The aim of the framework is to strengthen protection for patients, which also contains an expansive patchwork of protections that apply to doctors. It seeks to address the question - when patients are not scared of legislation, how do you protect doctors?

On the heels of the nationwide doctors’ protest in June, the Centre is working towards implementing safety guidelines for doctors. The Union Health Ministry has come up with a proposal under the National Patient Safety Implementation Framework (2018 - 2025) which highlights that health-workers’ safety is as important as patient safety and the latter will ensure the former.

Legislation vs Framework

The recent attack on doctors in West Bengal happened despite the West Bengal Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage to Property) Act, 2009 - which declares any violent act against doctors as a cognizable and non-bailable offence with imprisonment and fines for those found guilty. But that didn't prevent the crowd from attacking the doctors. So, can this framework do what legislation can’t?

Throwing more light on the progress of the work, Manoj Jhallani, additional secretary to Union Health Ministry told the media, “We are working on it. Hospital violence is an important issue that has to be taken care of.”

Apart from enforcing stringent laws against hospital violence, the healthcare fraternity have also called for training doctors to tackle such cases. Speaking to the media, Raju Vaishya, senior orthopaedic surgeon at Indraprastha Apollo Hospital said, “In the medical curriculum, the students are not briefed and educated about how to deal with the patients, relatives, and media appropriately. It seems of paramount importance now for the doctors to learn to deal with the violent patients and their relatives, and this must be included in the medical curriculum as a short subject.”

What Research tells us…

According to Indian Journal of Psychiatry, 75% of all doctors in India have faced some form of violence. Surprisingly, it is much higher than nearly 50% - 60% violence reported in the US and the UK. IMA's survey of doctors in 2015 revealed that 45.4% of the doctors feared possible violence; 24.6% feared being sued, and 13.5% feared criminal prosecution. Only 16.6% of doctors reported no stress of any kind.

Some doctors argue that the conflict was never between doctors and patients.

“The real battle is between a patient's requirements and available resources. Most of the government hospitals are not provided with adequate infrastructure, diagnostics and medicines which forces patients to go thousands of kilometres away from their native place to get treatment for even minor ailments. These hardships irk them, and when they come to the hospital, unfortunately, the doctor becomes the victim,” said Dr Harjit Singh, former President, RDA, AIIMS Delhi.

What’s in store for doctors in the NPSIF

The framework documents states that the communication strategy will be developed targeting patients as well as health care providers. Furthermore, it also talks about guidelines that elucidate the importance of hospitals having adequate resources, etc.

• Health care providers must invest more in strengthening health system across its core elements, such as, deliver effective, safe, quality personal and non-personal health interventions to those that need them with minimum waste of resources
• Must have well-performing health workforce, sufficient staff that are responsive, fair and efficient and productive, given available resources and circumstances
• Maintain well-functioning health information system that ensures your production, analysis, dissemination and health system performance, even related to medication errors, hospital acquired infections and other patient safety related aspects
• Ensure equitable access to medical products, technologies and vaccines that are of good quality and cost-effective
• Design efficient health financing system that raises required funds for health in ways people can use needed services and be protected from financial catastrophe
• A strategic policy frameworks must exist and be based on regulation, coalition building, attention to system-design and accountability
• Promote collaborative action by engaging all stakeholders to improve patient safety. Not only healthcare workers, health managers and decision-makers but also patients and their families, civil society and media- everybody has a crucial role to play in patient safety. What is more important is to recognize the connections between them

How to establish a culture of safety in healthcare facilities?

The framework touches upon patient safety concepts that need to be incorporated in the work culture of health care providers and the way they communicate with each other while taking care of patients.

• Involving patients as partners in their own care and to establish patient-centred care
• Understand that the objective of patient safety framework cannot be achieved without considering perspective of patients
• It is important to develop educational and information material on patient safety such as audio-visual material, brochures and IT based aids. Information on patient safety will be distributed to both patient as well as care providers through Mass Media, Print Media and Social Media
• Integrate toll-free helplines on patient safety within the existing ICT system of MoHFW. This system will enable anonymous reporting of incidents and practices compromising patient safety
• Reported incidents will be examined by an independent agency

The author, Sonali Desai is a Mumbai-based freelance writer and member of 101Reporters.com