French Government Tackles Violence Against Clinicians

FRANCE — During a visit to a 24-hour doctor service in Paris, followed by a visit to a psychiatric unit in Versailles, Agnès Firmin Le Bodo, France's health professions minister, accompanied by Aurélien Rousseau, minister for health, announced the long-awaited plan to protect the country's healthcare workers.

At the start of the week, Jean-François Cibien, MD, chair of Action praticien hôpital (APH) France's interunion doctor's committee, told us about his impatience and how he thought this new plan would be ignored. Absolutely not!

After the submission last June of an initial report that had been drawn up by Jean-Christophe Masseron, MD, chair of France's privately funded 24-hour doctor service SOS Médecins, and Nathalie Nion, senior healthcare executive at Paris' Hospital Trust, the health minister spent all summer planning how to tackle violence against healthcare professionals (HCPs) with the implementation of 42 measures.

Reports of Violence

Based on figures released by the country's national observatory for violence against healthcare workers (the ONVS), this plan is not only needed, but also vital to combat the sheer number of acts of violence reported. In 2022, a total of 18,768 reports were made, 45% of which came from nurses.

What are the main triggers of these acts of violence against healthcare workers? In more than half the cases (53%), there is an element of criticism "relating to treatment," treatment refusal in 17.1% of cases, and excessive waiting times for 10.2% of reports.

These incidents mostly occur in psychiatric units (22.9%), followed by emergency departments (13%), and long-stay units/nursing homes (10.8%).

What seems absurd is that, although safety issues are becoming increasingly concerning, just one of every two healthcare facilities "have installed glass partitions in their reception areas," with staff working in these areas being among the most exposed to such violence. Additionally, two thirds of facilities have still not drawn up health, safety, and legal agreements with the police.

Based on these observations, the campaign against violence in healthcare focuses on three points of increasing importance: (a) raising public awareness and training healthcare workers, (b) preventing violence and making it safer for HCPs to carry out their work, and (c) reporting acts of violence and supporting victims.

Communicate, Inform, Train

The general idea of this plan is to raise awareness and train HCPs before a violent incident occurs. To this end, Firmin Le Bodo has announced the organization of a national campaign to make the public aware of violence against healthcare workers.

As a secondary measure, the government plans to train all healthcare staff, from receptionists to doctors to nurses and beyond.

For doctors, this means adding a module to their residency at medical school on how to handle acts of aggression.

For private practice physicians, ongoing training as part of continuous professional development should be prioritized, in collaboration with France's professional medical boards and regional healthcare associations.

Beyond medical staff and healthcare workers, this training effort must also be expanded to hospital directors and administrative staff.

Prevention

The second part of Firmin Le Bodo's plan of action is centered on prevention.

"From building design to the internal layout of reception or treatment areas, there are effective methods to be taken to create distance between healthcare workers and certain violent patients, to ensure [there are] escape routes for staff faced with a problem, or to prevent the public from having access to certain areas. This applies to healthcare facilities and local clinics," said Firmin Le Bodo.

The government plans to make use of money provided by the country's healthcare investment funds and its crime prevention fund.

The safety of healthcare workers should become a routine consideration in healthcare facility accreditation and designing specifications for these facilities, in addition to the placement of surveillance cameras around hospitals, doctors' offices, and clinics.

For more isolated healthcare professionals, the government has adopted a proposition from the Masseron/Nion report (released in June) to equip them with alert devices (bracelets, hidden buttons, etc.) funded by professional medical boards and regional healthcare agencies.

Punishment and Support

Finally, the third part of the plan focuses on punishing the aggressors and supporting staff who have fallen victim to such behavior.

The government has proposed the creation of new criminal charges that can be brought against the perpetrators of such attacks on healthcare workers, as well as more routinely making such cases a criminal matter. The French health minister has also asked for harsher penalties for those acting aggressively toward healthcare workers.

As mentioned above, health, safety, and legal agreements are still not routinely implemented in healthcare facilities. The health minister plans to rethink the management of similar agreements. "To do so, in each region [of France], police commissioners and public prosecutors, in partnership with the directors general of regional health agencies, will be responsible for leading a meeting of security staff dedicated to the issue of HCP safety, involving all regional players (healthcare facilities with agreements in place, representatives of regional councils or regional [medical] board committees, etc)."

And to support HCPs making complaints, the authority advises that healthcare facilities support their employees in practical ways, such as by covering legal costs, and that it would be wise to remind their workers of this fact.

The minister expanded on this idea, requesting that facilities from this point forward should be able to file complaints on behalf of their attacked workers.

In the medium-term, after filing the complaint, it is also advisable to provide information to HCPs about the psychological support available to them.

"These topics will be included in the agenda for social dialogue to be headed by the minister of health and social care with medical boards and healthcare professional representatives over the following months," said the health minister, putting forward a timeline for the implementation of these measures.

This article was translated from the Medscape French Edition.

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