1. Professional Accountability in Healthcare
3HL002
Prepared by Sally Sturge

2. To discuss the meaning of professional accountability and to explore how healthcare workers are made accountable for their behaviour and actions.
Aim

3. Intended learning outcomes
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

4. In pairs discuss what you think ‘professional accountability’ is
In pairs discuss what you think ‘professional accountability’ is. Transfer these findings onto poster notes.
Group work

5. Professional accountability
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

6. 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

7. Yes 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

8. So who was accountable for what happened?
Case Study - Sophie

9. Marie’s accountability
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

10. 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…

11. Marie’s accountability
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

12. Joan’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

13. 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

14. Being made formally accountable
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

15. Explicit statements about responsibilities
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

16. Procedures to make performance or outcomes visible
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

17. What do we mean by this from a professional accountabilities perspective?
Penalties for poor performance (and rewards for excellent performance).
Disciplined
Sacked
Performance managed
Bonus
Promoted
Learning opportunities given with full funding.

18. Official mechanisms for examining 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.
Service user feedback

19. Process for investigating when things go wrong
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

20. Creating real accountability
How can we create real accountability in healthcare services?
Creating real accountability

21. Planning
Implementation
Review and monitoring
Service Users

22. Individual service users’ access to knowledge
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

23. Professional behaviours
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

24. 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