Patterns in Violence against Health Professionals in China

In recent years, the number of violent attacks on health professionals in China has rapidly increased. According to a 2013 survey of 316 hospitals in more than 30 provinces by the Chinese Hospital Association, violence against medical staff increased from 20.6 assaults per hospital in 2008 to 27.3 in 2012. The same survey shows that 40 percent of staff planned to give up the health professions (The Lancet, 2014). So far, thousands of health professionals have been injured, either by dissatisfied patients or patients’ families. The scale, frequency, and viciousness of attacks have shocked health professionals worldwide (The Lancet, 2014). During October of 2013, the frequency of these incidences rose to a peak – six attacks against health professionals occurred within ten days and two doctors were killed. This phenomenon is rather surprising, given the fact that China has one of the lowest homicide rates in the world (UNODC, 2013). Health professionals in China, once highly respected and were called “angels in white coats,” are increasingly in danger. Various reports have analyzed potential factors that may cause the surge of violent actions against health professionals in China. According to the studies, lack of investment in the health system and rising healthcare costs are the two major contributing factors (The Lancet 2014 and The Lancet, 2012). In 2012, China's population accounted for 22 percent of the world's total population, whereas China's total health expenditure accounted for only about 2 percent of the world's total health expenditures (The Lancet, 2012). Out-of-pocket health expenditure in China nearly tripled from 2000 to 2010 (WHO China Country Profile, 2012). Doctors nowadays face overwhelming workload, as hospitals typically expect them to see 100 or more patients per day. On the other hand, China is facing a nursing shortage, resulting in nursing staff burnout. It is reported that 2.18 million registered nurses are employed in China, but almost twice that number is needed to meet the targeted nurse-patient ratio of three to one (Global Times, 2011). As a result, health professionals find it extremely hard to foster a mutually rewarding relationship with patients (The Lancet, 2012). These two factors have potentially led to patients’ deepening dissatisfaction and even violent actions against doctors and health professionals. Moreover, studies have concluded that societal factors including distorted media reports about health professionals, poor health literacy and patients’ unrealistic expectations of medicine are all possible explanations to this problem (The Lancet, 2014). From 2011 to 2014, seventy-nine cases have been reported with clear information about the professionals being attacked and the hospital where the incidences occurred. Attacks are motivated by perceived professional malpractice and 10 people died as a result (TingTing Group, 2014). Despite wide discussion of these potential contributing factors, no study has yet generalized these factors from direct analysis of the cases. Few studies have described common patterns from these cases. This calls for a better understanding of the cases and the root causes of the violence, so that policy makers can derive better informed strategies that can potentially reduce the occurrence of such incidences. This study will use a multiple case study design to both describe and attempt to explain the violence that occurred in each case. The research questions will be as follows: Within-Case Questions 1. For each case, what are the general descriptive characteristics of the case, such as gender of the perpetrator and the victim, type of health professional victimized, and type of physical violence and weapon used? 2. For each case, what factors appear to have contributed to causing the violence? Across-Case Questions 3. What are the general patterns in the descriptive characteristics across all of the cases? 4. What are the general patterns among the causal factors across all of the cases?Bachelor of Science in Public Healt