Professionalism – Keep Talking

Karen Middleton’s voicepiece in the February AHP Bulletin signalled the start of the Big Conversation about the issue of professionalism and professional behaviour.  Since then, AHPs across the country, as well as many AHP professional bodies, have added their voices to the debate.

Social media – the good, the bad and the ugly

One area of discussion with regard to professionaism is that of the use of social media. There are guidelines from the HCPC and professional bodies – but in this edition we hear from David Davis, National Clinical Lead for AHPs in the Department of Health Informatics Directure, and get his take on the subject…

With everyone writing about social media – particularly in healthcare – one can’t help wondering if like every other area of IT, health and social care professionals are again on the back end of the early adopters curve.

It seems years ago – and probably was – that I was listening to a BBC Radio 4 programme about the upsurge in the use of Facebook and Bebo. There were various characters debating the likely future of the use of social media. Yet I remember one thing sticking in my mind – that while this was (at that time) the domain of teenagers only, it was here to stay and would affect everybody. It didn’t even occur to me that one day I’d be sat in front on my computer trying to articulate the importance of social media to health and social care professionals, and particularly AHPs.

Despite the natural cynicism that many of us (especially clinicians) may have felt towards the use of social media, there is undoubtedly some good.

Open the latest copy of the London Evening Standard, watch the BBC iPlayer, or visit the Department of Health website and you will find references to a range of social media such as ‘like us on Facebook’ or ‘tweet it’. If you like a new strategy on the Department of Health website, you can share it on Facebook, tweet about it or review it online. Provider organisations and local and central bodies are also using social media to enhance their existing communications.

For example, ambulance trusts are now tweeting about public health issues, as well as flagging up road accidents, and the police are able to support crime investigations using Twitter. Individual professionals are using the NHS Networks to learn, debate and share resources. Not only is it easy and quick, the audience are largely self-selected, so the specificity of the messages is likely to be enhanced. Combine that with the ability to add comment, or read comments from the great and good, and it delivers a totally new experience. You can be invisible, or highly visible, and still benefit from the practice.

To see the positive, social media is and must be embraced and enhanced to improve communication with patients and between healthcare professionals, to support learning and ensure consistency in high quality care and public health.

Understanding the difference between ‘the bad’ and ‘the ugly’ is perhaps more difficult to define, but many citizens, patients and healthcare professionals are aware of the negative sides of social media.

The bad can range from the unintentional consequences of a poorly worded comment about a colleague, which results in a grovelling and humiliating apology in the tearoom, to mistakenly quoting the latest evidence incorrectly.

The critical factor in this electronic environment is once you hit publish, post, or send, it’s there, somewhere, forever – even if you go back and delete it moments later. So before you tweet, attach, send or post, think about the consequences of what you are about to do.

It can still get you into serious trouble, but the denominator here is that it is inadvertent and not obviously unprofessional straight away.  For example, say that in your capacity as an AHP you had to visit your hospital’s A&E department, and found it was absolute pandemonium. When you finish your shift, you start talking about it on Facebook as being dangerous and avoidable, and that you work there as an AHP. The conversation ends up on the front page of the local newspaper with your picture from the Facebook screenshot.

With social media, the delineation between your personal and professional life is paper thin, if discernible at all, so it makes sense to think about the potential professional consequences before you publish your thoughts online.

The Health Professions Council website offers some excellent guidance on using social media. So, while keeping the bad and the ugly in mind, let’s focus on the good. Let’s embrace social media and use it proactively for our patients and public more widely.

We must also be innovative and keep our eyes on the future – which aligns us to the Government’s information strategy. In doing so, as AHPs  we must make sure we include this area as part of our professional thinking and ‘keep talking.’

The Big Conversation- it may start with a cup of coffee

Anna van der Gaag, Chair of the Health and Care Professions Council, found that Gerald Hickson and colleagues at Vanderbilt University School of Medicine in the United States have developed a range of strategies when teaching and exploring professionalism. These include an approach to tackling so-called ‘unprofessional’ behaviour, which starts with a conversation over a cup of coffee.

The ‘cup of coffee’ conversation is in fact the first step on a staged approach that can move up several levels to formal disciplinary interventions. Hickson’s research has shown that most issues can be resolved early in the process.

So what might a ‘cup of coffee’ conversation sound like? The Centre set out some basic principles as a guide.

Firstly, approach the person ‘coming to you as a colleague.’ You are describing the event to them, not seeking to control them.  You can use the same principles as you might use for sharing difficult news with patients.  Beware of the natural tendency to downplay the seriousness of the issue and keep a balance between empathy and objectivity.  By talking to them about the incident, you are also letting the person know that the organisation as a whole is able to see what is going on.

Open the conversation with a positive note, valuing the person and their contribution.  Then move on to explain what you heard or saw in as much detail as possible. Wait or ask for their view and always respond to concerns or questions they raise.  Anticipate different reactions, such as ‘it was because of something someone else did or did not do’, explanations, denial, acceptance and many others.

Remember that this conversation is not about control or hierarchy, or an opportunity to address multiple other issues. It is an informal intervention, colleague to colleague.

Closing the conversation should again be positive, with appreciation and understanding of what has been said. Give assurance that the conversation was completely confidential but also, if appropriate, reminding them of their professional responsibilities. You may have an opportunity to say that you also have a responsibility to act professionally, and talk about what this means for you.

This is one example of how early conversations can prevent certain ways of communicating or behaving from becoming accepted as ‘the norm’ within organisations. Most of us find it difficult to talk about ethics and conduct, but it is these underlying values that determine how we work and interact with patients and colleagues.

• Access further reading on this approach and the work of Gerald Hickson and colleagues

The effect of the NHS Constitution

A report on the effect of the NHS Constitution on patients, staff, carers and members of the public has been published and will inform efforts to fully embed the Constitution throughout the NHS.

The report considers whether, and to what extent, the Constitution has made a difference to patients, staff, carers and the public, and examines the degree to which it is succeeding in its aims.

Public awareness of the Constitution remains generally low and there is little evidence that patients use it as a means of exercising their rights. Staff awareness of the NHS Constitution is significantly higher than among the public but still few feel well informed about it.

The NHS Future Forum will now consider how content and awareness can be improved for the future. The Forum will present its advice to the Government in the autumn. Following this, there will be a public consultation on any changes to strengthen the Constitution, so patients, staff and the public have the chance to have their say.

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