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Abuse from patients whilst at work: what can you do?

Blog Author Roz McMullan

Blog Date 04/10/2017


​As the Northern Ireland Health and Social Care Board launch their new 'Zero Tolerance' campaign to stop abuse of health staff in primary care settings, we offer some advice for dentists and their teams, on how to stay safe in the workplace.


What's the problem?

There were 6,382 reported assaults against health care staff in Northern Ireland in 2016, according to figures from the Northern Ireland Health and Social Care Trusts, provided to the Northern Ireland Assembly.

Whilst incidents will vary hugely depending on the area, type of healthcare service and patient behaviour, it is something that practices need to be ready to handle. 

Maintaining the safety of staff and patients when a patient, unfortunately, becomes abusive or aggressive is an essential duty and there are certain things you can do to help minimise risk. 


What can you do?

First of all, anticipate these situations – make sure staff are trained in appropriate strategies for the prevention and management of violence and conflict resolution. 

Incidents can escalate quickly if they are handled poorly so all staff should be appropriately trained on how to deal with difficult or challenging people. 

The practice should also have policies in place on how to deal with difficult situations when they arise; linked to this is knowing what you can and cannot do when handling such patients, and considering whether you have to see them again.


What constitutes violent or abusive behaviour? 

If a patient physically assaults a member of the practice then this will be quite clear. Violence can take the form of a physical assault or threat, but might also include fear of an assault. 

Before someone turns to physical violence they will often give you warning signs, for example, through raised voices or abuse. 

What constitutes abusive behaviour is less clear. Generally, this can encompass anything from threats, harassment or swearing at any person on the practice premises. 

The test is subjective and you might ask yourself whether you or a colleague are put in fear for your safety.


Protect yourself and staff

Proactive measures can be taken, such as offering chaperones for appointments (a dentist and nurse are effectively each other's chaperone), displaying signs saying that abuse will not be tolerated and, ultimately, refusing to see patients with a history of abuse to staff or patients. 

Your team should know how to defuse difficult situations rather than exacerbate them; training on customer service, complaints handling and understanding dental phobia may all help in reducing the risks of violence but you will never remove the risk entirely.

General customer service advice says you should show you are actively listening to the customer – offer short words of encouragement, reflect back how they feel, summarise what they tell you or ask questions to seek clarification. 


HSCNI procedures

HSCNI-zero-tolerance-poster-400px.jpgWhere you wish to cease seeing a patient because of their behaviour, Health & Social Care (HSCNI) requires you to follow the correct procedures. 

You should always contact the police in these circumstances, even if the person assaulted does not wish to take the matter further. 

You can stop treating a patient and deregister them if they have been violent or abusive to any members of the team. 

You can deregister a violent or abusive patient immediately provided that you report the incident to the police and notify the health board, and follow this up with confirmation in writing within seven days. 

In this scenario, the dentist would not be required to complete the patient's treatment and the patient will be informed that this is due to a breakdown in the relationship. 

If behaviour falls short of being violent or abusive, you can still remove the patient from your dental list, provided that you give them three months' written notice. 

You must ensure that you complete the patient's treatment by the end of the notice period.


More information: bullying, harassment and violence at work

Our advice sheet Bullying harassment and violence at work is available for BDA members, with more information on dealing with bullying, harassment and threats, practice policies, risk assessment, and out-of-hours care. 


Roz McMullanRoz McMullan

Chair, BDA Northern Ireland Council