Implementing Sustainable Systems for Victim Support in the Medical Sector

Supporting and protecting victims of Domestic Violence (DV) in the health sector is crucial, yet it presents significant challenges for medical professionals. While individual commitment and engagement are essential, organisational factors also play a crucial role. They shape the conditions for individual engagement and allow or hinder the implementation of robust and long-term routines for victim support and protection. The VIPROM project therefore defined sustainability of training efforts as one of its main goals. In order to thoroughly understand which organisational factors enable the sustainable implementation of victim protection in medical institutions nine case studies across three countries (Austria, Germany, Sweden) were researched. Besides common factors, local specificities have also been relevant for VIPROM and the improvement of victim support in medicine more generally.

CASE STUDIES FROM AUSTRIA

In Austria, the case studies focused on the implementation of Victim Protection Groups (OSG) in hospitals, which are mandated by law since 2011. As OSGs were established to be cost-neutral and form loosely organised intervention teams rather than formally organised units, a lack of dedicated resources hinders their widespread implementation until today. In practice, the main task of the OSGs is to provide DV-related training and awareness-raising among hospital staff. In addition, OSG members are also responsible for counselling victims and producing information material for patients. Further activities include inter-organisational networking activities. Among the key findings from the Austrian case studies are the following:

• “Top-down” commitment (i.e. from hospital management) is key for the establishment and institutionalisation of victim protection measures.
• Establishing a functional (and funded) role for key people/leaders of the OSG is important as it helps to safeguard continuity even if committed individuals leave the organisation.
• As the treatment of patients affected by DV is a cross-cutting issue (potentially) affecting all departments, cooperation within and beyond the hospital is key.

CASE STUDIES FROM GERMANY

In Germany, the case studies focused on implementing DV-training in curricula for medical students, which is not a mandatory part of the curriculum and therefore differently implemented at different educational institutions. Therefore the first case covered a large university, which has already implemented DV-training for students as mandatory; the second case researched a smaller private university, which offers an elective subject; and the third case covered a training hospital, where DV is only taught as part of other issues, but does not comprise its own subject. Key findings included the following:

• In addition to the work of engaged initiators institutionalisation of DV-training also needs allies (including management as well as teaching staff and students) within the organisation.
• In order to mitigate the risks associated with reliance on committed individuals it is important to train larger numbers of lecturers/employees on DV-issues.
• The inclusion of DV-related learning objectives into the national competence catalogue could make it easier to incorporate these issues into medical education in the form of separate courses as well as in a cross-cutting fashion because they would then be relevant for the state exam.

CASE STUDIES FROM SWEDEN

The Swedish case studies focused on the national implementation of an educational objective defined in 2018/2019 in the knowledge area “men’s violence against women and violence in close relationships”. In contrast to the German example, the Swedish institutionalisation has been an outcome of an initiative at a high-ranking policy level. The case studies centred on nursing programs at two different universities that varied greatly by age and size of the institution and one college. Relevant findings included:

• Introducing the educational objective not only as a knowledge objective (as it is now), but also as an objective in terms of skills would further strengthen implementation.
• Support from an expert centre or similar body is important for implementation.
• Financial as well as temporal resources are necessary for sustainable implementation, as lecturers need time and space to develop their own knowledge and to adapt their teaching.

COMPARISON OF THE CASE STUDIES

Comparing the different cases, a number of factors stand out, which appear to be of general interest for the sustainable implementation of victim support systems in the medical sector, especially through the implementation of sustainable educational practices.

The results of the study reaffirm that sustainable implementation requires sufficient resources, particularly in terms of personnel, time and funding. In addition, resources in this field also include (official) recognition of work done in relation to victim protection and DV education. Even legal provisions, e.g. educational goals formulated as national policies, might be treated as resources by initiators implementing DV-related strategies in organisations. It is also important to take advantage of opportunities provided by organisational changes and reforms when implementing DV-related practices.

Knowledge is relevant in various forms for the sustainable implementation of DV education and victim support. Scientific knowledge might underpin the relevance DV-related work, thus providing arguments to engaged individuals concerning the relevance for medical professionals. In-house expertise – i.e. a broad number of knowledgeable employees from different professions represented in the organisation – is as important as networking and exchange. This includes networking between organisations of similar scope and size (e.g. hospitals) but also with specialised organisations that provide expert knowledge.

There also arises a certain trajectory of implementation: The starting point are often good practices, which emerge locally, i.e. in single institutions and through the work of committed individuals, which then spread through professional networks in relevant fields. As a second step, the recognition of these good practices and their formalisation at the level of national policies might follow. Even though this high-level recognition ensures the rapid spread of practices, it cannot guarantee the quality of implementation. This in turn might be fostered by the involvement of third-party organisations providing specific expertise and experience with exemplary cases.

The findings show that the successful implementation of sustainable DV-related education and support depends on a broad range of factors, including committed individuals on the local level as well as opportunities within organisations that enable sustainable implementation, and favourable political forces. With its combination of research, development of educational materials and train-the-trainer courses, the VIPROM-project seems fit to play a strong part in these developments.

MORE INFORMATION ON DOMESTIC VIOLENCE

If you are interested to learn more about domestic violence in the health sector, please visit our European training platform on domestic violence.

SOURCE

1. Alice Pearl Sedziafa, Eric Y. Tenkorang (2024). Institutional challenges to delivering domestic violence services in Ghana: A case of structural violence?, Women’s Studies International Forum, Volume 104, https://doi.org/10.1016/j.wsif.2024.102894.

ABOUT THE AUTHORS

Dr. Stefanie Mayer, is a researcher at the Institute for Conflict Studies (IKF) in Vienna. She studied political science at the University of Vienna finishing her Master in 2004. Since then she has been working as a researcher in various institutes and took part in a 3-year post-graduate programme in sociology at the Institute for Advanced Studies (IHS). 2016 she finished her dissertation on debates on racism and anti-racism in white feminist activism in Vienna. Her research focusses on gender issues in different social fields as well as critical intersectional perspectives on antifeminism and other ideologies of inequality.

Dr. Michaela Scheriau, works as a social science researcher at VICESSE (Vienna Centre for Societal Security) and is involved in the VIPROM project amongst others. She holds a master’s degree in Sociology (2015) and a PhD in Science and Technology Studies (2023) both from the University of Vienna. Her PhD project focused on bioethical decision-making in assisted reproductive medicine. Besides that, her research focus lies on the surveillance and governance of and through technology more broadly.

Brigitte Temel, MA, is currently a researcher ath the Institute for Clonflict Studies (IKF) in Vienna. She finished her master’s degree in Gender Studies (2015) at the University of Vienna. Her research focuses on violence against women, gender and sexuality, LGBTIQ studies and antifeminism.