Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council...

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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

Transcript of Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council...

Page 1: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

Professionalism and public priorities

Anna van der Gaag ChairHealth and Care Professions Council

Sharing Best Practice DaySouth Staffordshire and Shropshire Healthcare NHS Foundation Trust25 November 2014

Page 2: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

Outline

• Increased focus on professionalism in UK – why?

• Findings from research

• How this relates to current challenges

Page 3: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

‘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”

www.patientopinion.org.uk

Increase in public expectations

Page 4: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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”

www.patientopinion.org.uk

Page 5: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

The power of the patient and service user voice

Patient opinions online

• Set up in 2005• 99,086 stories told• Positive and negative comments posted on line

Many complaints about organisational and resource issues but also about care and communication with professionals

www.patientopinion.org.uk

Page 6: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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

Page 7: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

Four processes

set standards

approve courses that meet them

registers those who pass them

holds them to its standards

HCPC

Page 8: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

What are complaints about?HCPC data 2012-13

72%

Source: HCPC Fitness to PractiseAnnual Report 2013

Page 9: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

Reasons behind complaints from the public

Reasons %

Communication 10%

Communication and clinical care 35%

Clinical care 35%

Clinical care and probity 2%

Probity 4%

51% = issues of professionalism

Source: GMC State of Medical Education 2013

Page 10: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

HCPC standards

ConsultationApril 2015

Page 11: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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

Page 12: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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

Page 13: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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

Page 14: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

How is professionalism played out in practice?

good clinical care or ‘doing the job well’

self awareness

knowledge, skills & ability

putting patients firstfollowing protocols,

maintaining standards

Page 15: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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)

Page 16: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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.”

Page 17: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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

Page 18: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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

Page 19: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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

Page 20: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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

Page 21: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

References

ABMS Professionalism Working Group, American Board of Medical Specialties, January 2012. 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) p27-38. Crotty, B, Mostaghimi, A. (2011) Professionalism in a digital age. Annals of Internal Medicine 154, 560-2.GMC The State of Medical Education 2013. www.gmc-uk.orgGMC Fitness to Practise Factsheet 2012. www.gmc-uk.orgGreaves, 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. www.hcpc-uk.org HCPC (2011) Professionalism in healthcare professions. www.hcpc-uk.orgHickson, G. et al. (2007) A complementary approach to promoting professionalism. Academic Medicine, 82 (11) p1040-1048.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, 712-714. Young, A. (2012) Online professionalism; challenges and opportunities.International Association of Medical Regulators Conference, Ottawa, Canada, October 2012. www.buksa.org/IAMRA

Page 22: Professionalism and public priorities Anna van der Gaag Chair Health and Care Professions Council Sharing Best Practice Day South Staffordshire and Shropshire.

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