In 2014, it was reported that some soldiers stormed a hospital in Ore, Ondo State and assaulted many hospital staff when the hospital refused to take in a deceased soldier they brought to the mortuary the previous day because its mortuary was already full. Recently, THE PUNCH reported the case of angry relatives attacking a doctor in a hospital after losing a family member and a couple of days prior, a man and his son were arraigned for assaulting a doctor in a hospital.

According to the United States’ Occupational Safety and Health Administration, workplace violence is any act or threat of physical violence, harassment, intimidation or other threatening disruptive behaviour that occurs at the workplace.

Violence on healthcare workers in the course of their duties is not a rare occurrence because the healthcare setting can be a very stressful environment on the part of all, including the healthcare personnel, patients and their relations. This has resulted in the loss of lives, physical injuries, short and long-term psychological trauma (Post-traumatic stress disorder), changes in relationship with co-workers, demoralisation, feeling of guilt, feeling of incompetence, loss of confidence, loss of self-esteem, litigations etc. However, violence, even though rampant in healthcare settings, should not be permitted.

More than half of workplace violence occurs in healthcare and social service settings, especially in emergency rooms, the reason is because ERs are usually busy and often chaotic. Patients are competing for attention in the face of short-staffed and over-worked personnel. This makes ERs predisposed to people reacting in unusual manner to the stress they are going through.

In a typical hospital setting, the perpetrator could be patients (especially in psychiatric cases), relations/friends, and visitors. Some situations that could aggravate and make healthcare personnel susceptible to violence and harassments are inability or delay in obtaining needed services (including information and explanation); long waiting time, especially in emergency room; dissatisfaction with treatment; attitude of healthcare personnel; hurtful or insulting comments by members of staff, patients/relations under the influence of alcohol; feeling of anxiety and frustration; high medical cost and attendant frustration; fragmented, stressful and patient-unfriendly hospital bureaucracy; reactions to receiving devastating or unexpected news; aggressive patients/relations, among others.

Violence on healthcare workers under any guise is inexcusable and should be taken very seriously. The right approach is to tackle the matter holistically. Everyone has a role to play.  The management of hospitals should understand that violence or threat of it on their personnel should be avoided, and where it happens the matter should be thoroughly interrogated with an open mind with a view to understanding the cause(s), apportioning blame, punishing the culprit, and instituting measures to prevent a recurrence.

Every hospital management has the duty to maintain and ensure a safe work space for its entire staff and protect, without any equivocation, their dignity and integrity. It must be proactive and have zero tolerance for assault on its employees. It must not wait until the event happens before putting measures in place.

In being proactive they should be able to identify hazards and develop strategies to reduce or eliminate factors that may engender insecurity and threats to their staff in their work environment. An unsafe work environment where personnel are apprehensive of their fate in the hands of aggressive patients or relatives cannot encourage them to give their best to the patients under their care.

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In appropriate cases, physical barriers, technology and security presence should be deployed.  Healthcare personnel should be trained in crisis handling and de-escalating techniques. The capacity to diffuse a tense situation may depend on the level of experience of the personnel. That is why in some situations an experienced healthcare personnel with the capacity to handle and manage panicky, tense and highly anxious patients and their relations should be entrusted with certain assignments (or be readily available); not young and inexperienced staff. Being circumspect with the ability to anticipate and take care of the situation before it gets out of hand is important.

Even though hospitals are fertile grounds for outburst of emotions, an employee that is at fault should be sanctioned and if the patient/relations are at fault, they should be appropriately dealt with. Where there is a feeling of impunity and the perpetrator suffers no consequence as a result of his misbehaviour, then it is likely to recur with negative effect on the employee or vice versa.

Section 23 of National Health Act simply provides that “except for psychiatric patients, a healthcare provider may refuse to treat a user who is physically or verbally abusive, or who sexually harasses him or her.” The issue goes far beyond that. We should also be mindful of the fact that assault or threat of it is a criminal offence. The affected personnel can have recourse to civil and criminal action against the perpetrator.  In some jurisdictions outside our shores, there are criminal provisions specifically on violence on healthcare personnel happening on duty with heavier punishments.

Friction in the patient/healthcare personnel relationship is inevitable, but when it happens it must be ventilated and resolved in a civilised manner without reprisals. If patients and their relations have any concern, they have the right to complain and escalate it to the appropriate personnel or higher authorities until it is satisfactorily addressed. Section 30 of the National Health Act provides that “a person may lay a complaint about the manner in which he or she was treated at a health establishment and have the complaint investigated.” Hospitals should also have functional and responsive complaints resolution mechanisms. In all Federal Government-owned hospitals for example, there exists SERVICOM where aggrieved clients can lay their complaints and expect a satisfactory resolution.

Patients and their relations should understand and appreciate the fact that healthcare personnel are out to help them and that they would do their best to help their patients, hence they should never resort to violence.

Healthcare workers should always be sensitive to the feeling of patients and display a caring, warm and friendly attitude and be empathic in dealing with their patients.  They should relate with their patients with maturity and with all sense of professionalism.

Finally, the government should show more interest in this matter because violence on healthcare workers in hospitals is a threat to public health.

  • Olajide, Head (Legal Services), Lagos University Teaching Hospital, writes via [email protected]

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