Organisational Abuse includes neglect and poor care practice within an institution or specific care setting such as a hospital or care home or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment.
It may be a result of regimes, routines, practices and behaviours that occur in services that adults live in or use and which violate their human rights. This may be part of the culture of a service to which staff are accustomed and may pass by unremarked upon.
They may be subtle, small and apparently insignificant, yet together may amount to a service culture that denies, restricts or curtails the dignity, privacy, choice, independence or fulfilment of individuals.
Organisational Abuse is most likely to occur when staff:
- Receive little support from management;
- Are inadequately trained;
- Are poorly supervised and poorly supported in their work;
- Receive inadequate guidance.
The risk of abuse is also greater in services:
- With poor management;
- With too few staff;
- Which use rigid routines and inflexible practices;
- Which do not use a person-centred approach;
- Where there is a closed culture;
- Where there are inadequate quality assurance and monitoring systems in place.
Potential indicators of Organisational Abuse include:
- Unnecessary or inappropriate rules and regulations;
- Lack of stimulation or the development of individual interests;
- Inappropriate staff behaviour, such as the development of factions, misuse of drugs or alcohol, failure to respond to leadership;
- Restriction of external contacts or opportunities to socialise;
- Staff attitudes, where staff may view clients negatively, treating them like children, not involving them in making choices as they seem too confused or disabled. Staff may think that if clients do not appear to understand then they can talk in front of them as if they are not there.
Abuse is more likely to occur in services where staffing levels are insufficient to provide appropriate and timely intervention required to meet the complete range of physical and social needs.
Routines can become too set and rigid and may be fixed around the needs of staff, e.g. bathing routines, bedtimes set around the staff rotas and not around the individual.
Other circumstances that my increase the risk of abuse include:
- Lack of choice and consultation: about social needs, personal care needs and, activities, for example;
- Lack of personal belongings: lack of personal care items, shared toiletries, bulk-buying of personal care items, lack of personal clothing.
- Task-focused: where staff are focused on getting the job done rather than spending time with client.
- Lack of staff training: staff does not have the required knowledge/skills to provide care. No training or inadequate training has been provided.
- Staff Morale: staff can feel undervalued, may lack supervision or training.
- Poor staff conditions: staff can experience work-place stress, which is not being addressed by colleagues and their manager.
- Low staff self-esteem can lead to an environment in which abuse becomes the norm.
- Policies and procedures: Care Plans do not reflect the needs and wishes of the service users. Care Plan evaluation and record keeping do not contain evidence of implementation of care.
- Poor recruitment procedures leading to inappropriate appointments, for example appointing staff with convictions for theft.
- Lack of Compliance with MCA and DoLs.
The nature and timing of the intervention and who is best placed to lead will be, in part, determined by the circumstances. For example, where there is poor, neglectful care or practice, resulting in pressure sores for example, then an employer-led disciplinary response may be more appropriate; but this situation will need additional responses such as clinical intervention to improve the care given immediately and a clinical audit of practice. Commissioning or regulatory enforcement action may also be appropriate.
Environmental factors may also increase the risk of abuse, for example:
- The care environment is not suited to care or is unsafe, i.e. during building works rendering the area not compliant with Health and Safety legislation;
- The environment is dirty and does not comply with hygiene /control and infection standards.