CHANGE MUST COME

How safe are you out of your home? Especially the place where you spend most of your time: The workplace. Do you know that data from the Harvard Business School survey 2009, shows that 94% of service professionals put in 50+ hours of work a week? This is data from about ten years ago, yet it still reigns true now.
( Please follow the link to read this article it is quite an interesting read https://hbr.org/2009/10/making-time-off-predictable-and-required.)


Recently, there have been increased reports of incidences of workplace-related violence than ever. It may either be linked to greater awareness and identification of such acts or increased occurrences of the same.

 So what is workplace-related violence?
 According to the Occupational Safety and Health Act of the USA, workplace violence is defined as " any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the worksite. It ranges from threats and verbal abuse, to physical assaults and even homicide. It can affect and involve employees, clients, customers and visitors. It is unfortunate that in most African countries our constitutions do not adequately highlight this. Kenya is no different for instance, "in the present constitution the issues on occupational safety and health are not directly addressed. However, it states that no person should be held in slavery or servitude or required to perform forced labor.

 We should not accept this we need to propagate for it to change. Steve  Maraboli once said, "The victim mindset dilutes the human potential. By not accepting personal responsibility for our circumstances, we greatly reduce our power to change them."

( Please follow the links to read more on the OSH acts in Kenya)
https://www.ilo.org/wcmsp5/groups/public/@ed_protect/@protrav/@safework/documents/policy/wcms_187632.pdf,  http://labour.go.ke/wp-content/uploads/2019/02/National-OSH-Policy.pdf.

It is important to know all this because,

• It aids to prevents illness and injury to the employees when effectively implemented. Which has a ripple effect by enabling them to maintain or seek their economic empowerment.
• It reduces health and safety hazards to employees, therefore, promoting greater job satisfaction greatly improving their productivity.
•  It avoids serious consequences to the employers such as fines or having their businesses temporarily or permanently shut down. With global trends of recession this is a chance we shouldn't be willing to take.

Workplace violence can be categorized in many ways but the simplest is often based on the parties involved. Below is an example of such categorization;

1.  Criminal Intent-Criminal intent workplace violence incidents are when the perpetrator has no relationship with the targeted establishment and the primary motive is theft.
2. Customer/Client- In this type, the perpetrator is a customer or client of the employer and the violence often occurs in conjunction with the worker’s normal duties.
3. Worker-to-Worker- This is generally perpetrated by a current or former employee, and the motivating factor is often interpersonal or work-related conflicts, or losses and traumas.
4. Domestic Violence- Often perpetrated by someone who is not an employee or a former employee. eg by a spouse who is familiar with their partners' work schedule.
5. Ideological Violence -This type of violence is directed at an organization, its people, and/or property for ideological, religious or political reasons eg by extremists.

For a more in-depth look please follow the link https://www.everbridge.com/blog/five-types-workplace-violence/

As employers or employees in any organization, we have to put measures in place to curb such acts. Below I have briefly highlighted some of them, but a lot more needs to be done.


( All information is derived from https://www.osha.gov/as/opa/worker/employer-responsibility.html




Role of the employer

• Provide a workplace free from serious recognized hazards and comply with standards, rules and regulations issued under the OSH Act.
• Examine workplace conditions to make sure they conform to applicable OSHA standards.
• Make sure employees have and use safe tools and equipment and properly maintain this equipment.
• Use color codes, posters, labels or signs to warn employees of potential hazards.
• Establish or update operating procedures and communicate them so that employees follow safety and health requirements.
• Employers must provide safety training in a language and vocabulary workers can understand.
• Employers with hazardous chemicals in the workplace must develop and implement a written hazard communication program and train employees on the hazards they are exposed to and proper precautions (and a copy of safety data sheets must be readily available).
• Provide medical examinations and training when required by OSHA standards.
• Post, at a prominent location within the workplace, the OSHA poster (or the state-plan equivalent) informing employees of their rights and responsibilities.
• Keep records of work-related injuries and illnesses. (Note: Employers with 10 or fewer employees and employers in certain low-hazard industries are exempt from this requirement.
• Provide employees, former employees and their representatives access to the Log of Work-Related Injuries and Illnesses 
• Provide access to employee medical records and exposure records to employees or their authorized representatives.
• Provide to the OSHA compliance officer the names of authorized employee representatives who may be asked to accompany the compliance officer during an inspection.
• Not discriminate against employees who exercise their rights under the Act. 
• Post OSHA citations at or near the work area involved. Each citation must remain posted until the violation has been corrected, or for three working days, whichever is longer. Post abatement verification documents or tags.
• Correct cited violations by the deadline set in the OSHA citation and submit required abatement verification documentation.
• OSHA encourages all employers to adopt a safety and health program.

Role of employees

• Take reasonable care for your health and safety in the workplace. You must also take reasonable care for the health and safety of others who may be affected by what you do or don’t do.
• Cooperate with your employer about any action they take to comply with the OHS Act or Regulations. For example, use equipment properly, follow safe work policies and procedures and attend training.
• Don’t intentionally or recklessly interfere with or misuse anything at the workplace to support health, safety, and welfare.

In conclusion, we may find this is to be such a sombre way to start the year but I believe that as we continue with our wellness journey we must take care of ourselves holistically for better outcomes. For

THE ELEPHANT IN THE ROOM

Have you recently gone to care for a patient, then you introduced yourself then they went on to ask for your ethic name and a comment like"but you don't look like them," follows. Or you are busy triaging, then the question of what kind of doctors do you have crops up. Or those who are more specific and say "I want a Somali doctor or I want an Asian doctor they are the only ones who provide good care."Or someone blatantly asks you, "so what is your ethnic background" all while you are providing care and makes a very bigoted comment. Or yet still, maybe you were working with a doctor on how best to attend to a patient and the family says something like" no! we need a real doctor someone who is older, not this young fellow who is an intern."  Or my best, "you are too young to be working and are you even sure you know what you are doing."If you have experienced this I would wish to discuss how you handled it for I feel we often dismiss it but it creates a detrimental work environment.

A literature review conducted on several databases including PUBMED, HINARI, Google Scholar, Medscape, and NCBI reveals one thing, more needs to be done. There is little to no data on bias directed to health workers by patients yet a lot of studies have been conducted on health workers' biases towards patients. Does it mean that we have become so comfortable accomodating this behavior that it is part of the norm?

I chose to join the minority and actually voice it. Most of the journals available proved that it is quite a common phenomenon and unfortunately little has been done by most organizations to curb it. This is sad because such remarks then raise questions on how we should think of race, ethnicity, health, and individual autonomy. With the patients' right to medical care and the unspoken rule of complying with patients' preferences (let us be honest it happens quite often) how then do we reconcile patients' autonomy and accepted levels of ethnic, gender and religious equality. Please review the following article to see how it prompted such thoughts;
https://heinonline.org/HOL/LandingPage?handle=hein.journals/uclalr60&div=13&id=&page=.
try comparing how this article raises questions on issues that we as a country fail to even address in our current health bill. this is despite us being a middle-income country interacting with people from all over the world and facing these challenges daily. Where are we failing? Is it in failure to participate in the generation of policies that govern us as health workers. Please share your thoughts I am quite interested to hear from you?
Please find a sample of the journal links
https://journalofethics.ama-assn.org/article/how-should-organizations-support-trainees-face-patient-bias/2019-06?Effort%2BCode=FBB007
https://www.shrm.org/resourcesandtools/hr-topics/behavioral-competencies/global-and-cultural-effectiveness/pages/metoo-sparks-bill-to-stop-culture-of-silence-in-workplaces.aspx
https://www.statnews.com/2017/10/18/patient-prejudice-wounds-doctors/
http://kenyalaw.org/kl/fileadmin/pdfdownloads/Acts/HealthActNo.21of2017.pdf.

Basis of bias

A Medscape survey done in 2017, showed that among consumers who participated in the study their choice of health worker preference was linked to ;

• Sexual orientation (11%)
• Ethnicity (8%)
• Religion (7%)
• Political views (6%)
• Race (5%)

The study also clearly states that at times the perceived bias "might just be a poorly explained preference." For instance due to previous negative experiences with doctors of other ethnicities etc. What if the preferred professional doesn't have the needed skills yet, will we comply with a patient's request? Quite a murky zone right? It is quite important to address it so that we limit race/ethnicity health disparities, improve health outcomes and at times quite honestly save lives. Please follow the link to further analyze the said study https://www.webmd.com/a-to-z-guides/news/20171018/survey-patient-bias-toward-doctors-nurses.

Challenges faced by health workers who experience bias

• Disrupts team harmony.
• It impairs one's self-esteem and self-worth.
• Risk of hampered relations with other patients.
• It creates a moral-ethical dilemma for the health worker and organization.
• Complying and failure to comply can lead to Lawsuits.

.
What can we do?

Some of the recommendations from various articles revealed that;

1.  Comply with basic ethical guidelines through; evaluating the patient’s
medical condition; assessing the patient’s decision-making capacity, determine the
patient’s reasons for the request, the available options for responding, and the effect
on the health worker.

2. Try using problem-solving techniques especially if it may end up affecting their health. The techniques include negotiation, persuasion, and, if necessary, accommodation.

3. When such an event occurs it is important to conduct an assessment on the aggrieved staff, conduct a debriefing with affected staff, convene team meetings, conduct an event tracking, data collection, and initiate organizational cultural changes.

4. Being that our in set-up one is more likely to experience ethnicity bias. I would recommend if our work ID tags only displayed neutral names or rather the legal name one felt more comfortable using. I believe this would limit some awkward conversations we often get bombarded with.

5. Put more emphasis on educating the health workers on their rights and roles and have more organizations creating policies that also protect the health worker.Please follow this link https://lilylovelong.blogspot.com/2020/01/change-must-come.html.

In conclusion, we need to continue generating difficult conversations. Change can only occur when we openly declare the sad truths and deal with them. For