Measures to prevent violence against healthcare workers

@PraveenDixitIPS

By Praveen Dixit

Following the outbreak of Corona pandemic, though the healthcare workers continue to do their job diligently, attacks on them are persisting. Union Health Minister had announced that the Central Act would be enacted to prevent these incidents with stringent provisions, including making these offences non-bailable. Presently, various State governments including Maharashtra have enacted Act to Prevent Violence against Doctors. However, despite the legal provisions, the incidents of vandalism and abuse continue to be reported as well as getting viral on social media. Moreover, there appears to be hardly any conviction of the culprits which could have the deterrent effect on the offenders.

In the wake of violent incidents against resident doctors at various government hospitals, I was called upon to formulate a scheme to prevent such incidents. In consultation with Medical Superintendents of Medical Colleges-Hospitals, emergency wards were identified and armed contingents were posted from Maharashtra State Security Corporation. These personnel were equipped with communication sets so that additional assistance can be called at short notice. These security men and women were specially trained in handling the mob as well as relatives of patients. 

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Moreover, they functioned under selected retired police inspectors. Also, measures such as access control to emergency wards, restricting timing to visit patients and number of visitors were implemented. CCTV cameras and the emergency alarm system was provided to meet any contingency. By and large, the system has settled down and resident doctors express their satisfaction about the steps taken to enable them to work in a tension-free atmosphere. Surely, there is further scope to improve the situation.

The situation in private hospitals is more challenging. Most of the doctors work in isolation. In places, where there is a hospital, few of the above measures including deployment of guards, bouncers, CCTV cameras have been taken. Still, there is not much improvement in the ground reality.

It is therefore imperative that additional steps need to be considered. The reasons for violence in healthcare institutes may be sporadic as well as due to the absence of adequate training, lack of infrastructure as well as the absence of any policy to tackle such incidents. The foremost thing in this regard is to arrange for initial as well as mid-term training by experts regularly. The training modules should be addressing specific requirements of each level separately right from the billing clerk, receptionist, nurses, ward boys, technicians and senior-most subject experts. The focus should be on Dos and Don’ts and tips which can be practically implemented. It is advisable to have case studies and participants are encouraged to discuss these in the presence of experts to reach proper conclusions. 

Documentation of every aberration is an important requirement which is generally neglected. If there is a record of the past incidents, one can see the pattern likely to emerge and prevent or cure distorted behaviour in time. These recordings need to be shown to the staff from time to time to make them aware of what went wrong and how it was possible to avoid the same. Moreover, there is a tendency not to report the incidents to law enforcing agencies to avoid approaching the police or to remain present in court.

US Guidelines for Prevention of Violence in Healthcare mentions following measures:  i) management commitment, ii) employee participation, iii) worksite analysis and hazard identification, iv) hazard prevention and control, v) safety and health training and vi) record-keeping and program evaluation. 

To conclude, having enactment to prevent violence, per se, does not guarantee the absence of violence. Involvement from all stakeholders, preparedness to meet the contingencies, well laid out policy with standard operating procedures (SOP), frequent rehearsals of the drill, coordination with all stakeholders including law enforcement agencies even when there is no crisis are some of the tips which may help healthcare institutes to avoid and overcome incidents of violence if any. If Doctors adopt a more sympathetic attitude towards the patients and explain the circumstances properly, many adverse situations can be avoided.

The author is IPS & Director General of Police (Retired), Maharashtra State