Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire Healthcare NHS Foundation Trust 25 November 2014

Outline Increased focus on professionalism in UK – why? Findings from research How this relates to current challenges

‘Rude’ staff in an Outpatient Department “ I was attending for a clinic visit, nobody waiting at book in desk except me. One receptionist at desk, who kept head down and didn’t bother to acknowledge me in any way. I was left standing for 5 minutes until I had to sit due to knee pain. Another receptionist arrived at the second desk, they now both continued to ignore me while discussing a booking for a New York trip between their self’s” Increase in public expectations

Going for a scan – a story of two hospitals “ I know the NHS is stretched but it isn’t really the lack of resources which gave me the good/bad experience, it was the way the process was delivered – the basic care, compassion, understanding and professionalism were the elements which made each experience what is was”

The power of the patient and service user voice Patient opinions online Set up in ,086 stories told Positive and negative comments posted on line Many complaints about organisational and resource issues but also about care and communication with professionals

HCPC: who do we regulate? 329,000 registrants from 16 professions

Four processes set standards approve courses that meet them registers those who pass them holds them to its standards HCPC

What are complaints about? HCPC data % Source: HCPC Fitness to Practise Annual Report 2013

Reasons behind complaints from the public Reasons% Communication10% Communication and clinical care35% Clinical care35% Clinical care and probity2% Probity4% 51% = issues of professionalism Source: GMC State of Medical Education 2013

HCPC standards Consultation April 2015

On line professionalism: findings from the US Young, 2012 Types Inappropriate patient communication (69%) Mis-representation of credentials (60%) Outcomes Restrictions on license to practise (44%) Doctor suspended (33%) Issues Patient confidentiality Inappropriate contact Mis-information Depicted use of alcohol

Social networking and confidentiality - recent fitness to practise concerns at HCPC Dietitian – posted information about a patient’s diagnoses, care, medication, and personal circumstances, and published information about colleagues and their place of work on their personal blog Paramedic – uploaded a patient’s x-ray to a social network Clinical scientist – posted unfounded derogatory comments about a colleague’s practice using an alias on a professional forum

HCPC Research on professionalism Qualitative study with students and educators Explored perceptions of professionalism Three professions – paramedic, occupational therapy and podiatry University based programmes Focus groups and interviews (n=115) Second part of the study looking at measurement of professionalism

How is professionalism played out in practice? good clinical care or ‘doing the job well’ self awareness knowledge, skills & ability putting patients first following protocols, maintaining standards

Situational awareness and contextual judgement Negotiating boundaries “ You’re told you shouldn’t kind of do that thing [give a client a hug] but sometimes if you know your client well and...you have a frail old lady who is very upset it might be appropriate to just put your arm around them because we’re human, it’s compassion...it’s kind of knowing your client.” (placement educator)

Findings Professionalism perceived as an holistic concept Defined by context (including organisational support, the workplace, expectations of others, specifics of the service user encounter) Views did not differ significantly (regardless of professional group, training route or status as student or educator) “Rather than a set of discrete skills, professionalism may be better regarded as a meta-skill, comprising situational awareness and contextual judgement, which allows individuals to draw on the communication, technical and practical skills appropriate for a given professional scenario.”

Some examples of AHP strengths Clear communication Active listening Engagement Relationships Building confidence Focus on quality of life Involving users and carers in decision making

Evidence and values “To cope with the future, post modern healthcare will not only need to retain and improve on the achievements of the modern era, but also respond to the requirements of post modern society – namely, concern about values as well as evidence”. Muir Gray, 1999 Post modern medicine Lancet 354, p.1550

Maintaining professionalism together Studies Bergman et al (2007) Leistikow et al (2011) Hickson (2007) Common theme…. Peer led discussion and peer feedback is a key influence on behavior and self awareness

Conclusions For the regulators… Changes to training on professionalism and ethics Changes to standards For practitioners… More conversations about professionalism More engagement with service users Greater use of user feedback alongside other outcome measures

References ABMS Professionalism Working Group, American Board of Medical Specialties, January Bergman, D, Arnetz, B, Wahlstrom, R, Sandahl,C. (2007) Effects of dialogue groups on physicians work environment. Journal of Health Organization and Management 21(1) p Crotty, B, Mostaghimi, A. (2011) Professionalism in a digital age. Annals of Internal Medicine 154, GMC The State of Medical Education GMC Fitness to Practise Factsheet Greaves, F, et al. (2013) Use of sentiment analysis for capturing patient experience from free text comments posted on line. Journal of Medical Internet Research 15(11) e239. HCPC (2013) Fitness to Practise Annual Report. HCPC (2011) Professionalism in healthcare professions. Hickson, G. et al. (2007) A complementary approach to promoting professionalism. Academic Medicine, 82 (11) p Leistikow, I, Kalkman, C, De Bruijn. (2011) Why patient safety is such a tough nut to crack. British Medical Journal, 342;d3447. Wynia, M, Papadakis, M, Sullivan, W, Hafferty, F. (2014) More than a list of values and desired behaviours; a foundational understanding of medical professionalism. Academic Medicine, 89, Young, A. (2012) Online professionalism; challenges and opportunities. International Association of Medical Regulators Conference, Ottawa, Canada, October

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