Since the arrival of the coronavirus in 2021, numerous healthcare workers have been mistreated.
During the COVID-19 pandemic, hearing about healthcare workers being shunned in public places like hawker centres or even in taxis was common.
Some individuals were even subjected to public abuse, such as a nurse from Sengkang General Hospital (SKH) whose neighbour ridiculed, cursed, and sprayed him with disinfectant whenever he returned home.
Unfortunately, the situation has not improved much since COVID-19 measures have been relaxed.
According to a Tripartite Workgroup that surveyed over 3,000 healthcare workers and 1,500 members of the public, more than two-thirds of healthcare workers experienced or witnessed abuse or harassment in 2022, with half encountering abuse at least once a week.
As part of Tan Tock Seng Hospital’s (TTSH) efforts to address these incidents of abuse, its staff are now being taught self-defence techniques to protect themselves against violent individuals swiftly.
Measures in Place to Tackle the Rise of Abuse Against Healthcare Workers
To protect them from abuse, self-defence techniques are now being taught in sessions for frontline workers, including nurses and patient service associates.
To address the trend of verbal and physical assaults on healthcare staff, TTSH developed the Workplace Safety on Aggression and Fearful Encounter (WorkSAFE) program in 2017 to teach its staff self-defence techniques.
Since 2019, a group of approximately 100 senior healthcare workers have been trained on the relevant self-defence techniques, and they are now passing on these skills to approximately 3,000 frontline staff.
The program consists of eight modules that cover how to recognise workplace violence when it occurs and ways to de-escalate the situation.
This includes practical tips on how to avoid being grabbed by the hand or collar, being bitten or choked, and how to restrain an uncooperative patient safely.
According to Ms Leong Jan Mui, a senior nurse educator at TTSH who helped develop the program, the scenarios taught in the curriculum were based on the most common situations that staff face daily.
For example, one typical case is when a patient grabs the staff by their shirt collar.
In response, staff are taught to hold onto their wrist with both hands, press their thumbs firmly against their palms, and twist their wrists inwards to push the aggressor away.
To teach these skills to frontline workers who may not have time for a one-hour course, TTSH has used the concept of micro-learning.
For example, during roll calls between their shifts, the hospital takes 20 minutes to teach their nurses these skills.
As a result, Ms Leong said it took four to eight months to roll out the modules to all the frontline staff.
Self-Defence Training Better Late than Never
Ms Ranjeeta Kaur, a nurse manager at TTSH with 15 years of experience, shared that the self-defence training provided to healthcare workers is effective.
She cites an incident from eight years ago where a patient bit her colleague so hard that the scar still exists on her arm.
According to Ms Kaur, if her colleague had been trained in self-defence earlier, she may have protected herself better from the violent attacker.
To better equip front-line staff in responding to aggressive situations, SKH airs four videos of such situations during their regular front-line staff orientation and in-house training.
These videos depict scenarios based on abusive incidents faced by staff such as nurses, pharmacists, and call centre agents and provide specific guidance on the protocol to follow in each situation.
For instance, pharmacists are advised to acknowledge a patient’s frustration when they become verbally abusive.
They are then advised to make three attempts to inform the patient that their behaviour is unacceptable before activating hospital security if the patient persists in their aggression.
According to a spokesperson from SKH, staff found these videos helpful in guiding them on the workflow for managing abusive situations.
Abusive Actions Against Healthcare Workers Sadly A Norm
As of November 2021, Health Minister Mr Ong Ye Kung reported around 1,400 cases of abuse and harassment in healthcare, a number that has been increasing over the years.
Cases of abuse occur in various circumstances, such as when patients demand frequent updates that healthcare workers cannot provide, when patients require healthcare workers to speak in a specific language, or when patients expect healthcare workers to perform tasks outside their scope of work.
The study indicates that front-line healthcare workers are more prone to experiencing abuse and harassment, with over 55% of pharmacists witnessing or experiencing abuse or harassment at least once a week.
Mr Ong has observed a concerning pattern among healthcare workers wherein they are starting to perceive these abusive behaviours as “normal”, potentially as a result of experiencing repeated instances of mistreatment.
A study conducted in March 2023 by a Tripartite Workgroup consisting of representatives from various healthcare organisations and the Healthcare Services Employees’ Union (HSEU) supports this observation.
According to the study, approximately 40% of healthcare workers do not view being sexually harassed at work as a form of abuse.
Similarly, many of these workers rationalise physical assault, vulgar language, or discriminatory remarks aimed at them as “part of their job”.
However, hospitals such as TTSH, Admiralty Medical Centre, Khoo Teck Puat Hospital (KTPH), Yishun Community Hospital, and others are now taking a firmer stance against abuse.
This is a much better situation compared to the past, where abuse was normalised, and staff members would suffer in silence.
For example, these hospitals are now issuing warning letters to repeat offenders who abuse healthcare workers to prevent similar cases in the future.
TTSH has issued warnings to four patients since 2018.
These warning letters were usually their “last resort” towards aggressors who were noted to be incredibly abusive and had harassed staff to the extent that they could not carry out their duties.
For example, one patient was given a warning letter as he had demanded to smoke in his ward and used expletives on staff when refused.
Additionally, TTSH has measures for the police to step in if necessary.
More Healthcare Workers Are Coming Forward to Report Cases of Abuse
The healthcare community and the Government have been working towards improving working conditions in healthcare.
In a joint statement made in March 2023, public healthcare clusters SingHealth, the National Healthcare Group (NHG) and the National University Health System (NUHS) shared that they have been actively fostering a culture encouraging staff to report and speak out against abuse and harassment.
Since late 2021, SingHealth has worked with healthcare professionals, patients and caregivers to condemn abuse and harassment publicly.
As such, according to Ms Eileen Cheah, an assistant director of nursing administration at KTPH, staff have been observed to be more willing to report such incidents recently.
Similarly, Adjunct Associate Professor Habeebul Rahman, chair of TTSH’s staff well-being committee, added that more staff are now willing to report cases of harassment, even if the act was not physical.
NHG and NUHS have also set up networks such as a staff protection committee and a staff protection programme to ensure a safe working environment for all employees.
Mr Ong has implored the public to treat healthcare workers kindly as abuse and harassment can cause them significant stress and emotional burden.
He suggested that instead of resorting to violence, members of the public can report healthcare workers through feedback channels if problems arise.
Furthermore, the Ministry of Health (MOH) has implemented a standardised zero-tolerance policy against abuse in the public healthcare sector to protect healthcare workers better.
The healthcare clusters will develop further details regarding the policy in the second half of 2023.
The updated policy will include a standard definition of abuse and harassment across healthcare institutions, an effective reporting and escalation protocol, and clear and enforced consequences.
The Tripartite Workgroup defined “abuse” as any inappropriate words or behaviour that causes a healthcare worker to feel distressed, threatened, harassed, or discriminated against, even if the perpetrator did not intend to do so.
If such cases occur, aggressors can be charged under the Penal Code and the Protection from Harassment Act.
Section Three of the POHA states that a person who threatens, abuses or insults to cause and does cause another person harassment, alarm, or distress will be guilty of an offence.
Intentionally causing harassment, alarm or distress may result in the perpetrator getting a fine of up to $5,000, an imprisonment term of up to six months, or both.
Additionally, according to Section 352 of the Penal Code, individuals found guilty of assault or using criminal force may be imprisoned for up to three months or liable for a fine of up to $1,500 or both.
