Recommendations on protecting healthcare workers from abuse and harassment in Singapore

These include establishing a clear and common definition of abuse and harassment, including actions that cause distress, harassment, threat, or discrimination, regardless of intention.

Singapore's Tripartite Workgroup for the Prevention of Abuse and Harassment of Healthcare Workers has recommended the adoption of a standardised zero-tolerance policy against the abuse and harassment of healthcare workers.

Established back in April 2022, the workgroup spearheaded a national effort to prevent the abuse and harassment of healthcare workers in Singapore's public, private, and community care sectors. 

Since then, the workgroup has identified several key findings following extensive engagement with over 3,000 healthcare workers and 1,500 members of the public through surveys and focus group discussions. Firstly, more than two in three healthcare workers have witnessed or personally experienced abuse or harassment in the past year. Of these, half (or equivalent to a third of all healthcare workers) witnessed or experienced abuse or harassment at least once a week. Particularly, frontline healthcare workers such as pharmacists, patient service associates, and nurses are more likely to experience abuse and harassment.

The most common forms of abuse and harassment were shouting, threats by patients and/or caregivers to file complaints or take legal action against the healthcare workers, and demeaning comments. Healthcare workers experiencing abuse and harassment were also found to sometimes rationalise these as being part of their job.

Still, these workers often empathise with patients’ circumstances and do not take action against them. Abuse and harassment often end up being under-reported, as a result.

In light of such findings, the workgroup is recommending a standardised zero-tolerance policy against the abuse and harassment of healthcare workers using a three-pronged framework:

1. Protect healthcare workers who face abuse and harassment;
2. Prevent situations that lead to abuse and harassment, and
3. Promote positive relationships between healthcare workers and patients/ caregivers.

The workgroup aims to build a supportive culture where healthcare workers feel safe to work and confident to report abuse and harassment. In doing so, these recommendations will help establish:

1.  a clear and common definition of abuse and harassment, including any inappropriate behaviour or communication that causes a healthcare worker to experience distress, harassment, threat, or discrimination, regardless of intention;
2. an effective reporting and escalation protocol;
3. a supportive culture of reporting; and
4. clear consequences that are implemented and enforced. This may include issuing a warning to the perpetrator; disengaging by refusing unreasonable requests or in cases when the patient does not require any urgent medical care, discharging the abusive patient; and disengaging from abusive caregivers or visitors by preventing them from entering the premises.

It has also been recommended that institutions train staff to prevent potential abusive situations by equipping them with the skills and knowledge to manage and de-escalate challenging situations and deterring potential offenders through the enforcement of consequences.

The public healthcare sector has been encouraged to lead by example, with public healthcare institutions agreeing to strengthen their existing processes and implement this standardised zero-tolerance policy.

In line with the above, Minister for Health Ong Ye Kung shared in a Facebook post: "Ministry of Health, the healthcare clusters, the Healthcare Services Employees' Union, and I, as the Minister for Health, fully support the Workgroup’s recommendations."

In the coming months, he added, the Ministry of Health will work with public healthcare clusters to translate these recommendations into practices on the ground. Upon release, private healthcare institutions and community care organisations will be encouraged to refer to the parameters of this policy and adapt it to their processes and operating models where feasible.

MOH Holdings also plans to launch a national public education campaign in the second half of 2023 to promote positive relationships of trust and respect between healthcare workers, patients, and their caregivers. The objective of the campaign is to align expectations of healthcare workers’ roles, and promote respect for healthcare workers.

Lead image / Minsiter of Health Ong Ye Kung Facebook