All of us are aware of the growing incidents of violence against hospital workers across the country. The primary cause is due to poor communication and at times deviant medical protocols. It is also an established fact that the greatest amount of care within our country is rendered through the private sector at all levels – the primary, secondary and tertiary care. The earlier perception of health care being purely a noble and social service has metamorphosed into something tantamount to demand for care due to the monetization of this specific service. A patient has evolved into a customer with the automatic right to define the clinical and service expectations. Unfortunately, medicine in its current context is not a perfect science where outcomes can never be predefined or predictable. Whenever outcomes are not as per expected lines, it leads to disappointments and the consequent expressions of anguish / anger.
Most states in our country have strong laws to protect healthcare infrastructure as well as its workers. The long-term solution comes from going back to the basics of training healthcare professionals – doctors, nurses and paramedical staff on the importance of bedside manners and eloquent communication; breaking of bad news, clear documentation, multidisciplinary team meetings and family conferences. These are all basic steps that will mitigate the risk of aberrant behaviour from well-wishers of patients. All healthcare organizations always have a representative sample of society at large. The good, the bad and the ugly, reflected in human behaviour, may be seen in all service sectors. However, the large presence of a highly educated workforce represented by its knowledge workers makes this environment much more serene and calm.
If we had a behavioural instrument to measure the anxiety levels of people walking into hospitals, with the exclusion of its own workforce, we shouldn’t be surprised with the high index of anxiety. Most providers recruit staff, who fulfil a certain behavioural trait matrix that includes calmness, integrity, empathy and compassion. These values go into their core DNA. In addition to these ingrained values they are also put through a rigorous training module wherein the soft skills and the job competencies are reinforced. Such programmes across the continuum of care will ensure pleasant and consistent touch points. Aberrations do happen and there are frequent episodes of anxiety levels spilling over into aggressive behaviour which could be as simple as raising the decibel pitch of a regular conversation to throwing items around, breaking furniture or equipment to physical manhandling of staff.
Most healthcare institutions train their staff to handle such deviant behaviour. The infrastructure and security systems are also designed to contain these outliers. The level of security can be described as zoning concepts- with peripheral circulatory security systems to in-house building systems which are a combination of using metal detectors, access control systems, CCTV cameras or manned sentry posts. Acute care zones like operating theatres and the intensive care units have higher levels of security as compared to the non-acute care setting. There is also a strict internal policy of controlling visitors to patient areas. Overall, there are two levels of security; at the ambulatory and in-patient care levels.
From the patient’s side, they need to become active decision-makers in the care process. Therefore, in a larger family setup, one family member needs to be designated as a spokesperson, who may interact with the healthcare team to ensure that the flow of information is seamless. The increased digitalization of healthcare where information flow can be more equitable will also decrease the tendency of ‘bad blood’ within a healthcare setup. Though at present it looks challenging, the future outlook will reveal a much more serene and calm atmosphere where both the patient and the healthcare worker interact in a harmonious and respectful manner.
(The writer is CEO – Aster Medcity, Kochi)
