In the last week, in Sassoon Hospital at Pune, one local corporator allegedly assaulted the resident doctor when she noticed that the latter did not attend a patient on priority. As a reaction, the resident doctors association threatened to proceed on strike unless the corporator was arrested and case was registered under the provisions of Prevention of Violence against doctors Act. Similar incidents keep on being reported regularly either from public hospitals as well as private clinics. In few incidents the violence has even taken the toll of the doctor or usually results in huge property damage.
The reasons for violence in healthcare institutes may be sporadic as well as due to absence of adequate training, lack of infrastructure as well as absence of any policy to tackle such incidents and prevent these. The emphasis should be to take all measures to ensure that such violent incidents should not take place at all. The foremost thing in this regard is to arrange for initial as well as mid-term training by experts on regular basis. The training modules should be addressing each level separately right from the billing clerk, receptioninst, nurses, ward boys, technicians to resident doctors or senior most subject experts. The modules should address specific requirements and be provided by persons two ranks higher in the same hierarchy and not by someone who is not related to the field. The focus should be on Dos and Don’ts and tips which can be practically implemented. It is advisable to have case studies and participants are encouraged to discuss these in the presence of experts to reach proper conclusions. Fortunately now experts in the field have prepared case studies bank and it can be easily accessed from http://ciilm.com/case-studies/.Training modules can be made more effective if these are delivered through PowerPoint programs, having actual videos on the subject.
Secondly it is imperative that all those who run healthcare institutes need to consider all aspects about security right from the time of establishing the institute and upgrade it from time to time as newer technology becomes available. Domain experts in security need to be consulted as things which might appear to be simple may not have been noticed by others. A few things which may be mentioned include separate entry and exit gates, separate gates for the technicians and staff as well as for the doctors. Access control is an important aspect to avoid stampede as well as to prevent intruders. Installation of CCTV cameras with recording and night vision facility is critical. Along with the same there should be adequate trained staff to monitor these and they need to be equipped with instant communication facility to inform about the developing situation and directions to prevent further catastrophe. Adequate facility for visitors and persons accompanying the patients is critical to provide tension free atmosphere for the doctors, staff as well as for the patients.
Documentation of every aberration as well as various incidents is an important requirement which is generally neglected. If there is a record, one can see the pattern likely to emerge and prevent or cure distorted behavior in time. These recordings need to be shown to the staff from time to time to make them aware what went wrong and how it was possible to avoid the same. Moreover there is a tendency not to report the incidents to law enforcing agencies to avoid approaching the police or deposit in the courts when called. Very few are aware that evidence can be given through video conferencing even if the witness or complainant is away at a distant place. In fact the single most important reason for non-conviction in criminal cases involving violence against healthcare institutes is apathy of the complainants and refusal to appear before the magistrates when called to deposit.
To conclude, I would say having enactment to prevent violence, per se, does not guarantee absence of violence. Involvement from all stake holders, preparedness to meet the contingencies, well laid out policy with standard operating procedures (SOP), frequent rehearsals of the drill, coordination with all stake holders including law enforcement agencies even when there is no crisis are some of the tips which may help healthcare institutes to avoid and overcome incidents of violence if any.
