Professionalism and Accountability Joy Wingfield Short residential course

Professionalism and Accountability Joy Wingfield Short residential course Session 4 September 11 th 2006 1

The nature of professionalism • • Let’s have a debate! “professional” vs “amateur” “professional” vs “tradesman” What is a professional? What is a “professional” job? What is unprofessional? Why does it matter? 2

A definition of a profession • An occupation – Mastery of knowledge and skills – Vocation using knowledge in service of others – Competence, integrity, morality and altruism – Promotion of public good – Social contract – Right to autonomy and self-regulation – Accountable to those serviced and society • Do you agree? 3

RCP Working Party “Medical professionalism implies a set of values, behaviours and relationships that underpin the trust the public has in doctors” “Medicine is a vocation (whose) purpose is realised through a partnership between patient and doctor, one based on mutual respect, individual responsibility and appropriate accountability” 4

There’s more! “In their day-today practice, doctors are committed to integrity, compassion, altruism, continuous improvement, excellence and working in partnership with members of the wider healthcare team” So, not just evidence-based medicine then! The trend of change (direction of travel!) is away: from self regulation and privilege – may be good from discretion, judgement – may be bad 5

Ethical basis for professionalism • Why do we have a duty to care? • Let us analyse this from perspective of: – Deontology - duty based morality – Utilitarian – goal based morality – Virtue ethics – Rights morality 6

Definitions • Responsibility – Your job to do a specific task but not necessarily more • Accountability – Your job to achieve a specific outcome, ensure that others do their specific tasks and can be called to account for failures • Liability – Can be called to account in law and possibly pay if failure leads to harm 7

Accountability Exercise Suppose you are a pharmacist researcher – to whom are you accountable? At least six! 8

Personal accountability • Accountable for – Doing the “right” thing – Not doing the “wrong” thing - or nothing – Putting “wrong” things “right” – whistle blowing – Professional autonomy? independent? – Team working – other hcps and technicians – Addressing power imbalance – Vulnerable recipients – Specialist skills 9

Professional accountability • If you are on the register you claim particular knowledge and expertise • RPSGB disciplinary processes • Code of Ethics, professional performance, personal responsibilities, service standards • To what extent should personal conscience compromise the provision of healthcare? 10

Legal accountability and liability • Civil law – tort of negligence – clinical negligence – duty of care • Statutory criminal law – offences, prosecution, fines and prison • Statutory administrative law – Performance of NHS contract – Duty of quality – clinical governance – Administrative justice – fair, consistent, transparent and rational decisions 11

Healthcare accountability • Bristol, Alder Hey – Clinical governance – Healthcare Commission – NICE and NSFs – RCP Working Party on professionalism • Plus Shipman – Death of self-regulation – Centralised state control of professions? 12

Accountability in employment • • Independent practitioner vs employee Employer-employee contract Professional autonomy and discretion Commercial and patient confidentiality Vicarious liability and indemnity insurance Free-lance, locums, “extra” duties Compliance with organisational norms, policy, protocols, SOPs see session 10 13

Accountability and commerce • Commercial activities – price cutting, promotions, advertising, link selling • Patient – customer spectrum • Paternalism and autonomy in a shop • Economic goals - , sales, profit, dividends • Ethical anxiety from conflicting goals • Role of superintendent, middle managers – see session 10 14

How many accountabilities? • A pharmacist researcher is accountable to: – The sponsor – The research ethics committee – Research “gatekeepers” such as employers of staff to be interviewed – The research participants – The profession of pharmacy – The wider public – Any more? 15