News
Safety and security in state hospitals – call for immediate action
View(s):Special Committee report on A’pura due tomorrow; AMS suggests steps and SLMA to give Action Plan
By Kumudini Hettiarachchi
Put in place immediate safety measures for all healthcare staff, was the clarion call from the health sector this week.
“Intermediate, long-term and policy changes can come soon after,” many said, cautioning that there is no time for conjecture and prevarication.
The “immediate” steps urged by many included a thorough assessment of internal risks – no proper lighting, no gates, unmanned entrances and easy access from the external environment – within hospital premises and also for those going out into the field and addressing these dangers.
Moderated by Dr. Susie Perera, this session included Dr. Kumara Wickramasinghe (extreme left) and Dr. Palitha Abeykoon
Other steps included:
A workable grievance mechanism which is monitored by the head of the institution.
Creation of a ‘Healthcare Worker Safety Committee’ in each hospital to review and assess safety measures regularly and rectify them. The Hospital Development Committee could be co-opted for support. The same could apply to each Medical Officer of Health (MOH) office.
Review of all contracts between external security agencies and hospitals.
Instructions to hospital police posts about areas with possible external threats and seeking their help to prevent them.
Education of staff on precautionary and preventive measures to ward off threats.
A familiarization tour by a representative of the hospital administration when a new doctor/nurse reports to duty.
Identification of a few professionals who can help survivors/victims to provide psychosocial support, with privacy and confidentiality assured.
These requests came as the three-member committee appointed by the Health Ministry Secretary was due to submit a report on the provision of security and facilities to the staff of the Anuradhapura Teaching Hospital tomorrow (March 24) and the Sri Lanka Medical Association (SLMA) held an interactive discussion on ‘Safety at Healthcare Settings’ on Thursday evening.
Moderated by Dr. Surantha Perera, the speakers of this session (seated from left): Dr. Vibash Wijeratne, DIG Renuka Jayasundara, Deputy Minister of Health Dr. Hansaka Wijemuni, Dr. Sudath Dharmaratne and Dr. Janaki Vidanapathirana.
“A special report on this session will be sent to the authorities along with an Action Plan on Monday (tomorrow),” reiterated SLMA President Dr. Surantha Perera.
Assuring prompt action to ensure health staff safety, the Health Ministry’s Additional Secretary (Medical Services), Dr. Kumara Wickramasinghe paid tribute to the staff as “they work without thinking about their safety”. He is the former Deputy Director General (DDG) who headed the National Hospital of Sri Lanka (NHSL) and also Immediate Past President of the College of Medical Administrators of Sri Lanka.
A comprehensive view on ‘Healthcare settings in the public sector and the health workforce’ was given by Dr. Janaki Vidanapathirana. The state hospital structure includes:
55 Tertiary care institutions – National Hospitals; Teaching Hospitals; Specialized Teaching Hospitals; other Specialized Hospitals; District General Hospitals and 1 Board-managed hospital
81 Secondary care institutions – Base Hospital Types A & B and 1 Board-managed Hospital
1,072 Primary care institutions – Divisional Hospital Types A, B & C and Primary Medical Care Units
According to Dr. Vidanapathirana 66 of these institutions with a workforce of 84,106 are under the line Ministry of Health and 1,142 with a workforce of 64,752 under provincial ministries.
Another perspective came from the Chief Executive Officer of the private Ninewells Hospital, Dr. Vibash Wijeratne, on how they look after their staff.
“We look after our staff well and safety is covered from all angles,” he said, explaining that there is a special employee relations officer like in multinational companies. A professional advisor had recently spoken to the staff on workplace harassment. They also have an employee counsellor and any issues are reported directly to the head of management.
When asked by the Sunday Times how many incidents had been reported in the last two years, Dr. Wijeratne said there was one and disciplinary action had been taken.
The Deputy Inspector General (DIG) of Police, Renuka Jayasundara, spoke of the special areas designated at Police Stations to handle sensitive issues under the Women’s and Children’s Bureau, with Dr. Palitha Abeykoon delving into the ‘Charter for ensuring patient safety and well-being’ and Dr. Susie Perera suggesting that a Health Worker Safety Charter could be modelled on that.
The concluding session moderated by Dr. Lahiru Kodithuwakku was on making healthcare staff aware about the possible dangers they could face by Dr. Lakshman Senanayake and the need for confidentiality in cases of sexual harassment incidents by Prof. Anuruddhi Edirisinghe.
On a positive note, the Sunday Times learnt of measures taken in peripheral hospitals to ensure the well-being of their staff. The 235-bed Kantale Base Hospital with a workforce of around 450 had implemented ‘Sahurda Danawwa’ to enhance mental wellness of staff post-COVID-19 pandemic.
Suggestion boxes had been placed in least-crowded areas of the hospital for anonymous submissions, resulting in staff concerns coming to light. The concerns subsequently discussed had covered burnout, stress management, conflict resolution, morbid jealousy, work-life balance, working as a team and more.
Numerous sources confirmed that there are Health Ministry circulars and guidelines to safeguard health workers, with some medical administrators implementing them effectively.
Meanwhile, underscoring that there is ‘Zero Tolerance’ in many countries with regard to abuse and violence towards health staff in hospitals to maintain uninterrupted and efficient patient-care services, the Association of Medical Specialists (AMS), called for “robust” safety measures in Sri Lanka’s hospitals.
With regard to ‘Hospital access control and security systems’, it suggests restricted entry through identity badge access for hospital staff and limiting visitor access to specific areas; the setting up of security checkpoints at main entrances and restricted zones (such as ICUs, pharmacies, operating theatres, paediatric & maternity wards); and visitor management through visitor/bystander registration/passes and identification badges.
“Instal CCTV cameras in key areas (such as emergency rooms – ERs, hallways, waiting areas and parking lots) and ensure that security personnel actively monitor live feeds,” states the AMS with regard to surveillance systems, while urging the establishment of ‘Emergency call systems’ including place panic buttons at nurses’ stations, ERs and psychiatric units and wearable alarms for staff in high-risk areas. Parking areas too should be well-lit with security patrols, while escorts should be offered to night-shift workers.
The AMS highlights the need for a strict policy against workplace violence, threats or harassment and the ensuring of clear reporting channels with quick access to security and police in case of incidents.
It also requests the assigning of trained security guards to high-risk areas (ERs, psychiatric wards, maternity wards etc.) and the possible installation of metal detectors in ERs and where prisoners are treated, to prevent weapons from being brought in.
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