Laura Proctor's activity
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Laura Proctor posted an update in the group Philosophy and ethics for health care improvement 5 months ago
Good afternoon all, this sounds like interesting group, it caught my eye with the mention of ethics. What seems noteworthy to me is that most, if not all health care professionals go into their careers because they have an aspiration to make things better! I wonder where ethics support these staff and how senior managers and leaders ensure these are imbedded in their own code of conduct.
Hi Laura, thanks for joining our SIG! I appreciate the focus in your comment on how staff can be supported by managers, leaders, and ethical codes. There can often be a great deal of emphasis placed on the intentions and attitudes of individual staff when characterising professional ethics, but having appropriate institutional support and incentive structures is crucial for enabling ethical professionalism. Wouldn’t it be great if ethical healthcare practice was the path of least resistance?!
Thank you Polly for your welcome and reply. Lovely to meet you! I’m interested to hear more about the institutional support and incentive structures please can you elaborate on these ideas please to help me understand what these might contain. The reason I ask is that the messages that seem to come from the Trust include messages that when filtered down don’t seem to married up, messages don’t align with behaviours. I don’t like to use such broad and generalising language to refer to managers and Trust boards. My comments reflect my observations and a trend towards this behaviour (and I appreciate I will have blind spots). I’m genuinely fascinated to understand this as a means to supporting managers, senior leaders. I am really interested to understand how using and applying ethical codes everyone at every level can be supported and support each other. I’m sounding a bit idealistic but it’s something to aim for…
I guess I was thinking about a number of things which might affect the ability of healthcare professionals to act on their aspirations to make things better:
– some more structural, e.g. if there are workforce shortages, staff may not have much time to reflect on and think about improving their ways of working, because they are fighting fires the whole time;
– connected to this, if staff are heavily overworked or if there is a ‘blame culture’ in an institution, healthcare professionals may be incentivised to take a more ‘legalistic’ approach to their work, where they make sure they do the bare minimum, not because they don’t care but because they are worried about losing their job and don’t have the time or personal/emotional resources to do anything more;
– within institutions having a culture of openness and challenging hierarchical forms of power, might also enable staff to be honest about the issues that they come across in the courser of their work–and this can be set from the top and enacted through day-to-day management approaches. If staff raise issues or call out ‘senior’ staff, are they likely to be listened to or labelled as trouble-makers, how will it affect their chances of promotion, how will it affect their relationships with managers.
Does that resonate with what you were thinking at all?
I guess the point I’m making is that when it comes to improvement, many things fall outside of the frontline teams power to sort, usually the meatier things that hold a lot of influence are not the quick wins. In this case, senior leaders (meaning any manager who is above the clinical lead in a team) are in a position where they are expected to respond/step in to support the frontline staff to remove or partially remove the blocker by it system blockers or people, these blockers are any issues that prevent frontline staff from delivering the care that their patients needs or providing safe and quality care.
Many frontline staff are being denied that help, being ignored and told in effect to keep the show on the road (this was often my experience). Ethically and morally this seems completely wrong, to in effect ignore the needs of staff. I think it is because the NHS is so vast and many managers are just too far removed from the frontline, they don’t feel what the frontline feel. That’s what I mean by, where is the ethical and moral code of conduct to hold managers accountable? Hope that makes sense 🙂
Yes that makes lots of sense and I think connects to what I’m saying about too. There are much bigger structural and institutional issues which affect how staff are enabled to deliver healthcare and how it’s experienced by patients. But often these are sidelined in conversations about improvement which focus on small changes/projects which might make marginal improvements in processes and outcomes but miss the big systemic issues.
I wonder if one problem is that managers/leaders can also feel relatively powerless and with limited options because of the demands and incentives they face from their own managers or from DoH/NHS England and because of the way they are constrained by budgets and institutional design. Which isn’t to say that they actually are powerless!
Yes Polly I entirely agree. Particularly agree with this bit……. But often these are sidelined in conversations about improvement which focus on small changes/projects which might make marginal improvements in processes and outcomes but miss the big systemic issues. In this way Improvement becomes reduced (in my opinion) and their is a risk that frontline staff could then become disengaged because in reality there are fewer quick wins and in order to help tackle the meatier things they need help from outside their team.
I know a lot of middle mangers also feel powerless to intervene because of the organizational constraints and expectations on them. This can distract them from helping the frontline in the tangible ways they want to see. I entirely agree, many managers hand’s are tied. I do also wonder if we need a new type of leader who is not afraid to step out of this culture, it’s what I would call a radical leader and with it come lots of risks but for the greater good to challenge the culture that exists. This of cause takes great courage and wisdom and may throw up more ethical dilemas. The question is is it better to do the right thing for the greater good or do the right thing to stay in your job and keep your boss happy!?