Perspective
Origin and Prevention of Workplace Violence in Health Care in China: Legal and Ethical Considerations Jian Guan1,2 1
Clinical Centre, National Population and Health Scientific Data Sharing Platform, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China 2 Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Key words: Arbitration; Health Policy; Malpractice; Patient Safety; Workplace Violence
Workplace Violence in Health Care: A Continuous Global Problem and Its Characteristics in China Workplace violence is a persistent problem in health care worldwide. The victims are usually nurses and workers in the emergency department.[1‑8] The academic debate, as it develops overtime, would allow us to gain an integral insight about this problem. The author searched the related research and debate articles in English in PubMed (www.pubmed.com) dated from 1990 to 2016 [Figure 1]. In total, 1899 items with the keywords of “workplace violence,” 600 items with “workplace violence healthcare,” 786 items with “workplace violence nursing,” and 279 items with “workplace violence emergency” (there is some overlap between these four groups) have been published. Workplace violence in health care has become a prominent social problem in China in the recent years. A survey conducted by the China Hospital Association in 2012 showed that 96% of the hospitals investigated had verbal violence and as much as 60% had experienced physical violence.[9] Another survey in 2012 showed that more than 50% of the 2464 respondents in 12 hospitals from 2 provinces had experienced workplace violence and the rate of physical assault was 11%.[10] According to a survey conducted in 2014, 12.6% of 840 respondents admitted being physically attacked at their workplace in that past 12 months.[11] Direct care providers, including physicians and nurses, are more prone to suffer from physical assaults.[11] However, violence, including fatal physical assault, affects nearly all Chinese health‑care professionals.[12‑14] In addition, “medical mobs”–a group of Access this article online Quick Response Code:
people gathered at health care facilities threatening medical staff and create chaos for large compensation instead of the settlement of medical disputes–disturb medical working environment, although more often than not, they do not resort to violence.[15,16] Statistical analysis by the Ministry of Health showed that more than 17,000 violent affairs had occurred in 2010.[17] In 2015, the Supreme People’s Procuratorate summarized features of violence at hospitals as follows: occur frequently and suddenly with serious consequences, have a wide impact on the public, need urgent attention and handling, cause serious damage, and pose continuous potential dangers.[18] Thus, being employed as a hospital staff, especially as a direct care provider, is now considered a dangerous job in China.
Negative Effects of Workplace Violence on The Staff and Patient Outcomes Frequent instances of workplace violence have direct and indirect negative consequences on both the staff and patients, including compromised patient care.[19] Address for correspondence: Prof. Jian Guan, Clinical Centre, National Population and Health Scientific Data Sharing Platform, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China E‑Mail: [email protected] This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. For reprints contact: [email protected]
Website: www.cmj.org
DOI: 10.4103/0366-6999.209888
Chinese Medical Journal ¦ July 20, 2017 ¦ Volume 130 ¦ Issue 14
© 2017 Chinese Medical Journal ¦ Produced by Wolters Kluwer ‑ Medknow
Received: 20-02-2017 Edited by: Li-Min Chen How to cite this article: Guan J. Origin and Prevention of Workplace Violence in Health Care in China: Legal and Ethical Considerations. Chin Med J 2017;130:1731-6. 1731
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Workplace violence Workplace violence healthcare Workplace violence nursing Workplace violence emergency
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100 66 50
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6 1 3 2 5 2 124
29 27 6
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14 16 13 11
58 61 62 58
48 52
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115 120
80 74
35 34 34 37 30 24 23 20 26 19
51 44 46 48
112
62
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Years Figure 1: Workplace violence papers searched by keywords in PubMed from 1990 to 2016. Papers included in http://www.pubmed.com. Here shows the account of items from 1990 to 2016 when searched with “workplace violence” (blue), “workplace violence healthcare” (red), “workplace violence nursing” (green), and “workplace violence emergency” (violet), respectively.
Violence and inadequate managerial care after violent incidents may reduce nurses’ proficiency, which could have negative implications for patient care.[20] Physical violence against care providers has been associated with patient falls, medication errors, and late administration of medications.[20,21] Numerous studies have documented experiences of violent incidents resulting in severe psychological distress, increased work stress, and reduced work efficiency.[22‑26] Violence in the health sector is also associated with job dissatisfaction and turnover intention among care professionals.[27,28] Both bullying and physical violence have led to increased turnover intention. Shortage of physicians and long waiting time for visits and treatment are challenges faced by China’s health care, and these are also some of the reasons for workplace violence.[17] Chinese medical staff faces heavy workload, providing service to one‑fourth of the world’s population. An investigation by the Chinese Medical Doctor Association in 2009 showed that more than 60% of the registered physicians were not satisfied with the working environment. The Ministry of Health statistics in 2008 showed that 1 million people had acquired physicians’ license in the past 6 years; however, 40% of them did not register.[17] If this situation continues, Chinese patients will have to face a further shortage of physicians.[29] Moreover, the practice of defensive medicine among physicians in Chinese hospitals has been reported for years. 1732
This may also have negative implication for doctor–patient relationship and subsequently contribute to the incidences of violence against health‑care professionals. The author conducted a survey in 13 hospitals of Beijing from July 2007 to March 2008 that showed most of the respondents’ (83.0%, n = 811) practiced defensive behavior, and defensive practices were significantly associated with their experience of complaints (P = 0.0318) and medical negligence claims (P
Origin and Prevention of Workplace Violence in Health Care in China: Legal and Ethical Considerations Jian Guan1,2 1
Clinical Centre, National Population and Health Scientific Data Sharing Platform, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China 2 Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Key words: Arbitration; Health Policy; Malpractice; Patient Safety; Workplace Violence
Workplace Violence in Health Care: A Continuous Global Problem and Its Characteristics in China Workplace violence is a persistent problem in health care worldwide. The victims are usually nurses and workers in the emergency department.[1‑8] The academic debate, as it develops overtime, would allow us to gain an integral insight about this problem. The author searched the related research and debate articles in English in PubMed (www.pubmed.com) dated from 1990 to 2016 [Figure 1]. In total, 1899 items with the keywords of “workplace violence,” 600 items with “workplace violence healthcare,” 786 items with “workplace violence nursing,” and 279 items with “workplace violence emergency” (there is some overlap between these four groups) have been published. Workplace violence in health care has become a prominent social problem in China in the recent years. A survey conducted by the China Hospital Association in 2012 showed that 96% of the hospitals investigated had verbal violence and as much as 60% had experienced physical violence.[9] Another survey in 2012 showed that more than 50% of the 2464 respondents in 12 hospitals from 2 provinces had experienced workplace violence and the rate of physical assault was 11%.[10] According to a survey conducted in 2014, 12.6% of 840 respondents admitted being physically attacked at their workplace in that past 12 months.[11] Direct care providers, including physicians and nurses, are more prone to suffer from physical assaults.[11] However, violence, including fatal physical assault, affects nearly all Chinese health‑care professionals.[12‑14] In addition, “medical mobs”–a group of Access this article online Quick Response Code:
people gathered at health care facilities threatening medical staff and create chaos for large compensation instead of the settlement of medical disputes–disturb medical working environment, although more often than not, they do not resort to violence.[15,16] Statistical analysis by the Ministry of Health showed that more than 17,000 violent affairs had occurred in 2010.[17] In 2015, the Supreme People’s Procuratorate summarized features of violence at hospitals as follows: occur frequently and suddenly with serious consequences, have a wide impact on the public, need urgent attention and handling, cause serious damage, and pose continuous potential dangers.[18] Thus, being employed as a hospital staff, especially as a direct care provider, is now considered a dangerous job in China.
Negative Effects of Workplace Violence on The Staff and Patient Outcomes Frequent instances of workplace violence have direct and indirect negative consequences on both the staff and patients, including compromised patient care.[19] Address for correspondence: Prof. Jian Guan, Clinical Centre, National Population and Health Scientific Data Sharing Platform, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China E‑Mail: [email protected] This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. For reprints contact: [email protected]
Website: www.cmj.org
DOI: 10.4103/0366-6999.209888
Chinese Medical Journal ¦ July 20, 2017 ¦ Volume 130 ¦ Issue 14
© 2017 Chinese Medical Journal ¦ Produced by Wolters Kluwer ‑ Medknow
Received: 20-02-2017 Edited by: Li-Min Chen How to cite this article: Guan J. Origin and Prevention of Workplace Violence in Health Care in China: Legal and Ethical Considerations. Chin Med J 2017;130:1731-6. 1731
300
250
Workplace violence Workplace violence healthcare Workplace violence nursing Workplace violence emergency
240
200 Paper numbers
172
175
150 103
100 66 50
0
6 1 3 2 5 2 124
29 27 6
7
37
50
43
14 16 13 11
58 61 62 58
48 52
66
75
62
115 120
80 74
35 34 34 37 30 24 23 20 26 19
51 44 46 48
112
62
65
Years Figure 1: Workplace violence papers searched by keywords in PubMed from 1990 to 2016. Papers included in http://www.pubmed.com. Here shows the account of items from 1990 to 2016 when searched with “workplace violence” (blue), “workplace violence healthcare” (red), “workplace violence nursing” (green), and “workplace violence emergency” (violet), respectively.
Violence and inadequate managerial care after violent incidents may reduce nurses’ proficiency, which could have negative implications for patient care.[20] Physical violence against care providers has been associated with patient falls, medication errors, and late administration of medications.[20,21] Numerous studies have documented experiences of violent incidents resulting in severe psychological distress, increased work stress, and reduced work efficiency.[22‑26] Violence in the health sector is also associated with job dissatisfaction and turnover intention among care professionals.[27,28] Both bullying and physical violence have led to increased turnover intention. Shortage of physicians and long waiting time for visits and treatment are challenges faced by China’s health care, and these are also some of the reasons for workplace violence.[17] Chinese medical staff faces heavy workload, providing service to one‑fourth of the world’s population. An investigation by the Chinese Medical Doctor Association in 2009 showed that more than 60% of the registered physicians were not satisfied with the working environment. The Ministry of Health statistics in 2008 showed that 1 million people had acquired physicians’ license in the past 6 years; however, 40% of them did not register.[17] If this situation continues, Chinese patients will have to face a further shortage of physicians.[29] Moreover, the practice of defensive medicine among physicians in Chinese hospitals has been reported for years. 1732
This may also have negative implication for doctor–patient relationship and subsequently contribute to the incidences of violence against health‑care professionals. The author conducted a survey in 13 hospitals of Beijing from July 2007 to March 2008 that showed most of the respondents’ (83.0%, n = 811) practiced defensive behavior, and defensive practices were significantly associated with their experience of complaints (P = 0.0318) and medical negligence claims (P
