This presentation addresses the impact of workplace violence and strategically evaluates causes and makes recommendations for the same, in a hospital setting in India.

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

4. IMPACT
 INDIVIDUAL
Physical
Psychological
Professional
 ORGANISATION
Financial loss
Absenteeism
Attrition
Impaired reputation
 SYSTEM
Lives lost
Brain-drain
Near or complete collapse of the system

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.

17. THANK YOU!