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

2 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?

3 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?

4 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”

5 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

6 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

7 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

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

9 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

10 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?

11 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

12 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?

13 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

14 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

15 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?