Professional Accountability
in Healthcare
3HL002
2015-2016
Prepared by Sally Sturge
• To discuss the meaning of professional accountability and
to explore how healthcare workers are made accountable
for their behaviour and actions.
Aim
By the end of this teaching session you should be able to;
• Define ‘professional accountability’
• Identify the ‘Code of Conducts’ that healthcare
professionals abide to.
• To explore the differing ways that formal accountability
is enforced.
Intended learning
outcomes
• In pairs discuss what you think ‘professional
accountability’ is. Transfer these findings onto poster
notes.
Group work
• Must be prepared to describe and justify your actions to
others.
• To provide an account of your actions.
• If you are not able to provide an account of your actions,
you and/or your organisation will be held responsible.
• You must always act lawfully, whether those laws relate
to your professional practice or personal life.
Professional
accountability
• I was visiting a relative in a care home the other day and
she rang the bell to ask for a cup of tea. Nobody came for
half an hour and when the care assistant did arrive my
relative said, ‘I’ve been ringing my bell for half an hour,
what have you been doing?’ The care assistant apologised
and said that she had been helping with another resident
who wasn’t feeling very well.
• Is this a form of accountability?
Case study
• The care assistant felt obliged to justify her behaviour.
• Although my relative didn’t have a lot of power to
impose penalties on her – certainly not compared with the
power that a line manager or care homes inspector has –
but she could have complained to the manager of the
home or to a visiting inspector.
• In this sense she did have some power to hold the care
assistant responsible for her actions.
• It’s not just about record keeping!!!
Yes
• So who was accountable for what happened?
Case Study - Sophie
NMC (2015)
Prioritise People – Treat people as individuals and uphold their dignity;
• ‘Make sure you deliver the fundamentals of care effectively’
Prioritise People - Listen to people and respond to their preferences and
concerns;
• ‘Work in partnership with people to make sure you deliver care
effectively’
Practise Effectively – Always practise in line with the best available
evidence;
• ‘Maintain the knowledge and skills you need for safe and effective
practice’
Practise Effectively – Work Cooperatively
• ‘Respect the skills, expertise and contributions of your colleagues,
referring matters to them when appropriate.
Marie’s accountability
Preserve Safety – Recognise and work within the limits of your
competence
• ‘Make a timely and appropriate referral to another practitioner when
it is in the best interests of the individual needing any action, care or
treatment’
Preserve Safety - Act without delay if you believe that there is a risk to
patient safety or public protection
• ‘Raise your concerns immediately if you are being asked to practise
beyond your role, experience or training’
Promote Professionalism and Trust – Uphold the reputation of your
profession at all times
• ‘Keep to and uphold the standards and values set out in the code’
NMC (2015) cont…
Health and Care Professions Council (hcpc) (2008)
You must act in the best interests of service users;
• ‘You must protect service users if you believe that any situation puts
them in danger’
You must keep your professional knowledge and skills up to date;
• ‘You must make sure that your knowledge, skills and performance
are of a good quality, up to date, and relevant to your scope of
practice’
• ‘You need to make sure that whatever your area of practice, you are
capable of practicing safely and effectively’
You must act within the limits of your knowledge, skills and experience
and, if necessary, refer the matter to another practitioner;
• ‘When accepting a service user, you have a duty of care. This
includes the duty to refer them to others for care or services if it
becomes clear that the task is beyond your own scope of practice.’
Marie’s accountability
NMC (2015)
Practice Effectively – Work Cooperatively
• ‘Maintain effective communication with colleagues’
• ‘keep colleagues informed when you are sharing the care
of individuals with other healthcare professionals and
staff’
• ‘Work with colleagues to preserve the safety of those
receiving care’
• ‘Support students and colleagues learning to help them
develop their professional competence and confidence’
Joan’s accountability
Health and Care Professions Council (hcpc) (2008)
You must act in the best interests of service users;
• ‘You are responsible for the appropriateness of your decision to
delegate a task. You must be able to justify your decisions if asked
to.’
You must communicate properly and effectively with service users and
other practitioners;
• ‘You must communicate appropriately, cooperate, and share your
knowledge and expertise with other practitioners, for the benefit of
service users’
You must effectively supervise tasks you have asked other people to
carry out;
• ‘Whenever you give tasks to another person to carry out on your
behalf, you must be sure that they have the knowledge, skills and
experience to carry out the tasks safely and effectively’
• ‘You must always continue to give appropriate supervision to
whoever you ask to carry out a task.
Joan’s accountability
• Explicit statements about responsibilities.
• Procedures to make performance or outcomes visible.
• Penalties for poor performance (and rewards for excellent
performance).
• Official mechanisms for examining performance.
• Process for investigating when things go wrong.
Being made formally
accountable
• Contract of employment and a job description.
• For example, if we refer back to Sophie’s case study, Marie’s
job description will state that she is expected to support
residents in becoming as independent as possible. If Marie
consistently did things for Sophie that she could ably or
willingly do (because it was quicker, for example) she could be
made accountable for this behaviour by referring to her job
description.
• After Marie had been in the job for a few weeks, she also
found a set of guidelines in the staff handbook which covered
things such as what to do if a resident has a fit, and safety
issues to remember if arranging a holiday for a resident.
Explicit statements about
responsibilities
• To keep a record of the support you have given to a
client/patient.
• Which methods have you used or observed to comply
with this standard?
Procedures to make
performance or outcomes
visible
• What do we mean by this from a professional
accountabilities perspective?
Penalties for poor performance
(and rewards for excellent
performance).
•
•
•
•
Orientation induction
Probation period; regular formal review meetings
Appraisals
Can you think of any other ways to examine
performance?
Official mechanisms for
examining performance.
• Complaints procedure leads to an investigation.
• Grievance or disciplinary procedure which other staff can
use if they have a serious complaint about another
members behaviour or performance.
Process for investigating
when things go wrong
• How can we create real accountability in healthcare
services?
Creating real
accountability
Planning
Implementation
Review and
monitoring
Service Users
• Internet
• Freedom of Information Act (2000)
• These two factors allows service users to find out most of
the information that an agency keeps about its
performance and can use this to inform their own
situation.
Individual service users’
access to knowledge
• Actively listen to service users,
• Prioritise service users’ interests over ‘what is usually
done’,
• Reduce power imbalance by sharing information,
• Be honest about the dilemmas you face.
Professional behaviours
• Being accountable means that you have an obligation to
describe and justify your actions to others so that they can
judge whether you have fulfilled your duties adequately.
• Health and social care workers and organisations are
accountable to many different people and agencies. This can
lead to conflicts of accountability.
• People can be made accountable quite formally through
paperwork and procedures or more informally through
everyday conversation.
• Real accountability can be increased by involving service users
in the management, design and evaluation of services, and by
professionals acting in empowering ways.
Key points