Last week, a year to the day after the Francis Report on Mid Staffordshire was published, we hosted a seminar to continue our discussions on professionalism and to launch the next stage of our research (1). The seminar was led by Professor Zubin Austin from the University of Toronto, who has a particular expertise around competence and how we understand it in a health and care context (2). We were particularly pleased to welcome so many representatives from professional bodies, employers, educators and other regulators to this forum.
Professor Zubin Austin’s work in Ontario illustrates a number of important themes highly relevant to the collective desire to see improvement in health and social care in the aftermath of Mid Staffordshire.
First, that patients and service users are likely to have different expectations of professional competence from professionals. Service users and patients want professionals to be ‘accessible’, and ‘affable’. Technical know-how is important, but not more important than clear communication and authentic respect.
Second, the evidence suggests that professionals who are competent have several characteristics in common: they are professionally networked, and express satisfation with their career choice and with their personal lives. The key factor in what Zubin calls ‘competency drift’ is isolation. Zubin suggested that disengagement in one’s workplace is often linked to disatisfaction more widely, and that the ‘firewall’ that existed for previous generations between the personal and the professional world no longer exists. The core problem with competency has very little to do with technical skills alone and everything to do with the individual.
During the discussions, there was agreement that competency is multifactorial and is influenced by the environment as well as the individual. There was an appetite for exploring this new discourse on disengagement further, and encouraging people in health and social care to talk about how and why it occurs. Some were concerned about how this could be measured, whilst others proposed that it was the conversations themselves that were key to change. The evidence from Ontario is encouraging. Where interventions along these lines have been introduced, complaints to regulators have reduced.
There was an acknowledgement that all the agencies have a role to play in this discourse. If we can recognise and address personal and professional isolation before it becomes the trigger for poor practice, we may have an influence on the number and nature of complaints that are made.
Professor Zubin Austin called it a journey of a thousand small steps. For service users, patients and professionals, it is surely a journey worth making.
Anna van der Gaag
Chair
HCPC
Anna, Zubin and colleagues feed back on the event
Dr Anna van der Gaag in conversation with Professor Zubin Austin
Notes:
(1) HCPC is commissioning research to look at the factors which can lead to poor practise, why things go wrong when they do using a qualitative study of fitness to practise cases. This work will be published in January 2015.
(2) Austin Z. (2013) How competent are we at assessing competency?
Keynote, CLEAR Congress on Professional and Occupational Regulation, Edinburgh, June 27-28, 2013 www.clearhq.org.
Showing posts with label research. Show all posts
Showing posts with label research. Show all posts
11 February 2014
20 November 2013
Understanding Public Protection
Because the fitness to practise is such an important part of the work we do to protect the public, it is an area we are constantly trying to increase our understanding of and a process we are always reviewing.Research
One important way we do this is through research. Today, we have released the data from our latest study, which shows that a fifth of UK adults have encountered behaviour from a health or care professional that made them doubt their fitness to practise.
The research also found:
- More than a quarter said the health or care professional in question seriously or persistently failed to meet standards.
- 16 per cent said they felt the professional failed to respect the rights of a patient to make their own choices.
- 13 per cent felt they were ‘hiding mistakes’.
- 9 per cent felt they were exploiting vulnerable patients.
- One in twenty said they had experienced or witnessed reckless or deliberately harmful acts.
Despite these figures, just three out of ten reported their concerns and a further 73 per cent said they would not know where to go to report concerning behaviour.
This data supports our research published earlier this year exploring public perceptions of the concept of public protection and how this might inform the fitness to practise of health and care professionals. That research showed that the public was most concerned about dishonesty, both on and off duty, and had an expectation that, at a minimum, professionals would be competent and qualified. Importantly, the public also thought that judgements should always consider the context of a situation and be made on a case-by-case basis.
The findings of both research reports are reassuring because we are dealing with the areas the public feel they need protecting from the most – skills and behaviour – and support the case-by-case approach we already take fitness to practise. See our latest annual report and key information for a look at what we have been doing over the past year to protect the public.
Improving the FTP process
In addition to making interesting reading for professionals and regulators alike, the findings of the research are helping us in a broader piece of work to improve the FTP process for all concerned, for example reviewing the information we provide about the process.
Earlier this year, we held an event with representatives from stakeholder organisations, including professional bodies, to discuss the research on public protection and explore how we can continue to do this. Some key themes emerged from the discussions. These included:
- More and clearer information for employers and registrants explaining the difference between the FTP and other disciplinary or criminal proceedings.
- Case studies indicative of FTP cases that could be used as learning and discussion points.
- Clearer information for service users about what an FTP case looks like to help manage expectations on what we can and cannot deal with, as well as support and clear signposting for service users when they have a concern that is not a FTP issue.
- Better integrated and more interactive information, including cross-referencing exiting documents and more video and multimedia content.
We will be looking at both the research and the feedback we have received so far as we continue our review of the FTP experience.
Brian James
Brian James
Head of Assurance and Development, Fitness to Practise
Notes:
- Today's research release
- Understanding public protection research, 2013
28 February 2013
Personal reflections post Francis
Yesterday, I attended a one-day conference on the Mid Staffordshire Report at the King's Fund. Listening to Robert Francis, I was reminded of an incident that took place many years ago when I worked as a speech and language therapist in a hospital unit providing care for the elderly. The incident concerned a lady who had a stroke, resulting in some weakness on her left side. She had severe difficulties expressing herself, although her understanding of language was unaffected. She knew exactly what was going on and what was said to her. She did not appear to have many visitors, but was always pleased to see me and was very motivated to work to regain her speech.
The enduring and disturbing memory triggered by Francis was of coming to her bedside, to find her distressed, agitated and unable to speak, gesturing frantically to me, pointing to her bed. Her sheets were wet and soiled. I got her out of bed and helped her to sit on the chair. I told her I would go and find help. I went to the nursing station; there was no one there. There appeared to be no one around. I eventually found a nurse and told her what had happened. She looked blankly at me. She said: “I'm the only one here. Everyone else is on a tea break.” I said: “Where are the sheets? Can I change Mrs W?” “No,” she said. “It's not your job.” “But she is very distressed,” I persisted. “She will have to wait until the others come back.” “No,” I said. “She needs help now.” I went back to Mrs W and explained that there were very few nurses about. “I know!” she cried.
For several days afterwards, she was subdued, tired easily and was less motivated to work on her speech. I spoke to colleagues about the incident. I felt there was something wrong with a system that could not respond to distress, still less find it acceptable that a speech and language therapist was interfering in the care of a patient. I don't know how typical this was at the time, of course. Nevertheless, in my view, this should not have happened.
Since those days in the early 1980s, the NHS has gone through at least a dozen re-organisations, as well as witnessing a few major inquiries. Sadly, the same themes recur. From patients, those themes are poor care, not enough staff, not knowing what is happening to them, and lack of involvement in decision making. At worst, they are about neglect, rudeness, and lack of respect from staff. What do staff say? Staff shortages, lack of management support, poor supervision, feelings of disempowerment and disconnection. I have often heard front-line nursing staff say they are too overworked and understaffed to be able to afford the luxury of talking with their patients. Too many demands lead to emotional shut down and apparent lack of compassion.
Francis highlighted for all of us involved in delivering health care that a positive culture and clear lines of accountability are not optional extras. They are fundamental to good care. One element necessary to create and sustain both of these is for professionals to have and maintain a clear sense of purpose and a shared set of values that drive everything they do. Some would call this the heart of professionalism. HCPC has been working over the last few years on a programme of research looking specifically at professionalism. We have known for some time that the majority of complaints are about conduct not technical competence. We wanted to address this, initially through research, and later through dissemination and debate with clinicians, educators and students, as well as within the regulatory community. We published the first report in 2011 and the second will come out in 2015. The wider questions we have posed for those on our Register are: What does being professional mean to you? What do you do if you see unprofessional behaviour in others? Can you have a conversation about difficult things, like being a witness to poor care? How is professionalism learned? How do you cope with the stress of being a professional caregiver, working daily with vulnerable people, dealing with unforeseen illness, disability, distress and uncertainty?
Nothing in the Francis report or in today's discussions leads me to think we need to do less. In fact, stepping up our call to registrants to deal constructively with these difficult issues seems all the more relevant in light of this report. We will be looking closely at our responsibilities as a professional regulator, what more we can contribute, and what needs to change in our standards and our engagement with other agencies. Whatever re-organisation the health service undergoes in the coming months and years, it must not lose sight of the need to address the fundamental commitment to care, which we know is not universally delivered, still less universally understood. In the words of Francis: "Every single person serving patients must contribute to a safer, committed and compassionate and caring service."
This is not just about doctors and nurses. If we do not act collectively, we are all undone.
Anna van der Gaag
28 February 2013
The enduring and disturbing memory triggered by Francis was of coming to her bedside, to find her distressed, agitated and unable to speak, gesturing frantically to me, pointing to her bed. Her sheets were wet and soiled. I got her out of bed and helped her to sit on the chair. I told her I would go and find help. I went to the nursing station; there was no one there. There appeared to be no one around. I eventually found a nurse and told her what had happened. She looked blankly at me. She said: “I'm the only one here. Everyone else is on a tea break.” I said: “Where are the sheets? Can I change Mrs W?” “No,” she said. “It's not your job.” “But she is very distressed,” I persisted. “She will have to wait until the others come back.” “No,” I said. “She needs help now.” I went back to Mrs W and explained that there were very few nurses about. “I know!” she cried.
For several days afterwards, she was subdued, tired easily and was less motivated to work on her speech. I spoke to colleagues about the incident. I felt there was something wrong with a system that could not respond to distress, still less find it acceptable that a speech and language therapist was interfering in the care of a patient. I don't know how typical this was at the time, of course. Nevertheless, in my view, this should not have happened.
Since those days in the early 1980s, the NHS has gone through at least a dozen re-organisations, as well as witnessing a few major inquiries. Sadly, the same themes recur. From patients, those themes are poor care, not enough staff, not knowing what is happening to them, and lack of involvement in decision making. At worst, they are about neglect, rudeness, and lack of respect from staff. What do staff say? Staff shortages, lack of management support, poor supervision, feelings of disempowerment and disconnection. I have often heard front-line nursing staff say they are too overworked and understaffed to be able to afford the luxury of talking with their patients. Too many demands lead to emotional shut down and apparent lack of compassion.
Francis highlighted for all of us involved in delivering health care that a positive culture and clear lines of accountability are not optional extras. They are fundamental to good care. One element necessary to create and sustain both of these is for professionals to have and maintain a clear sense of purpose and a shared set of values that drive everything they do. Some would call this the heart of professionalism. HCPC has been working over the last few years on a programme of research looking specifically at professionalism. We have known for some time that the majority of complaints are about conduct not technical competence. We wanted to address this, initially through research, and later through dissemination and debate with clinicians, educators and students, as well as within the regulatory community. We published the first report in 2011 and the second will come out in 2015. The wider questions we have posed for those on our Register are: What does being professional mean to you? What do you do if you see unprofessional behaviour in others? Can you have a conversation about difficult things, like being a witness to poor care? How is professionalism learned? How do you cope with the stress of being a professional caregiver, working daily with vulnerable people, dealing with unforeseen illness, disability, distress and uncertainty?
Nothing in the Francis report or in today's discussions leads me to think we need to do less. In fact, stepping up our call to registrants to deal constructively with these difficult issues seems all the more relevant in light of this report. We will be looking closely at our responsibilities as a professional regulator, what more we can contribute, and what needs to change in our standards and our engagement with other agencies. Whatever re-organisation the health service undergoes in the coming months and years, it must not lose sight of the need to address the fundamental commitment to care, which we know is not universally delivered, still less universally understood. In the words of Francis: "Every single person serving patients must contribute to a safer, committed and compassionate and caring service."
This is not just about doctors and nurses. If we do not act collectively, we are all undone.
Anna van der Gaag
28 February 2013
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