Professionalism and Accountability

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?