Norwegian Healthcare Investigation Board (Ukom) has investigated cases where healthcare personnel in public healthcare services have subjected patients and recipients of healthcare to boundary-crossing, sexualised behaviour. The actions range from personalising or romanticising interactions to committing sexual abuse.
Patients generally place high degrees of trust in healthcare services and the treatment they receive. When healthcare professionals engage in abuse, this trust is severely undermined, which can have significant harmful effects on those accessing healthcare. Such actions represent a serious patient safety issue.
Ukom has received several alerts regarding healthcare workers’ boundary-crossing sexualised behaviour. The issue has also gained substantial media attention over recent years.
Using incidents from two different municipalities as examples, Ukom explored how alerts of such behaviours are being managed. We investigated the roles of municipalities, the County Governor, and the Norwegian Board of Health Supervision in these cases. Additionally, Ukom examined how organisational responsibility for addressing these incidents is maintained.
Effective systems and procedures are imperative for preventing and handling boundary-crossing sexualised behaviour in healthcare settings. A reliable reporting system and serious consideration of adverse events or concerns are essential for capturing such incidents.
Ukom’s investigation highlighted several significant findings:
- There is a need for greater insight into mechanisms that can lead to healthcare personnel committing boundary-crossing sexualised acts toward patients and users.
- Reporting such incidents are challenging for patients and users, and whistleblowers do not always receive adequate support.
- These incidents are rarely reported through the Norwegian national reporting systems for serious adverse events in public healthcare.
- Employers lack sufficient tools to prevent, detect, and intercept such actions.
- Regulatory authorities face challenges in documenting and verifying these events.
- There is variation in how County Governors handle such cases.
Based on the findings, Ukom could identify several areas for improvements. One such preventive measure against inappropriate behaviour toward patients and users, is increasing awareness of role boundaries and professional ethics in the workplace as well as in health education programs. Monitoring and mentoring of healthcare workers during their professional practice and specialisation could also help detect and prevent such incidents. Overall, education on the subject matter can make it easier to recognise warning signs among colleagues who might be at risk of overstepping professional boundaries.
Healthcare services and regulatory bodies need to optimise the mechanisms by which whistleblowers are supported throughout the reporting process and ensure that it is safe to come forward.
There is a need to improve patient safety, particularly during gynaecological and other intimate examinations. Patients need more knowledge about indications for, and how a normal gynaecological examination should be executed.
Ukom sees a need for a national tool for managers in healthcare services, helping them develop local procedures to prevent and address boundary-crossing sexualised behaviour by healthcare personnel.
It is essential that cases involving boundary-crossing actions in healthcare services are thoroughly enlightened during the regulatory process. To improve patient safety and better support for whistleblowers, swift case management and broader information gathering are necessary. It can be demanding for patients to describe their experiences in written words. Hence it is imperative that patients are offered a supplementary meeting with the regulatory authorities to bring forth their perspectives.
Ukom recommends that regulatory authorities develop a system to maintain a comprehensive overview of all alerts regarding boundary-crossing sexualised behaviour by healthcare personnel, including cases that the County Governor closes without forwarding them to Norwegian Board of Health Supervision.
For public health care providers to fulfil their organisational responsibilities pertaining to patient safety, they must receive early notification from regulatory authorities about behaviour that may compromise this.
This report is directed to patients, government departments, regulatory authorities, the police, labour unions in health care and social services, educational institutions, as well as managers and staff in healthcare services.
The translation from Norwegian to English is based on AI. Ukom has reviewed, edited and quality assured the translation.