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Five Prevention Tips for Creating a Culture of Safety within Healthcare Organizations

In 2017, a CNN investigation found that more than 1,000 nursing homes were cited for mishandling or failing to prevent alleged cases of rape, sexual assault and sexual abuse at their facilities between 2013 and 2016.

An investigation by the Atlanta Journal Constitution identified over 2,400 physicians accused of sexual misconduct with patients.

Even with these investigations, researchers find “it is not possible to provide an accurate estimation of the frequency of sexual violations in medicine”, and that is simply because so few victims report.

Fortunately, sexual misconduct in healthcare organizations is preventable. Here are some tips for creating a culture of safety for your patients.


1. Discuss and build better professional boundaries.

Identifying professional boundaries with patients allows an organization to define a bandwidth of acceptable behavior and makes it easier to identify when boundaries have been violated. Discussions of professional boundaries should include:

  • Physical interactions
  • Verbal interaction
  • Electronic communications and social media
  • Incidental and non-incidental contact
  • Favoritism
  • Gift-giving and receiving
  • Referrals

2. Integrate a comprehensive approach to chaperones and assistants.

Chaperones or assistants are often present during examinations to support patient privacy and to assist in the maintenance of professional boundaries during one-on-one interactions. However, simply having a chaperone or assistant present during intimate examinations does not entirely eliminate the risk. A comprehensive approach needs to be in place, which includes identifying:

  • Situations when a chaperone is required;
  • Who can serve as a chaperone based on their role within the organization and the specialized training they have received;
  • The role of the chaperone during the examination, including where to stand, how to provide support and comfort for the patient while balancing privacy concerns;
  • How the concept of a chaperone is introduced and offered to patients;
  • How to document the chaperone’s presence; and
  • How to educate chaperones on identifying and reporting red flag behaviors.

3. Create robust patient education and feedback loops

Educating patients contributes to overall safety. When patients understand the professional boundaries in place and what to expect during their interactions, they are more likely to get involved and ask questions. With that, they will feel more comfortable to report concerns of any nature that may affect the safety of others.

4. Expand response procedures and minimize reporting barriers

How your organization responds to reports of suspicious or inappropriate interactions, boundary violations, or suspected abuse can dramatically affect the harm to the individual and damage to your organization. Once your organization learns of a concern or allegation about the treatment of a patient, swift and determined action must be taken to reduce any subsequent risk of harm. These should include clear response methods that integrate a continuum of responses. It is not enough to simply have these protocols in place. Everyone should be equipped with information on how to report and elevate concerns of any nature, and there should be transparency in the responding process.

5. Ensure leadership understands and is committed to a culture of safety

Commitment to a culture of safety within healthcare organizations starts at the top. To establish this culture of safety, leaders must demonstrate a commitment to abuse prevention — publicly and frequently, in words and actions. Commitment requires abuse prevention to be a designated responsibility and requires a comprehensive systems approach to abuse prevention.