Professionalism in healthcare

Anna van der GaagAnna van der Gaag, Chair, Health and Care Professions Council, explores the link between multidisciplinary teams and thriving professionalism.

The most recent British Social Attitudes Survey suggests that patient satisfaction with accident and emergency services is at a six-year low. Across professional health regulation, complaints are at an all time high. Many of these complaints are about behaviour, ethics and professional conduct. Why is this trend occurring and what can we do to address poor practice before it leads to a complaint?

It is likely that the increase in complaints and decrease in levels of satisfaction with services have multiple causes. The pressures on the system, resource issues and staff being asked to do more with less inevitably impact on the number of complaints. The growth of social media as a mechanism for comment, available 24 hours a day, internet sites like iWantGreatCare.org and Patient Opinion, which give people new opportunities to say what they think about their health professional or hospital service, are also contributing factors. We have seen a rise in complaints about breaches of confidentiality on social networking sites, and health professionals using social media as a mechanism for criticising colleagues. This type of online unprofessional behaviour is on the rise, as the lines between personal and professional lives become more blurred. Changing social norms and new ways of communicating are important influences on professionalism and how it plays out in everyday life.

The HCPC commissioned research to improve our understanding of this complex area. The first HCPC report suggests that ‘professionalism’ is seen not so much as a discrete competency but a situational judgement, a set of behaviours influenced by context, rather than a fixed characteristic. These behaviours are strongly influenced by the particular care group and peer group as well as the knowledge and skills of an individual.

The second phase of this work is ongoing, but its findings have led us to generate further debate about the centrality of ethics and conduct in day to day practice. For example, our work suggests that professionals find it more acceptable to discuss issues of competence than conduct with their peers. They find it difficult to challenge each other about how they talk to patients, whereas comments about technical aspects of competence are much more common. This depends very much upon the nature of relationships, and the level of trust and mutual respect which exists between individuals and within teams. Where there are high levels of trust and strong team working, professionalism thrives.

In his vision of the future, Don Berwick talks about the centrality of team based care where the hierarchies between professions have lost their edge, where people are genuinely respectful of each others skills and expertise and their primary aim is to work together for the good of the patient. In these environments, there is a constant search for new technologies to improve care and a respect for the patient as an equal partner in the process, with expertise, with insight, with knowledge that no professional can ever have.

Changing expectations, social norms and new technology will mean that more is demanded of us as health professionals wherever we work. We need more, not less, talk about professionalism and values in the 21st century. Radiological professionals, with their well established team-based models of care, can be leaders in these much needed conversations.

Anna van der Gaag, Chair, Health and Care Professions Council, UK

About HCPC

HCPC is a UK wide regulator of 320,000 professionals from 16 health and care professions, including radiographers and clinical scientists. Its role is to protect the public by setting and monitoring standards, quality assuring education programmes, and investigating complaints.

The 2014 Welbeck memorial lecture at UKRC in Manchester was given by Anna van der Gaag, Chair of the Health and Care Professions Council (HCPC).

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Diagnostic Imaging and Patient Choice

Peter Harrison 120 x 100

Peter Harrison

In the first of our guest blogs, Peter Harrison, Managing Director of Siemens Healthcare Sector, talks about how patient choice is driving a requirement for transparency of clinical performance.

The prevalence of internet usage has had a profound impact on patients’ engagement with their own health. Ask any GP and they will tell you stories of patients presenting to them with a confident (often inaccurate) self diagnosis of their conditions based upon internet research. While I am sure that this can frequently be unhelpful, surely the net impact of patients taking more interest in their health must be celebrated?

The internet has empowered consumers. Parents can now easily check Ofsted reports to establish the highest performing schools, and consumer guides before making purchasing decisions. The writing is on the wall—patients and carers will increasingly (and appropriately) position themselves as healthcare consumers and will demand the information to make informed choices on healthcare provision. GPs will provide counsel, but increasingly, patients and carers will also seek direct access to information. We are already starting to see greater transparency of clinical performance at a surgeon level. A good example can be found at the Society for Cardiothoracic Surgery website (http://www.scts.org), where risk-adjusted mortality rates can be viewed down to discrete surgeons, set against a scatter graph plot of their contemporaries.

I anticipate that a similar trend will apply to diagnostic imaging. Consumer demand will drive increased transparency of performance and a range of measures to enable patients and carers to make more informed decisions when exercising choice of provider. Those measures will likely extend to facets of modality performance that support accurate diagnosis (such as spatial and temporal resolution), but I also expect patients to be take a greater interest in wider facets of the imaging experience, such as safety and comfort. When considering modalities that utilise ionising radiation, patients may well want to understand what dose they are likely to receive during a scan. Not unreasonable, but there will also be a responsibility to help patients understand that the radiology team will need to appropriately balance minimisation of dose with the diagnostic quality to ensure appropriate specificity and sensitivity. Perhaps patients will want to establish what dose-reducing technologies are available within the imaging department and the extent to which the technologies are appropriately deployed?

Beyond traditional clinical quality and safety, issues of accessibility will also be of interest, with respect to both waiting times and bariatric considerations. What kind of experience might they expect with regards to patient care and comfort?

As the NHS adopts greater plurality of service provision and extends choice of provider to patients, successful imaging service providers will seek to differentiate themselves by affording due consideration to equipment selection and standards of service. I expect that those who are sensitive to these dynamics will be those who thrive and deliver a sustainable service, dependent upon both clinical referral and patient choice.

Peter Harrison is Managing Director, Siemens Healthcare sector, UK