5 Crucial Steps to Take NOW for Sexual Abuse and Molestation (SAM) Safety in Healthcare

When we think of healthcare, we usually picture doctors, nurses and other medical professionals working hard to improve our health. But there's a critical aspect of healthcare that often gets overlooked: patient safety, particularly when it comes to maintaining emotional and physical boundaries. This is especially important in preventing sexual abuse and molestation (SAM) in healthcare settings.

Unfortunately, healthcare spaces can sometimes become places where vulnerable patients are at risk. That's why it's crucial for healthcare systems, providers and organizations to take proactive steps to protect patients from any form of sexual abuse or exploitation.

In this article, we'll explore five key actions healthcare providers must take right now to ensure patient safety and prevent SAM. These steps not only protect patients but also help safeguard healthcare providers, fostering a culture of trust, transparency and professionalism across the organization.

This article is part of OmniSure’s series on 25 Trends in Risk Management for 2025. Here, we dive into the first of five important issues, focusing on how the healthcare industry can tackle SAM and improve patient safety in the year to come. As the healthcare landscape evolves, making SAM prevention a top priority is more important than ever.

1 — Make Patient Advocates the Standard of Care in Healthcare

To truly protect patients, especially during sensitive medical procedures, healthcare must undergo a major shift. One of the most important changes we can make is to ensure patient advocates become a standard part of the care process. But what does that really mean, and why is it so critical? Let’s break it down and explore how integrating patient advocates can help create a safer and more respectful healthcare environment.

What Is a Patient Advocate?

In the past, the term “chaperone” referred to someone present during intimate exams, but the role of a patient advocate goes much further than that. A patient advocate is a neutral third party whose main job is to ensure the patient’s rights, dignity and safety are always respected, while also supporting the healthcare professional.

Patient advocates step in when patients are at their most vulnerable — whether they're undressed, sedated or receiving intimate care. Their role is to observe the interaction between the patient and the healthcare provider, and to intervene if anything deviates from standard procedures, could be misunderstood, seems wrong or violates trust. They act as a safeguard for both the patient and the provider, helping protect everyone’s rights and boundaries.

The Importance of Patient Advocates in Healthcare

Having a patient advocate in the room isn’t just a “nice-to-have” feature — it’s essential for creating a safe, transparent and respectful healthcare environment. In the past, patients often had to request an advocate if they felt uncomfortable, which places an unfair burden on them, especially when they’re expected to trust their healthcare professionals. Instead, healthcare providers should automatically include an advocate whenever a patient is vulnerable. Although the advocate’s interventions may be small, such as repositioning a drape for modesty, their impact on patient care, safety and experience is significant.

This should become standard practice in situations like:

• Intimate exams
• Sedation
• Care for minors or patients with disabilities

Making It Standard Practice: Healthcare Training and Staffing

For patient advocates to become a standard part of care, healthcare organizations must prioritize all staff members — whether they're front desk workers, medical techs or doctors — are trained to offer and arrange for an advocate when needed. This is a team effort, and everyone needs to be on the same page.

Cross-training programs and competency checklists can help make sure this policy is followed consistently across the organization. It's not just about having advocates available; everyone must know when to offer one and how to do so in a way that puts patient safety first.

Onboarding and Ongoing Training

·???????? Effective onboarding and ongoing training are key to preventing abuse and ensuring patient safety. New hires need to understand what constitutes misconduct and how it impacts both the patient and the organization. From the start, a clear zero-tolerance policy for inappropriate behavior should be set.

·???????? Ongoing training keeps staff up to date on new laws, policies and emerging healthcare issues. Regular education helps everyone recognize sensitive situations and respond the right way. This approach maintains a high standard of care and always prioritizes the well-being of patients.

Credentialing: Ensuring Safe Staff

·???????? Credentialing is a crucial part of keeping patients safe. Background checks, license verification and reference checks are crucial first steps to ensure that healthcare staff are trustworthy and qualified to provide care.

·???????? Regular screenings help identify any potential issues before they escalate, making sure all staff members are continuously clear of any allegations against their license and committed to maintaining a safe environment for patients.

Do you have a patient-advocate-friendly environment?

Integrating patient advocates into the care process is a vital step toward creating a safer, more ethical healthcare environment. By making advocates a standard part of care, healthcare organizations can ensure that patients feel protected and respected, while also empowering staff to maintain high standards of safety and trust. This approach strengthens the entire healthcare system, fostering transparency and professionalism at every level.

2 — Educate Patients About What To Expect During Medical Exams To Prevent Sexual Abuse

One of the best ways to reduce anxiety and avoid misunderstandings during medical exams is by clearly explaining what patients can expect. This is especially important for sensitive procedures that might make patients feel vulnerable or anxious. Reporting inappropriate behavior is difficult if a patient is not provided with clear expectations prior to the exam or procedure. When patients are well-informed, they feel in control and confident about their care.

How To Educate Patients

Healthcare providers have several ways to ensure patients know what to expect before, during and after their exam or procedure. This includes:

• Pre-appointment handouts: Giving patients clear, easy-to-read materials when they schedule or check in for their appointment helps set expectations. These handouts should explain the steps of the exam and let the patient know when a patient advocate will be present.
• Patient portals: Leveraging mobile accessible tools allows patients to digest information when they are best positioned to learn. These tools often offer the provider the ability to track patient engagement and the opportunity to offer targeted reinforcement or comprehensive education as needed.
• Posters in exam rooms: Placing simple, visible signs in exam rooms serves as a helpful reminder for patients. These posters can outline the procedure and explain the advocate's role, which can ease anxiety by giving patients a visual reference.
• Patient navigators: In specialized areas like gynecology or urology, patient navigators (trained professionals) can walk patients through sensitive procedures, answer questions and offer emotional support both before and during the exam.

Example of exam explanation:

Pelvic Exam

• Undressing: You’ll be asked to undress from the waist down and cover yourself with a sheet for privacy.
• Positioning: You’ll lie on your back with your legs in stirrups, which allows the provider to perform the exam.
• Patient advocate: A patient advocate will be present to make sure you feel comfortable and respected throughout the procedure.
• During the exam: The provider will start with an external visual exam, then use a speculum for an internal check (such as a Pap smear or HPV test). They may also perform a bimanual exam to check your uterus and ovaries. In some cases, a rectovaginal exam might be included.

Encourage Patient Questions

Patients should always feel comfortable asking questions or raising concerns before their exam. This open dialogue helps prevent confusion and ensures patients feel heard and respected. Healthcare providers can encourage this by asking simple questions like:

·???????? “Do you have any questions about the exam or what we're going to do today?”

·???????? “Is there anything you're unsure about or anything you'd like me to explain more?”

·???????? “How are you feeling about the procedure? Anything on your mind before we start?”

·???????? “Patients sometimes ask what equipment will be used. Would you like an overview?”

Make Patient Education an Essential Part of Care

Educating patients about what to expect during their exams can significantly reduce anxiety and improve their overall experience. Whether it’s through handouts, posters, patient navigators or encouraging open dialogue, clear communication is essential. The message to patients should be: Don’t hesitate to ask questions, voice your concerns or share how you're feeling. Your healthcare team is there to support you and ensure your experience is as comfortable and straightforward as possible.

3 — Implement a Speak-Up Program

Building a culture of accountability is essential for preventing abuse. That’s why healthcare systems need to create an environment where everyone including, patients, staff and visitors feels comfortable speaking up?if they notice anything questionable, confusing, inappropriate or concerning.

Learn from Other Speak-Up Campaigns

Campaigns like the “Handwashing Posters” in hospitals or the familiar “See Something, Say Something” slogan at airports show just how powerful simple, clear messaging can be. A similar approach could make a big difference in healthcare settings.

An easy-to-remember slogan such as “Courage Speaks — Safety Listens” could be displayed on posters throughout hospitals or clinics. These reminders would reinforce the message to everyone — staff, patients and visitors — about the importance of speaking up and ensuring safety at all times.

Create a Culture of Safety

A speak-up culture isn’t just about encouraging people to report issues; it’s about creating a safe environment where everyone feels comfortable doing so. Staff should be trained to recognize inappropriate behavior and understand how to report it without fear of retaliation. Having open conversations about what counts as inappropriate behavior and how to speak up should be a natural part of the workplace culture.

Here are five tips for creating a successful Speak-Up Campaign:

·???????? Keep the messaging clear and simple: Make sure the campaign uses easy-to-understand, memorable messages that everyone can relate to. Something like the “See Something, Say Something” slogan clearly communicates which behaviors are unacceptable.

·???????? Use visible reminders: Display campaign materials — posters, flyers and digital signs — throughout the facility, especially in high-traffic areas like break rooms, waiting areas and hallways. This helps reinforce the message throughout the day.

·???????? Offer anonymous reporting options: Give staff, patients and visitors a confidential and easy way to report concerns, whether it’s through a hotline, secure website or physical drop boxes. This ensures privacy and protection for those who might fear retaliation.

·???????? Get leadership involved: Leaders should actively support and promote the campaign, leading by example. When leadership openly emphasizes the importance of speaking up, it shows staff that the initiative has their full backing.

·???????? Provide ongoing training: Offer regular training sessions to teach everyone how to recognize inappropriate behavior and how to report it. Don’t make it a one-time thing — consistent reinforcement keeps the campaign top of mind and boosts its effectiveness.

5 Signs of Potential Sexual Abuse by a Healthcare Provider

Sexual abuse in healthcare settings is a serious issue, yet it often goes underreported. Patients, especially those in vulnerable situations, can be more susceptible to exploitation by healthcare providers. To protect those at risk, it's crucial to recognize the signs of potential sexual abuse. Here are five key indicators everyone should watch for:

1.?????? Inappropriate Physical Contact or Invasive Examinations

What to Watch For: Unnecessary or excessive physical contact, especially when it feels unwarranted or uncomfortable. For example, a provider touching private areas without consent or clear explanation. Routine exams should never make a patient feel violated. If something feels off, trust the patient’s discomfort.

2.?????? Patient Shows Fear or Discomfort Around Certain Healthcare Providers

What to Watch For: If a patient seems anxious, scared or reluctant when a specific provider enters the room or is assigned to their care. This could be a sign of past inappropriate interactions, especially if there’s no obvious medical reason for their reaction.

3.?????? Conflicting or Inconsistent Explanations for Medical Procedures

What to Watch For: A provider offering vague or inconsistent explanations about procedures, particularly those involving intimate areas of the body. If the explanation doesn’t match standard practices or makes the patient uneasy, it might be a red flag for inappropriate behavior.

4.?????? Unexplained Injuries or Trauma to Private Areas

What to Watch For: Unexplained injuries, bruising or trauma in the genital or breast areas that don’t have a clear medical cause. These may be dismissed as part of routine care but should be taken seriously and documented carefully, as they could indicate sexual abuse or mistreatment.

5.?????? Sudden Behavioral Changes or Withdrawal After Provider Interactions

What to Watch For: If a patient suddenly becomes withdrawn, depressed or fearful after interacting with a specific provider, especially following an intimate procedure or exam. A shift in behavior could suggest that something inappropriate happened during the care they received.

Recognizing these signs is essential for everyone involved in patient care. If anyone suspects sexual abuse, speaking up promptly is crucial to protecting vulnerable patients and ensuring the right action is taken.

4 — Provide Bystander Training

Bystander training is an essential tool for creating a safe healthcare environment where everyone feels comfortable and supported in speaking up when something doesn’t seem right. It's not just about recognizing inappropriate behavior — it’s about knowing how to act on it. Below are some real-life scenarios and tips on how to express curiosity, advocate in the moment, intervene, elicit patient feedback and report concerns appropriately.

How To Express Curiosity When Something Feels Off

Sometimes, the first step in preventing misconduct is simply noticing when something is unusual. For example, if a staff member sees a provider hugging a patient, it's okay to express concern, especially if it's not typical practice in the healthcare setting.

·???????? Bystander: “I noticed you hugging a patient. That’s not something we see every day. Are you okay? What’s going on?”

·???????? Provider: “She asked for a hug because she just learned she has cancer. I told her I don’t usually hug patients, but I made an exception in this case because she had no family with her.”

·???????? Bystander: “Makes sense. Just be sure you document that so there’s no misunderstanding. I’d hate to see that come back and bite you if the patient has a change of heart or if someone else saw what I saw. You never know these days.”

This kind of gentle questioning is essential for protecting both patients and providers. It shows concern without immediately assuming something inappropriate happened. The goal is to ensure transparency, good communication and proper documentation to avoid future misunderstandings.

How To Advocate in the Moment

Sometimes, it’s not about questioning behavior, but about advocating for the right course of action in the moment. Here’s an example:

·???????? Bystander: “Dr. Jones, don’t forget this,” handing him exam gloves.

This small action ensures that proper protocols are followed, helping the provider stay on track with patient safety standards.

How To Intervene

Intervening is sometimes necessary to prevent a potential issue from escalating. Here’s a scenario where a dental hygienist might be about to violate safety protocols:

·???????? Bystander: “Harry, the patient is sedated, and you can’t be alone with her or let anything block the line of sight until Dentist Falk arrives. There must be at least two people with the patient at all times. I’ll stay with you and the patient.”

This intervention ensures patient safety by reinforcing guidelines, while also providing support to the healthcare provider, helping them stay within professional boundaries.

How To Elicit Patient Feedback

It's crucial to make sure patients feel comfortable expressing concerns. If a bystander notices that a patient seems uneasy, they should gently inquire:

·???????? Bystander: “Patient Sue, I’m concerned about your well-being. You seem startled or uneasy. Is there anything or anyone that’s made you uncomfortable?”

This open-ended question invites the patient to share their feelings without fear of judgment or retaliation. It creates an opportunity for the patient to voice concerns, which could be a critical part of identifying potential issues early on.

How To Report Incidents

If a bystander sees something that raises red flags, reporting the concern is the final, crucial step. Whether it’s through a formal system or speaking with a manager directly, the bystander should follow the reporting protocols in place. This is essential to ensure the issue is properly addressed and investigated.

The goal of bystander training is to empower everyone in the healthcare environment — from medical staff to support personnel — to act in ways that prioritize safety, transparency and respect. By encouraging a culture where speaking up is the norm, not the exception, healthcare facilities can prevent harm and maintain trust within the system.

5 — Consider Collateral Sources of Information

In healthcare, protecting patients and ensuring a safe environment requires more than just criminal background checks. While these checks are important, they don’t paint the full picture. To truly safeguard your patients, you need to gather information from multiple sources and be on the lookout for subtle signs of potential issues. Here’s how to take a more well-rounded approach to identifying risks.

Know the Red Flags of Sexual Abuse and Molestation

When hiring or evaluating healthcare professionals, it’s essential to watch for behaviors that, while seemingly harmless, may signal deeper problems. These “red flags” can point to potential ethical violations or misconduct. Here are a few to keep in mind:

• Grooming behaviors: Does the staff member frequently volunteer for late-night shifts alone? Do they go out of their way to help others or give favors that seem excessive? While these actions may seem generous, they can also be a way to build trust and create opportunities for inappropriate behavior.
• Boundary-pushing comments or actions: Pay attention to how individuals interact with others. Do they make jokes that cross the line, or brush off inappropriate comments as “just jokes?” Normalizing such behavior can desensitize others to increasingly inappropriate actions, making it harder to identify when things go too far.

While these behaviors may not immediately indicate something serious, they’re worth investigating. The sooner you spot them, the easier it is to prevent bigger problems down the road.

Standardize Feedback Collection

Another key to identifying potential issues is to regularly collect feedback from both employees and patients, right after an interaction. Don’t wait weeks or months to gather this information. Timely feedback helps organizations catch problems early and ensures that people feel comfortable speaking up.

Ask open-ended questions such as:

• “Was there anything or anyone that made you feel uncomfortable today?”
• “What was the best part and the worst part of your experience?”

These simple questions can provide insight into what patients or employees are experiencing and help shine a light on any red flags before they turn into bigger issues. Make feedback collection a regular part of the process — whether it’s through brief surveys or routine check-ins with staff. The more consistently an organization collects feedback, the more likely it is to catch issues before they escalate.

Don’t Silo Abuse Reporting

Abuse reporting shouldn’t be left to one department or group. Encouraging open communication across teams is critical for identifying and addressing issues early. Often, it’s not the victim who reports misconduct — it’s a colleague, a patient or even an outside observer who spots troubling behavior.

For example:

• In one case, a security guard noticed a man photographing up women’s skirts. What seemed like an isolated incident led to the discovery of a much larger abuse case involving the woman being drugged and assaulted by her husband and others.
• In another case, an investigation into child pornography uncovered evidence of abuse by a dental assistant. Though the initial investigation had nothing to do with abuse, further reports of suspicious behavior ultimately connected the dots.

These examples highlight the importance of paying attention to all sources of information, no matter how minor they may seem. Encouraging open reporting across departments helps connect the dots and reveals patterns that might otherwise go unnoticed. If a nursing assistant notifies Human Resources that a nursing supervisor has created a hostile environment by using sexually explicit language to describe her colleagues, Human Resources should alert the Patient Safety Officer and/or the Risk Manager who can investigate if or how the supervisor’s behavior has or could impact patient care. ?

Use Trusted Outside Eyes for Risk Assessment

It’s also a good idea to bring in outside experts who can evaluate the organization’s risk from an unbiased perspective. Independent risk assessments can identify blind spots that those within the organization may overlook. For example, OmniSure has been helping professional liability insurers spot risks, make recommendations and reduce harm for over 25 years.

By having a trusted third party assess practices, you can gain fresh insights into potential vulnerabilities in ?the organization. These experts can point out areas where system changes, procedures or standards of care can be improved to prevent abuse or misconduct, providing the opportunity to address issues before they become a problem.

Create a Culture of Awareness

Ultimately, patient safety and staff protection depend on taking a holistic approach. Relying on criminal background checks or any single source of information isn’t enough. By considering collateral sources — such as employee and patient feedback, cross-departmental communication and outside assessments — healthcare organizations can build a strong system for identifying and preventing abuse.

This proactive approach ensures that no issue slips through the cracks and helps the organization respond quickly if something does go wrong. It’s all about staying vigilant, connecting the dots and creating a culture where everyone feels responsible for the safety and well-being of those they serve.

Preventing Sexual Abuse and Molestation Starts Right Here, Right Now

A successful strategy to prevent and address sexual abuse in healthcare requires a collaborative, multidisciplinary team. Key roles that may already exist in the healthcare office or facility include:

·???????? Risk Manager: Oversees the reporting, documentation and investigation of abuse allegations. Works with legal teams and leadership to ensure a transparent process and protects whistleblowers and victims from retaliation.

·???????? Patient Safety Officer: Ensures patient safety by educating patients on their rights and abuse reporting procedures. Coordinates follow-up care, including emotional and physical support for victims, and provides access to counseling.

·???????? Quality Improvement Specialist: Ensures ongoing evaluation and improvement of abuse prevention policies. Regularly updates protocols, addresses weaknesses and keeps the organization proactive in maintaining patient safety.

·???????? Compliance Officer: Ensures adherence to legal and ethical standards. Oversees documentation practices and helps navigate legal challenges, minimizing organizational liability.

·???????? Education Specialist: Develops and implements training programs on recognizing, reporting and responding to abuse. Ensures that all staff receive trauma-informed care training and stay updated on best practices.

·???????? Clinical Representation: Front line clinicians (nurses, doctors, therapists) who identify signs of abuse and take immediate action to protect patients. Their insights help refine operational practices to safeguard patient well-being.

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