Social partners discuss violence at the workplace

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At a conference held in October 2003, the Bulgarian social partners discussed the growing problem of workplace violence in the health sector, based on the findings of an international research project. Participants at the event agreed to launch a follow-up action plan for the prevention and elimination of workplace violence in this sector.

On 20-21 October 2003, the Federation of Health Trade Unions affiliated to the Confederation of Independent Trade Unions in Bulgaria (CITUB) and the Medical Federation of the Confederation of Labour Podkrepa (Support) organised an international conference on 'Workplace violence in the health sector in Bulgaria'. The event was supported by the International Labour Office (ILO) and Public Services International (PSI), the international organisation of public sector trade unions. It was attended by representatives of ILO, PSI, the World Health Organisation (WHO), the Bulgarian Ministry of Health, the Parliamentary Health Committee, theLabour Inspectorate, the National Health Insurance Fund, the National Association of Employers in the Health and trade unions. Representatives of health trade union federations from Macedonia, Romania and Czech Republic were also invited.

The aim of the conference was to acquaint the Bulgarian public authorities and social partners with the main findings of the work of a joint programme on addressing violence at work in the health sector conducted by the ILO, PSI, WHO and International Council of Nurses (ICN), which has produced framework guidelines on the issue. The particular focus was a case study on Bulgaria, carried out in the framework of the joint programme by the Institute for Social and Trade Union Research, on the basis of a survey.

According to the Bulgarian study, the public and the staff employed in the health sector are still unaware of the problem of workplace violence. Its significance is largely underestimated and it is interpreted in the context of the hardships facing people in their daily life, stress due to the negative consequences of Bulgaria's long and painful reform process, and the general violence and crime that has arisen as part of the transition. Violence in Bulgarian society is perceived with tolerance and is still shrouded in silence, the report states. On the whole, violence is not on society's agenda - there is no transparency and public concern and no measures for preventing violence and providing adequate protection for victims.

Physical violence is not typical for the health sector in Bulgaria, according to the study, but it is not exceptional either. Some 7.5% of respondents to the survey stated that they had been a victim of physical violence, while 10.2% had witnessed physical violence. Physical violence generally occurs in circumstances of conflict between patients and doctors, with aggressive patients reported as being the perpetrators in 65.8% of recorded cases.

With regard to psychological workplace violence, the most widespread form is verbal abuse. Among survey respondents, 37.2% said that they had been subject to such abuse and, according to most of them, it is the typical form of violence. The second most common form is bullying/'mobbing', which was reported by 30.9%. Only 2.2% of respondents reported that they had been subjected to sexual harassment. In contrast to physical violence, where the patient is usually the perpetrator, in term of psychological violence the number and proportion of incidents where a staff member or line manager is the perpetrator has been growing.

The survey found that the factors generating workplace violence in healthcare are rooted in the broad social, economic, organisational and cultural context. At the same time, however, some specific characteristics of the healthcare system are found to heighten the risk of workplace violence. The factors contributing to such violence include: the social and economic situation in the country; healthcare reforms; stress and social tension; the personality of patients; specific groups of patients; management style; relations at the workplace; work organisation and working conditions; lack of security measures and control; and lack of special bodies and procedures.

The survey and the discussions at the conference in October suggested that currently there are no effective specific strategies and activities for addressing violence at the workplace, either in the health institutions or on the institutional and national level in Bulgaria. The trade unions and the professional organisations do not have their own strategies either. Conference participants stated that it is high time to admit the existence of violence at the workplace, the health sector included, and to propose effective short- and long-term strategies for its prevention and elimination, involving all social actors at different levels. Participants at the conference agreed to launch a follow-up action plan to address the problem, including: proposals for amendments to current labour legislation and some other specific laws; embedding the issue of violence in the social dialogue and collective bargaining agenda at all levels; and risk assessment, intervention and monitoring.