PERFORMANCE MANAGEMENT
Bad behaviour N
CAS, the National Clinical Assessment Service, has published a good practice
guide to help NHS organisations dealing with concerns about a practitioner’s behaviour.
Professor Pauline McAvoy, NCAS medical director, told NHE: “The guide is for everyone with responsibility for managing the possible impact of the practitioner’s behaviour on clinical practice, including medical and clinical directors, responsible officers, PCT commissioners and managers as well as HR professionals.”
The guide, ‘Handling Concerns about a Practitioner’s Behaviour and Conduct’, is a practical ‘lessons learned’ document building on NCAS’ 11 years of experience in advising
“Behaviour relates to how someone interacts with other people – how they communicate, how they might relate to communications difficulties, how individuals work in teams and how they react when under stress.
“However, such concerns can also relate to an organisation and how the workplace is organised and the way resources and teams are structured. This guide can be used wherever practitioners work – general practice, community and hospital sectors and whatever their speciality, grade or employment status.”
The guide itself notes that behavioural issues can come to light more readily in a secondary care setting, due to organisational structure and governance, whereas in primary care and
How should medical organisations deal with health practitioners whose behaviour has become a concern for their colleagues or patients? Professor Pauline McAvoy, NCAS medical director, tells NHE about new guidance it has issued.
to abide by organisational rules, poor team relationships and leadership, withdrawal or non-participation and a failure to comply with reasonable management requests. Behavioural issues can also put patient safety at risk.”
Behavioural concerns often arise during periods of change in a clinicians’ personal life or working environment: potentially making the current upheaval in the NHS a tough time. But asked about the effect the transition to clinical commissioning and the structural reform of the NHS is having on behaviour and referrals, Professor McAvoy told us: “There has been a fall in the number of primary care referrals in the last year, which NCAS believes may be due to uncertainty created by the current organisational changes in the NHS.
“Dealing with concerns early helps to avoid future problems. Delay stores up problems for the future and makes it more difficult for individual practitioners to return practice.”
to safe
But she noted: “Secondary referrals have continued to rise in the last year.”
referring organisations on the most effective ways of handling concerns about practitioner performance.
NCAS says that between December 2007 and October 2010, when it handled 3,000 cases of practitioner performance concern, 57% were recorded as having some type of behavioural component.
Although there is no standard definition of behavioural concerns for UK clinicians, it tends to involve inappropriate language, actions and inactions, NCAS said, to the extent that they interfere with their interactions with others or the quality of their healthcare delivery.
Importantly, problematic behaviour does not just mean rudeness or aggressiveness in the traditional sense – a lack of assertiveness and over-caution can also be a concern, especially where it leads practitioners to become over- reliant on help from others.
NCAS lead adviser Karen Wadman explained:
because of the way GPs set up their practices, it can be effectively ‘hidden’. It notes: “In secondary care, medical managers and clinical tutors can expect to deal with behavioural problems on a regular basis. This will be even more common for HR managers and therefore it is important that whoever is involved in managing the concern maintains organisational consistency in the action taken.
“In primary care, behavioural problems may be hidden within the practice setting and only come to light because of a serious incident, complaint or partnership dispute.”
The guide notes that although poor behaviour can be linked to lower clinical quality, this is not necessarily the case.
It says: “It is important not to disregard poor behaviour even if the practitioner is clinically sound. Poor behaviour,
which
can include unpredictability, irritability, aggression, arrogance and hypersensitivity, can result in poor conduct including a failure
Some of the advice in the guidance document arose from NCAS’s conference last year, which focused heavily on the issue of behaviour.
Professor McAvoy said : “We dedicated our 2011 conference to helping NHS professionals to understand behavioural characteristics that can contribute to performance concerns. The new guide builds on the conference and distills our experience over 11 years.”
NCAS survived NHS structural reforms, unlike its former parent body the National Patient Safety Agency, but is having to move to a self- sustaining financial basis in the next few years. It is now hosted by NICE.
FOR MORE INFORMATION Download the guidance at
www.ncas.nhs.uk/ publications/
Individual practitioners concerned about a colleague’s performance and uncertain who is responsible for managing the issue can call NCAS’ free, 24-hour advice line – 020 7972 2999.
national health executive Jul/Aug 12 | 23
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