Budget debate: Review of workflow models for doctors, workgroup to tackle abuse of healthcare workers

Healthcare staff, especially young doctors, have been bearing the brunt of the Covid-19 waves, as they face long hours and fatigue. PHOTO: ST FILE

SINGAPORE - Current workflow models for healthcare workers will be reviewed and measures will be put in place to improve their well-being, especially for junior doctors, said Senior Minister of State for Health Koh Poh Koon on Wednesday (March 9).

Healthcare staff, especially young doctors, have been bearing the brunt of the Covid-19 waves as they face long hours and fatigue, leading to increased resignation rates.

Dr Koh told Parliament on Wednesday during the debate on his ministry's budget that 20 per cent of all junior doctors have exceeded the stipulated 80-hour work week due to the nature of clinical work or exigencies of service.

To improve work hours, he noted that some have proposed night float systems - where doctors take turns to take on night shifts for a few days at a stretch without covering daytime work - while others man the day shift.

"Doctors may feel more refreshed when they start their night shifts with a full day's rest, although there are possible trade-offs in requiring more manpower to do a shift system, more handoffs between team members, which carries some risks of omission in tasks and possibly reduced learning experiences," Dr Koh noted.

He added that the system has so far been trialled in two large departments, with plans to do so in smaller departments curtailed due to Covid-19.

"When the situation allows, we intend to restart the trials," said Dr Koh.

However, aside from the issue of work hours, he stressed that it is important not to "lose sight" of the important considerations inherent in the nature of the work of doctors.

"With shorter working hours a week, a junior doctor may have to undergo a longer apprenticeship to acquire the necessary competencies," he added.

Dr Koh pointed out that the workload and nature of clinical work now are different compared with yesteryears. With an ageing population, there will be more cases of chronic diseases, with more expectations for "collaborative and consultative care".

Therefore, there is a wider need for transformation in the current care delivery arrangements, and junior doctors should not be stretched beyond "what is physiologically possible and risk compromising patient safety".

He added that he recently met junior doctors from the Singapore Medical Association's Doctors-in-Training Committee and others from all three healthcare clusters to discuss the challenges they faced, and the trade-offs of possible workflow changes.

In December last year, the National Wellness Committee for Junior Doctors was set up to improve their overall well-being. Dr Koh said the work group will focus on reviewing current workflow models such as manpower and work hour norms as well as career development and training, and promoting a more inclusive culture so junior doctors can feel safe speaking out on matters related to their safety and well-being.

Preliminary proposals will be made by the middle of this year so that some measures can be implemented, with a view to complete the final recommendations by early next year, he added.

A new Tripartite Workgroup was also set up this month (March) to prevent the abuse and harassment of healthcare workers as these cases have been on the rise over the past few years, said the Ministry of Health (MOH).

Dr Koh noted that the number of abuse cases has been on the rise - in end 2021, there were about 1,500 cases, up from 1,080 in 2018.

"The actual number may be higher, as many healthcare workers exercise empathy and therefore, do not always take a legalistic approach and report and escalate every altercation. However, their compassion should not be misconstrued as an acceptance of abuse or harassment. We need to make sure that our healthcare workers feel safe in their work environment," he added.

This is in spite of public healthcare workers coming under enhanced protection under the Protection against Harassment Act if they are abused or harassed when carrying out their duties, Dr Koh noted.

The workgroup will develop and implement strategies targeted at preventing abuse, raise public awareness on what constitutes harassment, and establish processes to ensure that these initiatives are implemented, said MOH.

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