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A Stand Against Abuse


1.     Thank you for attending today’s engagement session.


Problem Caused by a Minority


2.     What is a key difference between healthcare and other sectors, such as manufacturing, finance, tourism, construction, social services and education? Well, unlike many other sectors, healthcare has the word ‘care’ in it.


3.     Help, kindness, comfort, consolation – they encapsulate the healthcare sector. We may deploy advanced technology and state-of-the-art treatment and medicines, but there is no substitute for care, which requires the human touch. That is why healthcare workers are the heart and soul of the healthcare sector.


4.     Healthcare workers put in many hours of hard work every week, sometimes under trying conditions. They are driven by their sense of mission, of wanting to help patients, and the joy of seeing them regain their health.


5.     The great majority of patients, their loved ones and the public know that, and appreciate the contribution of healthcare workers. Many healthcare workers will tell you this is what motivates them to give of their best in their jobs.


6.     During the COVID-19 pandemic, I saw how members of the public would send food and flowers to hospitals to say ‘thank you’ to healthcare workers. Students drew nice cards for healthcare workers. Every so often, they sent them to my office and asked that I pass them on to the hospitals.


7.     Amongst our young, many aspire to be part of the healthcare sector. Our education institutions are not short of applicants for their healthcare courses. Today, more than one in twenty students go into healthcare courses, mostly nursing.


8.     By and large, healthcare is a well-respected and dignified profession. Healthcare workers treat and care for their patients professionally and with kindness, and their patients reciprocate by treating healthcare workers with respect.


9.     However, there is always a small proportion of the public who behave badly towards our healthcare workers. They will demand that healthcare workers do unreasonable things, threaten or hurl discriminatory remarks at them.


10.     While a small minority, it is enough to significantly affect morale. If you encounter this once in a week, it is enough to spoil your whole week.


11.     As a profession that is centered around care, such abusive behaviour is unfair to everyone. It is unfair to healthcare workers who are simply trying to help.


12.     It is also unfair to the majority of members of the public who are understanding and respectful to healthcare workers, because a disproportionate amount of time is always spent on handling the abuse cases, and at the expense of those who are appreciative and understanding.


The Workgroup and their Findings


13.     In response to the increasing number of cases of abuse and harassment against healthcare workers, the Ministry of Health (MOH) announced that we were forming a Tripartite Workgroup to look into the issue of healthcare workers being abused and harassed.


14.     My direction to the Workgroup was simple – where there is a problem with abuse and harassment, we must be prepared to stand up against it.


15.     The Workgroup engaged more than 3,000 healthcare workers and 1,500 members of the public. We are grateful for the support of the Healthcare Services Employees’ Union, healthcare associations and societies, as well as all the participants who shared their open, honest views with us.


16.     These are the key findings, and they are worrying:


17.     First, abuse is quite a common occurrence. Almost one in three healthcare workers has witnessed or experienced abuse at least once a week. The more common types of behaviour are verbal abuse, including discriminatory or demeaning remarks directed at healthcare workers, or threats, including to take legal action.


18.     Second, abuse happens under a range of circumstances. For example, patients and family members could be worried about their medical issues and request for frequent updates. And when healthcare workers are unable to meet these expectations, emotions run high.


19.     Another common circumstance is when patients make requests that start off reasonable, such as needing a nurse to speak in a certain language, but the request grows into something ugly and discriminatory.


20.     Then there are patients who treat healthcare workers as personal attendants and ask that they do tasks outside of their scope of work or might expect an unreasonable degree of preferential treatment. Threats were then made in order to get what they want from the healthcare workers.


21.     There are also patients with diminished mental capacity or medical conditions like dementia who do not intend to harm healthcare workers but are not in control of their own behaviour.


22.     Third, many healthcare workers have grown accustomed to abuse as part and parcel of their work. Most of our healthcare staff remain professional, empathetic and compassionate towards patients even in challenging situations. While sharing their experiences of abuse, they expressed understanding, saying that the patients were going through a lot of stress and uncertainty.


23.     Let me categorically say this – abusive behaviour towards healthcare workers is not acceptable. In a healthcare setting, where our job is to provide care, we have somehow left bad behaviour to be tolerated and uncorrected.


24.     While many healthcare workers find ways to cope, it is wearying and demoralising to experience this on a regular basis. It is simply not acceptable.


25.     The Tripartite Workgroup has drawn up a set of recommendations to address the issue. I support their recommendations fully.


Prevent and Promote


26.     The first recommendation is to Prevent abuse from happening, especially when healthcare workers interact with patients with diminished mental capacity. We can prevent these abuse incidents by understanding the pathology.


27.     To this end, we will continue to equip healthcare workers with the necessary skills to avoid and better manage emotionally charged situations. For example, they can be trained to identify escalating situations, and to better manage frustrated patients or those with dementia.


28.     One example is Khoo Teck Puat Hospital, which uses a care technique called Humanitude, where healthcare workers are trained to focus on aspects like gaze, speech and touch.


29.     They sit the patients upright when addressing them, and when escorting patients, they guide gently by placing a hand on the back instead of reaching for the patients’ arms. This can help patients with dementia to remain calm and co-operative, while maintaining their dignity.


30.     The second recommendation is to Promote positive relationships between patients and healthcare workers. We will be launching a public education campaign in the latter half of this year to align expectations and promote respect for healthcare workers.


31.     We want to help patients and families understand the role of a healthcare worker, and that healthcare workers cannot be expected to do everything for them, all the time.


32.     We know that in any service or care setting, an occasional mismatch of expectations is inevitable. When that happens, concerns and feedback should be raised appropriately and constructively through the appropriate channels.


33.     Most fundamentally, we should, as a society, uphold the social norm to treat our healthcare workers with dignity and respect, regardless of whether we are a patient or a family member. The public education campaign aims to make this clear.


Protect – Standing Up Against Abusers


34.     Finally, we need to take a firmer stance and Protect healthcare workers through a zero-tolerance policy against abuse. A problem we face today is that different individuals view abuse differently. An abuser may feel his actions are justified by the circumstances, but the healthcare worker at the receiving end of the abuse is hurt.


35.     A starting point to protect healthcare workers against abuse is therefore to have a common definition of abuse, and recognise abuse when we see it.


36.     The Tripartite Workgroup has therefore defined abuse as any inappropriate words or behaviour that makes a healthcare worker feel distressed, threatened, harassed or discriminated against, even if the perpetrator said he did not intend to do so.


37.     Abuse, as I said, happens under varied circumstances, some of which will be mitigating, and we can even express understanding for. But it does not absolve the behaviour from being an act of abuse, because there is a real physical and psychological impact on healthcare workers. We want the healthcare worker to still report it, and have the incident properly addressed.


38.     We therefore also need an efficient reporting process, so that the healthcare worker can escalate the incident and seek recourse. They should be given updates and closure on the outcome of the report, so that they do not feel helpless and alone when encountering abuse.


39.     While many of these processes are already in place, they can be time-consuming and often produce less than satisfactory outcomes. They will need to be improved and ought to be standardised across healthcare institutions, especially in our public healthcare sector.


40.     But ultimately, to protect healthcare workers, we need to stand up against the blatant abusers. In a healthcare setting, this has to be carried out sensitively.


41.     Where urgent care is needed, it will be delivered, regardless. This is part of the oath every healthcare worker has taken. But where care is not urgent, or if the abuser is a visitor and not a patient, which is often the case, there must be a disengagement process.


42.     Supervisors on the ground, like nurse managers or doctors in charge of a ward or department, must be empowered to carry out such disengagement. They can, for example, refuse unreasonable requests, prevent abusive visitors from entering the premises, or for egregious cases, make a Police report. For the latter, abusers may face criminal charges, as well as penalties under the Protection from Harassment Act.


43.     With these measures, we hope to build a culture and environment where staff can feel better supported by their institution to report incidents of abuse.


44.     When an incident of abuse has been escalated and ascertained, the staff must feel that he is not alone, and people around him are behind him – his supervisor, management, the Ministry, the Minister, and most importantly, the great majority of the public.


45.     It cannot be the case where a supervisor takes action to disengage from an abuser, the abuser complains to the Member of Parliament or the Minister for Health, and the supervisor gets reprimanded for bad service. We will have to stand together on this, against the very small minority of abusers.


Translating our Stand into Action


46.     In the coming months, we will be working with the public healthcare institutions on the details of the Workgroup’s recommendations, to translate them into practices on the ground.


47.     When ready, we will publish the operating guidelines, so that there can be a common understanding and expectations for our public healthcare system. We encourage other healthcare institutions such as community care organisations and private healthcare providers to take reference from the guidelines where appropriate.


48.     Healthcare workers deserve to be treated with respect, like anyone else. We are grateful to those who have stood up for them and expressed appreciation and understanding.


49.     Together, we can ensure that healthcare workers feel safe and supported, and this allows them to continue doing their best work for all Singaporeans, in a positive environment, centered on care and kindness, as it should be.

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