The Tripartite Workgroup for the Prevention of Abuse and Harassment of Healthcare Workers has launched the Tripartite Framework for the Prevention of Abuse and Harassment in Healthcare. The Framework provides all healthcare institutions with a common definition of abuse and harassment, and a consistent set of standards to safeguard their workers.
2. While the vast majority of patients and their next-of-kin are respectful and appreciative towards healthcare workers, there is a small minority of individuals who resort to words and actions which are abusive to healthcare workers. To provide quality patient care, healthcare workers need to work in an environment where they feel safe and are not threatened or traumatised by incidents of abuse and harassment. The impact of each act of abuse and harassment is profound, extending beyond the trauma to the immediate victim. It destroys the trust between patients/ next-of-kin and healthcare workers, and adversely affects the quality of patient care.
3. The Framework consolidates the findings and recommendations released in March 2023 by the Workgroup, comprising representatives from the Ministry of Health (MOH), Healthcare Services Employees’ Union (HSEU), public healthcare clusters, community care partners and private healthcare providers. The recommendations of the Workgroup are:
a) Protect healthcare workers who face abuse and harassment;
b) Prevent situations that lead to abuse and harassment; and
c) Promote positive relationships between healthcare workers and patients/ caregivers.
Tripartite Framework for the Prevention of Abuse and Harassment in Healthcare
4. Since announcing its recommendations in March 2023, the Workgroup has scanned best practices and engaged multiple stakeholder groups to develop the Framework for implementing a zero-tolerance policy against abuse and harassment. The Tripartite Framework for the Prevention of Abuse and Harassment in Healthcare covers the following areas:
i. A common definition of abuse and harassment, which would guide how public healthcare institutions identify, and subsequently prevent and manage such incidents in a consistent manner;
ii. Standardisation of protocols for healthcare institutions, ranging from immediate incident response, reporting, post-incident management; and
iii. Follow-up actions to be taken against perpetrators to protect healthcare workers and those around them.
A detailed implementation guide will be circulated to all healthcare institutions for their reference. Please refer to Annex A for the Framework.
Implementation of Framework
5. The public healthcare clusters have committed to adopting the Framework, with the aim of revising and updating their internal protocols across their hospitals and institutions by June 2024.
6. With the adoption of the Framework, healthcare workers can look forward to a safer working environment. They can take immediate action to protect themselves and others from harm, such as by firmly telling the perpetrator to stop their abusive behaviour or activating security personnel. Every public healthcare institution will have a staff protection function to oversee proper and fair reviews of reported abuse and harassment incidents involving staff. Necessary physical and wellness support will also be provided for staff who are victims of abuse and harassment.
7. Healthcare institutions will have the autonomy to take action against perpetrators, through issuing warnings, removing abusers from the premises and disengaging them in communications, refusing unreasonable requests outside of the healthcare workers’ job scope, or discharging abusive patients who are assessed to not require urgent medical care. Repeated offenders will also have their behaviour documented in their medical records.
8. Group Chief Executive Officer of the National Healthcare Group (NHG), Professor Philip Choo, said, “NHG is committed to zero tolerance towards abuse and harassment of our staff who dedicate themselves every day to provide best care to our patients and the population we serve. We recognise that the vast majority of people we serve are respectful to our healthcare workers and the work that we do. However, we cannot allow the behaviour of a minority of individuals to wear down the morale of our staff and make it difficult for them to provide high standards of care. Adopting the tripartite framework, we will set up Staff Protection teams at all NHG Institutions to ensure that NHG remains a safe workplace for all employees. We will also step up our training efforts to help employees understand the gravity of this issue and to learn how to manage promptly incidents of workplace abuse and harassment. Our support will extend to post-incident care, where affected staff will be given time and space to recover. We consider any incident of abuse and harassment as one too many, and will continue to reinforce across all our Institutions that we take such incidents seriously. Everyone must play a part in ensuring a safe and respectful environment for working and for healing to take place.”
9. Chief Executive of the National University Health System (NUHS), Professor Yeoh Khay Guan, said, “NUHS is committed to ensuring a safe working environment for healthcare workers, with a strong stance against abuse and harassment. In collaboration with the Tripartite Workgroup, NUHS supports the standardised zero-tolerance policy for preventing abuse in healthcare institutions. This policy reinforces reporting and escalation channels while raising awareness of consequences for such behaviour. NUHS has existing protocols and a staff protection programme, including education, training, and a case escalation process. Staff are encouraged to report incidents and support one another, with consequences for abusive patients and visitors. NUHS emphasises a zero-tolerance policy for abuse, actively building a culture that encourages reporting and standing against harassment. The public's patience and cooperation are sought as NUHS works towards creating a secure environment for healthcare workers.”
10. Group Chief Executive Officer of SingHealth, Professor Ivy Ng, said, “SingHealth fully supports the Framework and implementation guide by the Tripartite Workgroup for the Prevention of Abuse and Harassment of Healthcare Workers. We take a zero-tolerance stance towards the abuse and harassment of our staff, and will not hesitate to take necessary actions in reporting and standing up against such behaviour. We value our patients who entrust us with their care and our staff who give of their best every day. We strive to provide a healing and safe environment and to do so, it is imperative that we treat each other with mutual respect and kindness. We are grateful to many patients and caregivers who have been our strongest partners and advocates.”
11. Other healthcare institutions such as community care organisations, private hospitals and clinics, are encouraged to similarly support the zero-tolerance policy and adapt the guidelines for their operating environment.
Launch of Public Education Campaign
12. In conjunction with the launch of the Framework, MOH Holdings will progressively roll out a national public education campaign. The campaign will promote positive relationships between healthcare workers and patients, as well as their caregivers and families, and encourage a zero-tolerance policy against abuse culture. The campaign also seeks to raise public awareness of the importance of such positive relationships, and the definitions of abuse and harassment. The goal is to foster positive empathy by driving much-needed conversations and inspire actions that will safeguard the well-being of our dedicated healthcare workers.
Tripartite Effort
13. The Workgroup and secretariat in MOH would like to thank all stakeholders who have supported the development of the Framework and implementation guide. These include the HSEU for helping reflect the concerns of healthcare workers, as well as the public and private healthcare institutions whose involvement was crucial in these efforts. Key stakeholders have also shared their support of the Framework.
14. President of HSEU, Ms K Thanaletchimi, said, “HSEU welcomes the Tripartite Framework for the Prevention of Abuse and Harassment in Healthcare, with the strict adoption of zero-tolerance policy. We are heartened to note that there are unified standards of response to safeguard our workers and launch of national public education to promote positive relationship between healthcare workers and public. We certainly hope that the Framework can be adopted by the healthcare eco-system, for both public and private healthcare, because every worker matters. Every worker, including healthcare workers, deserves respect and dignity. We look forward to the implementation of the framework, monitoring of outcome and further review if necessary.”
15. Healthcare workers deserve a safe working environment like anyone else. MOH is grateful to those who have stood up for them, and expressed appreciation, respect, and understanding for their contributions. Together, we can ensure that healthcare workers feel safe and supported, and this allows them to continue doing their best at their work for all Singaporeans.
MINISTRY OF HEALTH
13 DECEMBER 2023