THE Malaysian Medical Association (MMA) is deeply concerned over the toxic work culture in many public healthcare facilities and its impact on patient safety. We are still receiving reports on bullying among public healthcare workers and will be bringing up the matter to the Ministry of Health (MOH) soon.
We have also received updates from colleagues in the public healthcare sector confirming that pockets of bullying still occur at public healthcare facilities and at various levels, involving Heads of Departments (HODs), specialists, medical officers (MOs), housemen and other healthcare workers in the system.
As a result, affected healthcare workers are unable to perform at their best. This issue should not be viewed lightly as bullying among healthcare workers poses a significant threat to the quality of care and patient safety.
We therefore urge the MOH to urgently act to once and for all, put a stop to this toxic work culture that has taken root in our public healthcare system.
All healthcare workers from every rank should feel safe and respected when carrying out their duties.
In the best interest of patients, all public healthcare workers should also be free to express their concerns without fear or favour. We must collectively commit to fostering a work environment that prioritises patient safety and the wellbeing of their care providers.
High-stress environment for non-NSR specialists and for those awaiting promotions:
We are deeply alarmed by disturbing reports we have received regarding specialists, especially those who have not yet achieved National Specialist Register (NSR) status, facing excessive, undue pressure due to a toxic work environment.
This worrisome trend can have a significant impact on the quality of care and can potentially lead to the attrition of invaluable talent if not promptly addressed.
As immediate steps to address the issue of bullying and improve the public healthcare work environment, the MMA proposes the following:
Holistic and anonymous feedback mechanism: A system where feedback is welcomed from healthcare professionals across all levels. This mechanism will serve as a direct channel to report incidents of harassment, bullying, or any other concerns affecting workplace wellbeing. It should also include an anonymous channel where healthcare providers can report issues directly.
Role of Heads of Departments (HODs): HODs must take immediate steps to ensure a conducive work environment that prioritises patient safety. Their responsibilities must include regular evaluations of work culture and immediate action against toxic behaviours. In cases where the Head of Department (HOD) himself/herself is the problem, the option of anonymous reporting can be used.
Direct communication channels: The conventional hierarchy, where the Health DG relies solely on state and hospital directors, heads of services for feedback needs to be re-evaluated. We propose a system where open, direct communication and feedback are not only encouraged but considered vital for institutional improvement.
Mental health support: Given the high-stress nature of the medical profession, implementing mental health support systems, such as regular counselling and workshops on stress management should be included as part of holistic programmes to develop public healthcare human resources. Professional mental health assessments similar to requirements for pilots or those in high responsibility positions should also be considered.
Legal measures: Existing Medical Act and regulations should be revised, as currently it requires a valid complaint or report for action to be taken. In most cases, the victim is fearful of the process to penalise the person they are making a complaint against or reporting to the authorities. Immediate action should be able to be taken against any offender, irrespective of their rank or standing within the institution.
Only by transforming our work culture can we ensure the safety and wellbeing of our patients and healthcare providers. It is a collective responsibility, one that we must take seriously to maintain the integrity of our healthcare system.
We must, together, send a strong and clear message that any form of bullying will not be tolerated. – September 15, 2023
Dr Azizan Abdul Aziz is the President of the Malaysian Medical Association