from autonomous professional to accountable practitioner
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From Autonomous Professional to Accountable Practitioner. Lindsey Graham 4Ps Co-Director of Development Dublin 4 December 2002. What does it mean to be a professional. in the 21 st Century?. - PowerPoint PPT PresentationTRANSCRIPT
From Autonomous Professional
to Accountable Practitioner
Lindsey Graham4Ps Co-Director of Development
Dublin 4 December 2002
What does it mean to be a professional
in the 21st Century?
“We will put you on a pedestal, treat you like heroes/warriors/Gods in exchange for you fighting the nasty enemy called disease and protecting us from what we fear most - death
Doctors accepted they would work 80-100 hours a week (at the expense of personal and family lives) to fight against disease – in exchange they have been lauded, listened to, obeyed and never challenged”
Patrick Pietroni, GALE Memorial Lecture
Societal changes
• Loss of professional status and authority
• Impact not only on doctors but teachers, solicitors, university professors…
• Rise of market forces and consumerism• Complexity of modern society - one
profession alone cannot solve healthcare problems
Why is morale low in UK doctors?
• Doctors are losing their voice - disenfranchised and disempowered
• Resources are inconsistent with demands• Constant change - imposed from above• Less respect from the public and the
politicians• Not enough time to offer quality service• Professional autonomy being eroded
Dr Elisabeth Paice, Dean Director of Postgraduate Medical
and Dental Education, University of London, Cuba 2001
The contract: the patient's view
• Modern medicine can do remarkable things: it can solve many of my problems
• You, the doctor, can see inside me and know what's wrong
• You know everything it's necessary to know• You can solve my problems, even my social
problems• So we give you high status and a good salary
BMJ May 5 May 2001 Volume 322 1073
The contract: the doctor's view• Modern medicine has limited powers. Worse,
it's dangerous• We can't begin to solve all problems, especially
social ones• I don't know everything, but I do know how
difficult many things are• The balance between doing good and harm is
very fine• I'd better keep quiet about all this so as not to
disappoint my patients and lose my status
BMJ May 5 May 2001 Volume 322 1073
The new contractboth patients and doctors know
• Death, sickness, and pain are part of life• Medicine has limited powers, particularly to solve
social problems, and is risky• Doctors don't know everything: they need decision
making and psychological support• We're in this together• Patients can't leave problems to doctors• Doctors should be open about their limitations• Politicians should refrain from extravagant promises
and concentrate on reality
BMJ May 5 May 2001 Volume 322 1073
Professionalism
What is a Professional?
Quality
Integrity Respect
Dr Elisabeth Paice, Dean Director of Postgraduate Medical and Dental Education, University of London, Cuba 2001
Autonomous professional•clinical freedom•commitment to individual patient•collaboration with other professionals •self-directed learning•self-regulation
Direction of Travel
Dr Elisabeth Paice, Dean Director of Postgraduate Medical and Dental Education, University of London, Cuba 2001
Autonomous professional•clinical freedom•commitment to individual patient•collaboration with other professionals •self-directed learning•self-regulation
Accountable practitioner•clinical governance•service to population•multi-professional teamwork•learning aligned to organisational needs•external regulation
Direction of Travel
Dr Elisabeth Paice, Dean Director of Postgraduate Medical and Dental Education, University of London, Cuba 2001
New professionalism
The new professional?
Leadership
Ownership
Fellowship
Dr Elisabeth Paice, Dean Director of Postgraduate Medical and Dental Education, University of London, Cuba 2001
“Public and patient participation in healthcare has been on the Irish health system agenda
for some time now”
Public and Patient Participation in Healthcarea discussion paper for the Irish health services,
December 2002Chapter one, Introduction
Public Involvement must be
• Integral to every part of the NHS• Genuine and not tokenistic• Engaged and listening
DoH, ‘Patient and Public Involvement in the new NHS’, 24 September 1999
‘The relationship between service and patient is too hierarchical and
paternalistic’
“The patient’s voice does not sufficiently influence the provision of
services”
The NHS Plan, July 2000
Why Involve?
• Accountability• Transparency• Improve services• Improve sensitivity to users’ needs• Make life easier for care providers• NHS Plan• Health & Social Care Act
“ Professional, clinical and managerial staff are often unprepared, unaware and, at times, hostile to public participation
Attempts to involve the ‘public’ on professional and managerial committees often end in frustration on both sides”
Professor Patrick Pietroni
Preparing Professionals for Partnership with the Public
An education programme for people delivering health care
Aim to enlarge the space in the middlewhere both needs overlap
Who Shapes the Partnership?
• Politics / policy• Professionals• Managers• Community / users• Private / commercial sector• Media
Involvement Continuum
Patient’s relationship with clinician
Patient’s relationship with practice ordepartment
NHS Trust involvement with community
There is no prescription!
There is no right or one way to involve people but there are wrong waysThere are principles of…
…respect…support
…working participatively
Decision Making
Paternalism
Clinician
Shared
Clinician & Patient
Consumerism
Patient
Shifting the information giving paradigm
Letter sharing has got it all!
“Your Guide to the NHS”, January 2001
“In future, you will be sent copies of letters between
any doctors involved in your care unless you ask not to
receive these.”
Head in the Sand
Sounds like a lot of effort to me
.. and I don’t thinkthat the patientsreally want it
…. and there’s certainly nothing in it for me
Robert MacDermott, Consultant GynaecologistCopying Letters to Patients, National Conference 30 October 2002
Benefits for doctors
• Compliance with treatment regimes• Easier follow-up consultations• Appreciation from the Trust• Appreciation from the patients
– Honesty, openness– Detailed information about their illness– Involvement in decision-making
Robert MacDermott, Consultant GynaecologistCopying Letters to Patients, National Conference 30 October 2002
Letter sharing
• Gives information• Evidence I have listened and
understood• Improves and consolidates trust• Better doctor-patient relationship
Robert MacDermott, Consultant GynaecologistCopying Letters to Patients, National Conference 30 October 2002
Benefits for patients
“Thank you for the copy of the letter. It made it seem as if I was more involved with my care, It was easier to talk to the GP about my care, without the problem of trying to remember all that was said at the hospital appointment, which would have been very difficult as I was very nervous at the time. I feel more positive knowing that I am fully informed. It has taken some of the worry of having surgery away by creating a more personal liaison between hospital Consultant and patient”
Small things can make a big difference
Stay with what’s in your
control and influence
Who’s Health Service is it Anyway?
Who’s Health Service is it Anyway?
public, patients and all who provide services
working in partnership