5. CAUSES AND CONCEPTS
Increased waiting time
Patient dissatisfaction
Lack of communication between doctor and
patient due to limited time
Unavailability of resources at public health
sectors leading doctors to refer patients to
private sectors, thus infuriating the patient
RESOURCE ALLOCATION
Human resources
Funding (GDP)
Other resources (investigative and
treatment modalities)
6. CAUSES AND CONCEPTS
Burnout
Stress
Poor communication
Lack of communication between patient and
doctor due to burnout and work-overload
Lack of empathy
PERFORMANCE Management
Duties lasting around or more
than 60 hours per week, with 36
hours shifts
Specialty hierarchy
7. CAUSES AND CONCEPTS
Patient expectations
Miscommunication
Media
culture
Negativity
Marketing
Level 3 : Assumptions
‘Any loss of life is a doctor’s fault
as medicine can cure anything’
8. CAUSES AND CONCEPTS
No strict law against perpetrators of violence
Lack of security personnel
Legislation and security
9. CAUSES AND CONCEPTS
Lack of accountability by managers
Blaming the victim and lack of support
Lack of communication by leaders to workers
regarding policies
Leadership vacuum amongst doctors
LEADERSHIP
10. STRATEGIC RECOMMENDATIONS:
RESOURCE ALLOCATION
o Number of Doctors : minimum 1/1000
o Basic modalities for investigations and treatment be present in every public hospital
o GDP : Min 4% as recommended by WHO
o Health insurance policies
PERFORMANCE MANAGEMENT
o Time and shift management
o Goals and roles clearly established
o Imparting communication skills to healthcare workers
SECURITY
o Reduce number of entrances to avoid overcrowding
o 2 visitors per patient
o Security personnel at entrances
o Training to workers
11. STRATEGIC RECOMMENDATIONS:
LEGISLATION
o Zero-tolerance policy
o Patient protocol displayed alongside patient-rights
CULTURE
o Journalism
o Society’s attitude
LEADERSHIP
o Managers should support the victim
o Reporting and quick action in case of a violent incident
o Policies be well communicated to workers, on a timely basis
GOVERNMENT RESPONSIBILITIES FOR THE HEALTH OF THE CITIZENS
o Health insurance policies
o Adequate resource management
12. CONCLUSION
Multifactorial problem
Multipronged approach
Risk factors identified
Related to concepts
To come up with a strategic solution
Change my approach as a professional
Lead to make a change : influencing others with a clear vision
Actions needed to prevent an incident
13. References:
Bordignon, M. and Monteiro, M., 2016. Violence in the workplace in Nursing: consequences
overview. Revista Brasileira de Enfermagem, [e-journal] 69 (5), pp.939. 10.1590/0034-7167-2015-0133.
<http://www.scielo.br/scielo.php?pid=S0034-71672016000500996&script=sci_arttext&tlng=en>
Express News Service, 2017. Orthopaedic doctor of Dhule hospital ‘thrashed’ by patient’s kin: Brutal attack
on doctor sparks anger among medical fraternity. The Indian Express. [press release] 15 March, 2017.
Available at: http://indianexpress.com/article/cities/pune/orthopaedic-doctor-of-dhule-hospital-thrashed-by-
patients-kin-brutal-attack-on-doctor-sparks-anger-among-medical-fraternity-4569235/
Iyer, M., 2017. Epidemic of violence against doctors a global threat, jail term no deterrent. Times of India.
[press release] 26th March 2017. Available at: http://timesofindia.indiatimes.com/city/mumbai/epidemic-of-
violence-against-doctors-a-global-threat-jail-term-no-deterrent/articleshow/57834135.cms [Accessed 19 Jul.
2017].
Iyer, S., 2017. Maharashtra Doctors’ Strike: 135 patients dead in 3 BMC hospitals, Bombay High Court sets
tomorrow as ultimatum for doctors. INDIA. [press release] 24th March, 2017. Available at:
http://www.india.com/news/india/maharashtra-doctors-strike-135-patients-dead-in-3-bmc-hospitals-bombay-
high-court-sets-tomorrow-as-ultimatum-for-doctors-1957785/ [Accessed 19 Jul. 2017]
14. References:
Kar, S., 2017. Addressing underlying causes of violence against doctors in India. The Lancet, [online]
389(10083), pp.1979-1980. Available at: http://thelancet.com/journals/lancet/article/PIIS0140-6736(17)31297-
7/fulltext.
Kazmin, A., 2017. Patients attack doctors for India’s healthcare failings. Financial Times, [press release] 8th
June, 2017. https://www.ft.com/content/842767bc-31b6-11e7-9555-23ef563ecf9a?mhq5j=e1. Available at:
https://www.ft.com/content/842767bc-31b6-11e7-9555-23ef563ecf9a?mhq5j=e1 [Accessed 19 Jul. 2017].
Kumar, M., Verma, M., Das, T., Pardeshi, G., Kishore, J. and Padmanandan, A., 2016. A Study of Workplace
Violence Experienced by Doctors and Associated Risk Factors in a Tertiary Care Hospital of South Delhi,
India. Journal of Clinical and Diagnostic Research, [e-journal] 10 (11) Available at:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198359/>.
World Health Organisation (WHO), 2017a. WHO | Violence against health workers. [online] Available at:
http://www.who.int/violence_injury_prevention/violence/workplace/en/ [Accessed 27 Jul. 2017].
15. References:
Sharma, D., 2017. Rising violence against health workers in India. The Lancet, [online]
389(10080), p.1685. Available at: http://www.thelancet.com/journals/lancet/article/PIIS0140-
6736(17)31142-X/fulltext.
Sharma, P., 2017. Over 40,000 doctors to go on mass leave in protest against assault on
Sion Hospital doctor. India Today. [press release] 23rd March, 2017. Available at:
http://indiatoday.intoday.in/story/delhi-doctors-go-on-strike-sion-hospital-doctor-thrashed-
maharashtra-doctors/1/910679.html [Accessed 19 Jul. 2017].
Steinman, S., 2003. Work Place Violence in the Health Sector - Country Case Study: South
Africa. [online] Geneva: World Health Organisation. Available at:
http://www.who.int/violence_injury_prevention/violence/interpersonal/en/WVcountrystudysou
thafrica.pdf [Accessed 19 Jul. 2017].
16. DISCLAIMER:
This presentation is based on data and literature available until August 2017. This work was
submitted as a part of an assignment for the module Applied Leadership and Management
(MOD005292) for the course M.Sc. Diabetes Care in August 2017 to ARU, Cambridge, UK,
under the guidance of Dr. Emmanuel Idowu. All sources and aids used have been indicated
as such. All texts either quoted directly or paraphrased have been indicated by in-text
citations. Full bibliographic details are given in the reference list which also contains internet
sources containing URL and access date, where possible.
The Author was a student of M.S. (by research) in Diabetes Care at ARU Cambridge at the
time when this work was undertaken. The Author has no other financial relationships with
any organisations that might have an interest in the submitted work; has no other
relationships or activities that could appear to have influenced the submitted work. All
opinions presented in this manuscript belong to the author alone, and not any institution to
which they are or were affiliated. The Author(s) declare(s) that there is no conflict of interest.
For any queries or suggestions, kindly contact the author at niyotikhilare@gmail.com.