Senator Raffy Tulfo interpellates 'Culture of Bullying' in the Philippine health industry

Summary

The transcript discusses a pervasive issue of bullying in hospitals, particularly affecting junior doctors during their residency training. It highlights the negative impact of this toxic environment on mental health and proposes solutions: setting departmental standards, hospital policies against bullying, and strict regulation by the Professional Regulation Commission. The discussion also touches on the need for a grievance mechanism for doctors and the importance of a conducive work environment for quality healthcare delivery.

Takeaways

• 🏥 **Bullying in Hospitals**: There's a prevalent issue of bullying among medical staff, particularly affecting junior residents.
• 👨‍⚕️ **Impact on Residents**: The stress from bullying can lead to mental health issues and may affect residents' ability to provide optimal healthcare.
• 📚 **Tradition of Harsh Discipline**: A tradition of harsh discipline exists, intended to instill hard work but has become toxic.
• 📉 **Ethical Violations**: The assigned duties sometimes exceed medical training and labor laws, violating the medical practitioners' code of ethics.
• 🤔 **Concerns Raised**: There are numerous reports of residents unable to handle the stress due to toxic environments during their training.
• 🛠️ **Need for Change**: There's a call for hospitals to establish a healthy and professional work environment for medical frontliners.
• 🏢 **Hospital Administration's Role**: Hospital administrators are urged to create policies against bullying and ensure a conducive work environment.
• 🏥 **Department Heads' Responsibility**: Department heads are expected to supervise and control the behavior of their subordinates to prevent bullying.
• 📋 **Regulatory Oversight**: The Professional Regulation Commission is tasked with ensuring hospitals follow guidelines for residency training and maintain ethical standards.
• 📝 **Grievance Mechanisms**: There's a need to strengthen grievance mechanisms in hospitals to allow victims of bullying to report incidents safely.
• 🌟 **Healthcare Improvement**: The Universal Healthcare Act includes provisions for a rating system to reward health facilities that provide better service, efficiency, and equity.

Q & A

What is the main issue being discussed in the transcript?

The main issue being discussed is the problem of bullying and a toxic work environment faced by medical frontliners, particularly resident doctors, in hospitals.

Who is the speaker addressing in the transcript?

The speaker is addressing the chair and other members of a committee or forum, discussing the concerns related to the treatment of resident doctors.

What is the speaker's concern regarding the treatment of resident doctors?

The speaker is deeply concerned about the stress and bullying experienced by resident doctors during their training, which can lead to mental health issues and is considered a violation of medical practitioners' code of ethics.

What are the specific examples of bullying mentioned in the transcript?

The transcript mentions that first-year residents often experience bullying from their senior counterparts, including being humiliated in public, being assigned non-medical duties, and having their personal time encroached upon.

What is the origin of this toxic practice according to the speaker?

The speaker suggests that this toxic practice may have originated from a tradition where senior residents or consultants intended to teach discipline and hard work to new doctors, but it has since become excessive and harmful.

What solutions does the speaker propose to address the issue?

The speaker proposes that hospital administrators, department heads, and the Professional Regulation Commission (PRC) should establish guidelines and policies to prevent bullying, strengthen grievance mechanisms, and ensure a healthy work environment for doctors.

What role does the Department of Health play in this issue according to the transcript?

The Department of Health is responsible for overseeing the implementation of residency training programs and ensuring a safe and conducive work environment for medical residents.

What steps has the Department of Health taken to address the issue?

The Department of Health has created a technical working group to develop a policy for improved implementation of the residency program and issued guidelines for a safe and conducive work environment for medical residents.

What is the speaker's stance on the handling of suicide cases among medical professionals?

The speaker emphasizes the sensitivity of handling suicide cases and the need to follow international guidelines to prevent copycat incidents. They also mention the importance of creating avenues for doctors to report grievances and receive due process.

What is the speaker's suggestion regarding the universal healthcare rating system?

The speaker suggests implementing a rating system for health facilities as part of the universal healthcare act to acknowledge and reward facilities that provide better service, efficiency, and equity.

How does the speaker plan to ensure that hospitals adhere to the guidelines against bullying?

The speaker plans to issue a department order to remind hospital directors of their responsibilities and to ensure that all facilities have the necessary guidelines in place.

Outlines

00:00

🏥 Bullying in Hospitals: A Concern for Medical Frontliners

The speaker addresses the issue of bullying in hospitals, particularly targeting medical frontliners. They mention that doctors, especially first and second-year residents, often experience bullying from senior staff, which can occur during work hours and personal time. This toxic behavior, which was once intended to instill discipline and hard work, has escalated and now involves unethical tasks and violations of medical practitioners' ethics. The speaker expresses deep concern over the stress caused by this environment, which can lead to residents' inability to cope, and calls for attention to this issue.

05:00

🚑 Protecting Medical Frontliners: Creating a Healthy Work Environment

The speaker continues to discuss the negative impact of the toxic work environment on medical frontliners, emphasizing that it is not an isolated issue. They call for the protection of medical workers by ensuring a healthy work environment. The speaker suggests that hospital hierarchy, including department chairs and hospital administrators, should take responsibility for setting standards and implementing policies against bullying. Additionally, they urge the Professional Regulation Commission to ensure hospitals have guidelines for residency training and to supervise both public and private hospitals to maintain a professional workplace.

10:03

📚 Residency Training Reforms and Grievance Mechanisms

The speaker proposes specific actions to address the issues faced by resident doctors. They advocate for the establishment of guidelines and rules for residency training, the strengthening of grievance mechanisms in hospitals, and the Professional Regulation Commission to review disciplinary procedures. The speaker also raises concerns about the universal healthcare rating system and calls for support for hospitals to improve service efficiency and equity. They mention the creation of a technical working group for a policy on a safe and conducive work environment for medical residents.

15:05

🤝 Collaborative Efforts to Combat Bullying and Disruptive Behavior

The speaker discusses the importance of handling sensitive matters such as suicide and the need to follow international guidelines to prevent copycat incidents. They mention that hospital directors are responsible for investigating such cases and that bullying is considered disruptive behavior, which is against the code of ethics of hospital professionals. The speaker suggests creating avenues for doctors who are bullied to report grievances and receive due process. They also mention their office's openness to complaints from residents and the importance of hospital administrators ensuring a healthy and professional workplace.

20:07

🏢 Support for Healthcare Workers and Hospital Infrastructure

The speaker highlights the need for support for healthcare workers who are under stress, especially during the pandemic. They mention ongoing investigations into cases of stress-related issues in private hospitals and emphasize the importance of increasing public hospital bed capacity to alleviate overcrowding. The speaker also touches on the importance of building additional hospitals and supporting legislation to improve healthcare infrastructure. They conclude by discussing the need for support mechanisms for victims of crimes and the role of the government in providing such support.

Keywords

💡Bullying

Bullying in the video refers to the toxic behavior experienced by junior medical residents from their senior counterparts. This includes both verbal abuse and the assignment of non-medical duties. The video highlights how this practice negatively impacts the mental health and productivity of medical professionals and calls for an end to it within hospital environments.

💡Residency training

Residency training is the structured period in which doctors gain practical experience in hospitals under supervision. In the video, the issue of a toxic work environment during residency is emphasized as a factor that can 'break' residents, despite their competence. The video advocates for stricter guidelines and healthier conditions during this training phase.

💡Toxic environment

The toxic environment described in the video refers to the culture of bullying, overwork, and mistreatment that junior medical staff often face in hospitals. This harmful atmosphere exacerbates the stress of already demanding medical jobs, leading to negative outcomes for both healthcare workers and the overall quality of patient care.

💡Grievance Machinery

Grievance Machinery refers to formal systems within hospitals that allow employees to safely file complaints and seek redress for unfair treatment. The video argues that such mechanisms should be strengthened so that resident doctors can report bullying or other issues without fear of retribution.

💡Patient safety

Patient safety is the protection of patients from harm while receiving healthcare. The video discusses how a disruptive work environment, including bullying and stress among medical staff, can compromise patient safety. It highlights the need for a healthy work environment to ensure doctors can perform their duties effectively and safely.

💡Code of ethics

The code of ethics mentioned in the video refers to the professional standards that guide medical practitioners' conduct. The video stresses that some duties assigned to residents violate this code, as they are non-medical in nature and exploitative, thus calling for stricter adherence to ethical guidelines in hospitals.

💡Stress

Stress, in this context, refers to the mental and emotional strain placed on medical residents due to the toxic environment in hospitals. The video discusses how the overwhelming pressure, combined with bullying and overwork, leads to burnout and mental health issues, making stress management a crucial issue.

💡Resident doctors

Resident doctors are medical graduates undergoing specialized training in hospitals. In the video, they are the primary group affected by the toxic culture of bullying and overwork. Their experiences of being exploited by senior staff are central to the video’s call for systemic change in medical training environments.

💡Hospital administration

Hospital administration refers to the management and leadership responsible for overseeing hospital operations. The video calls on administrators to implement policies that prevent bullying, ensure proper grievance mechanisms, and maintain a healthy work environment for healthcare workers.

💡Department of Health

The Department of Health is the government body responsible for overseeing healthcare systems. The video calls for its involvement in ensuring that hospitals, both public and private, maintain strict guidelines for residency programs and work environments, emphasizing the need for national standards to address bullying and toxic practices in hospitals.

Highlights

The necessity for optimal healthcare is emphasized, including addressing both physical and mental health concerns.

A sickness affecting medical frontliners in hospitals is identified, involving bullying and toxic work environments.

First and second-year residents often experience bullying from senior counterparts, affecting their work and personal time.

The tradition of senior residents teaching discipline through harsh methods has become detrimental to medical training.

The assigned duties sometimes exceed medical training and labor laws, violating the code of ethics for medical practitioners.

The toxic environment is highlighted as a significant stressor during residency training, potentially leading to mental health issues.

The need to protect medical frontliners by fostering a healthy work environment is stressed.

Hospital hierarchy must take responsibility for addressing the toxic culture.

Hospital administration should establish policies against bullying and ensure a supportive work environment.

The Professional Regulation Commission must ensure fixed guidelines for residency training and strict implementation.

The selection of hospital heads should be scrutinized to ensure they can maintain a healthy workplace.

A call for guidelines and rules for residency training hospitals to be strictly implemented.

The need for a grievance mechanism in hospitals where employees feel safe to report issues.

A request for the PRC to review disciplinary procedures for doctors to ensure fairness.

The universal healthcare act's rating system for health facilities is discussed to reward better service, efficiency, and equity.

A technical working group was created in 2021 to develop a policy for a safe and conducive work environment for medical residents.

The Department of Health has implemented guidelines to improve the residency training program.

The Secretary of Health acknowledges the need for an eight-point action agenda, including support for healthcare workers.

The Secretary of Health promises to issue a department order to address the issues raised.

The importance of increasing public hospital bed capacity to reduce stress on healthcare workers is discussed.

The government's commitment to supporting victims of crimes, including providing a support mechanism, is highlighted.

Transcripts

[Music]

will

be he or she will be competent to give

the Optimal Health Care for their

patients

which could be physical injuries

illnesses and other health concerns or

even mental health concerns but it seems

that there is a sickness going around in

hospitals that's affecting our medical

frontliners I

am first resent doctors into

and sometimes nonan

stff

private let me first lay down the

basis Mr chair it

seems my first year residents in my

first year at second year usually they

exper erien bullying from their senior

counterparts

out of their own

pockets

ji in front of many people including

patients

consultant and I also remember Mr

chair

us are done both during work hours

instead of doing actual work for the

hospital and during personal hours when

the junior resident is supposed to take

the rest Mr chair

this toxic practice might have stemmed

from a tradition where the senior

residents or Consultants intended to

teach discipline hard work and greet to

the naop doctors

unfortunately this tradition has gone

out of hand and has gone beyond medical

training the duties being assigned are

no longer medical related going beyond

the bounds of labor law and are

violations already of the code of ethics

of medical practitioners and frankly it

is no longer

healthy the toxic environment can no

longer be

ignored Mr chair I'm deeply deeply

concerned because

apparently

residents

Sude

hpal hosp

City it seems that they were not able

that that they are able they were not

able to handle the stress during The

Residency

training they already what they already

have what it takes but what broke them

is the toxic environment during their

residency while I'm sure that this is

this is not true for all circumstances

there are too many reports that have

reached me to say that this is an

isolated case we have to protect our

medical frontliners by helping them to

work in a healthy environment the nature

of their work is highly stressful

already

doctors

for

HPS those are resident

doctors reaction

doctors

seniors Mr chair since the tradition is

something coming from from above those

from above the hospital hierarchy must

take

responsibility the chair of each

department exercises supervision and

control over those beneath them I'm

sure they should lay down standards

within the

department number two the hospital

Administration must also work with them

to provide a policy for the entire

hospital where bullying is not to be

tolerated the hospital administrator

including the board must take care of

their people number three the

do as the regulating Department agency

must ensure that all hospitals have

fixed guidelines in the implementation

of The Residency

training and there must be strict

implementation of this also the do must

continue to supervise both public and

private

hospitals there are instances where the

selections of the heads of the lgu

hospitals are left to the discretion of

the local government

unit the do must make sure that those

running the hospitals are capable of

maintaining a healthy efficient and

professional workplace for our

Doctors Hospital administ

administrators

the Professional Regulation commission

has the power to discipline our

positions they are tasked to make sure

that our doctors comply with their code

of

ethics disciplinary

casesc

res doctor first

year

for suggested

action Mr chair I want to

see to see that this practice

stops will still continue to work in

their

industry they do not want want to burn

Bridges and be branded as difficult to

work with and so let me say it out loud

for

them

first I hope that there will be

guidelines and rules for The Residency

training hospitals there must be

mechanism for this to be implemented

strictly second I want strengthen

grievance Machinery in

hospitals griev machinery the employees

of Hospital must be comfortable and must

feel safe when they run to these

grievance machineries third I implore

upon PRC to look into the disciplinary

procedure of our

doctors in this line let me raise my

concern in my other

resolutions heal service is to infuse

support for hospitals through the

universal healthcare I would like to ask

F help regarding the implementation of

the rating system of health facilities

in section 27 of the universal healthc

Care

Act there is a provision requiring phal

to establish a rating system under the

incentive scheme to acknowledge and

reward Health Facilities that provide

better service efficiency and Equity

that's all Mr

chair

senator uh if you'll allow

me so I can get this over

with okay Mr chair oh go ahead uh

Senator rafy um Secretary of Health

doc first and second year resident

doctors yes Mr

chair specific

Department Health secretary

2021 create technical working group for

a policy on a safe and conducive work

environment for medical residents under

the medical residency training

when was this secretary this is a

department personal order 2021 D

3129 sir

20212 mon um November November of

2021 chair assistant secretary shade

Marcado

okay residency training program for

medical doctors as part of the national

Health Workforce support system aims to

ensure quality of training and health

human resource development for the

health system in view of enhancing

residency training program as the

Implement implemented in various

hospitals under the Department of Health

uh a technical working group was created

actually you technical working group's

function was responsible for developing

a policy for improved implementation of

The Residency program

cond

has been implemented

yes

guidelines Department order guidelines

on safe and conducive work environment

for medical

residents in

2022 guidelines sir

uh uh they they actually looked at all

the residents and very specific you

screening uhing process

consults Consultants including

Consultants okay uh working conditions

uh workplace support structure and

policies

exactly Implement

sir2

so uh in the

change

understand you came into the

picture

Mr chair may I just be clear that uh

handling of uh suicide is a sensitive

matter and there are international

guidelines that we follow to make sure

that there are no copycats that actually

come after I can submit to the good

Senator the wh guidelines of handling I

understand I know sir very sensitive

matter I know

sir

doctor the the hospital directors are

the ones uh enjoined to do the due

process for investigations of such cases

that happen in public hospitals or any

other hospital for that

matter

so standard

policy trend is really to look at it

from what we call disruptive behavior so

that the

trend patient safety patient safety one

of the dangers of patient

safety bullying in a hospital and

bullying is part and considered as

disruptive behavior

these are all considered disruptive

behavior and in the code of ethics of

Hospital professionals

included against that are banned and so

basically

report the draft no very important

create in the hospitals an Avenue for

the doctors that are bullied to be able

to have an Avenue to to have Grievances

and then to be given

uh also due process because we cannot

just accuse people that they are bullies

because there are situations Mr Senator

the

problem they just keep

quiet

like I did mention to you here

earlier they themselves are victims of

bullying

yeah yes Mr chair uh my office is open

to anyone any Resident in our public

hospitals we have 87 and my office is

open for them to complain to me directly

so I used to do this when I was a chair

as well of a Residency program uh they

get directly to me so I can understand

uh younger residents that will complain

so Mr secretary if I may

suggest doctors the training

and I saw that in some Private Hospital

in fact if I'm not mistaken St Luke's

Hospital

doctor rights why don't you do that in

all hospitals yes I will issue a

department on this uh my Hospital

directors are behind me some of them are

actually sitting here and listening to

this we will make sure that this

reminders are placed in all uh

facilities of can you guarantee to us to

this

committee doctors can you guarantee that

to us yes Mr chair uh if for your

information I have an eight-point action

agenda as I assume the office of

Secretary of health and in this uh

eight-point action agenda two of the

action points involve this one one is

number six which is

G

and healthare workers both of these

cover this particular issue which I have

also noticed Mr chair

so they always hear me when I visit them

I just visited the hospital in Bal where

we inaugurated the heart center and I

told them uh if you're if you want to be

a good

Hospital nurses in our hospitals thank

you Mr

chair

okay am I right did I hear it right we a

copy of our uh findings how

about

hosp going investigation ongoing but

that was more than a month ago yes we

asked for due process

and information and facts and

lastly uh

whether they're residents or not junior

or

senior they can no longer take the

stress in Private Hospital

cityor this was before pandemic I

adding to that stress

boom

precious

resources

I think that's is

something secretary thank you Mr chair

uh that's the reason most of the house

bills I am supporting because we really

need to increase our public hospital bed

system

overcrowded Regional hospital and aside

from life or death situation additional

stress healthare workers so we need to

really build all the other hospitals

that this uh good legislators are

pushing so we are in support of many of

all of them

actually last Mr

chair we don't have to mention

names they want to keep it secret and I

respect

thator res

uh Mr chair rape is a crime and uh the

Avenue for the victim to uh to complain

in our uh court of law is there in our

law enforcement so I know I think she

did

complain support from the from the

government yes we will support uh the

victim if the victim go back to your

record I Will Raise

Hell we will follow up this case but

it's really in the court of law already

if they file the case then we will

follow

up she cannot do it

alone support mechanism coming from the

government com from the

doc all by

herself

support

yes Mr chair we will do that Mr

chair