Putting the spotlight on ourselves: Governance to improve practice.
Another timely blog by Neil Langridge, Consultant Physiotherapist, discussing the recent Social Media discourse surrounding governance and professionalism.
For clarity, the purpose of this blogpost is threefold:
To assure and reassure patients that there are current governance processes in place.
Add a viewpoint on the context of governance and professionalism
To clarify a position in response to proposed models of reform that should be rejected within the context of unethical behavior without due process.
Over the last 24 hours I have read and watched some interesting opinions on how as a profession we should internally govern practice. As a clinician who has been involved and led investigations where serious incidents have happened, such as operations that should not have occurred, missed cancer diagnoses, HCPC referrals, and inappropriate/unprofessional behaviour etc I have wanted to engage with the discussion with a little more depth.
There is no doubt that certainly across numerous health sectors certain disasters, injustices, unsafe practices have led to changes in policy, process, safety measures and ultimately improvements in care. The Francis Report is a great example of significant developments in which learning from terrible circumstances have seen changes in policy and practice, the Shipman enquiry also, was a clear example of learning from tragedy, unsafe, and unethical practice.
As a profession I am not suggesting that the recent discussions are in line with this level of circumstance, however what can we learn from these processes to ensure the profession remains able to assure the public is that we remain as vigilant as we can about improvements to care, and/or dealing with unsafe or unethical practice.
I have experienced serious incidents and learning (as I am sure many readers will have too) for example, having to apologise directly to a patient that we missed an opportunity to diagnose the cancer they had earlier, working with a colleague who through investigation identified further deeper issues in the working environment, making HCPC referrals which I knew could be devastating (but I knew it was the right thing to do). What I had to do in every case was to be sure of the evidence I had to support my reports, if not then my conduct would come into question, I would not being fulfilling my role, and patients and staff would be no safer if I was not vigilant in my assessment of the evidence in front of me.
I made sure I worked with partners such as the Freedom to Speak Up Guardians, engaged in open discussions with staff, but most importantly patients and through these relationships, what I was looking for, was to ensure the patient was listened to, treated fairly, given the information they needed, and offered every opportunity to engage through the process. I also had to also always consider the clinicians’ well-being as these can be incredibly stressful times, and they needed support as well.
Vital to this is that we always want and must learn from these processes, patients generally say through complaints about services that they don’t want what happened to them to happen to others, and they are 100% correct. It is our ethical duty to learn from incidents and to audit those improvements and therefore the CQC, HCPC, patient advocacy groups, professional bodies etc can quite rightly be assured on behalf of the patient/public that learning, change and progress has been made.
The reason I wanted to write on the back of the SoMe discussions was that if, as a profession, we do not follow these principles and processes, then we ourselves under the pretense of righteous behaviour, will ultimately undermine how clinical governance works, and in doing so, we ourselves will be the unethical clinicians in our approach to improving practice.
Patients want to know we ask the questions, they want to know we apply the principles of due diligence, and they want to know we have the credible processes to provide safe practice, hence the need to work with the processes and governing bodies, not independently of them, to continue to provide improvements in care.
In the private sector if clinicians are ultimately falsely advertising or treating unethically, then we should make the right referral inclusive of trading standards and advertising watchdogs, let them build the case from evidence, and we should still make the appropriate clinical referrals to ensure we have done what we should from an ethical perspective.
My main point being, is that we should be challenging unethical practice but if carried out in a “Name and Shame” model, then the transparency, learning, and safety gets lost under a blanket of personal opinion and bias; and it’s clear from previous changes in clinical culture that working in partnerships, working in evidence, and working within governance models, is how we can remain a trusted clinical profession.
Neil Langridge @neiljlangridge
Consultant NHS Physiotherapist