Reflection is important for any healthcare professional to gain insight into the circumstances that led to things going wrong, and from this to demonstrate remediation.

In the first of three fitness to practise articles, we take an in-depth look at remediation.  Following on from this, we will take a similar in-depth look at insight and finally remediation.  All three are vitally important in any fitness to practise investigation.

Reflection

The reality is that sometimes things do go wrong in medical practice and mistakes are made.  When this happens, reflection is important for any healthcare professional to gain insight into the circumstances that led to things going wrong and from this to demonstrate remediation.

Health care regulators must have confidence that health and care professionals are fit to practise and this is no more relevant than those going through a fitness to practise investigation.

What is Fit to Practise?

Generally speaking, a health and care professional is fit to practise if they have the training, skills, knowledge, character and health to do their job safely and effectively. Where a regulator has concerns about a health and care professional’s fitness to practise, they can take action including suspending or removing the health and care professional from practice.

What is reflection on fitness to practise?

The general meaning of reflection is about giving thought and consideration to something.

When things go wrong at work, professionals are often asked to consider not only what went wrong, but how and why things went wrong and what they can do to take future preventative measures. Clinically, this often happens as the result on an audit or if a serious incident occurs as part of an SI review or Root Cause Analysis exercise.

Similarly, as an individual healthcare professional it is important to be able to describe what happened, evaluate what happened, analysis the cause, contributory factors and impact on yourself and others so that steps can be taken, and measures put in place to highlight triggers and prevent any recurrence.

This is often easier to achieve in competence cases rather than misconduct cases, particularly where there has been an element of dishonesty, but it is not impossible.

Practical considerations – Reflection & Insight

Reflecting on the circumstances that might have led to alleged impairment of your fitness to practise will vary based on the circumstances, but you must be able to demonstrate you have gained real and genuine insight.

Some things to consider when undertaking a reflective piece:

1. Read any guidance issued by your regulatory body

Reflection

1. Where things have gone wrong, this should be accepted (where appropriate – seek legal advice in the first instance)
2. Think about the circumstances that lead to something going wrong (personal, organisational etc.)
3. Consider the wider impact/consequences (colleagues, reputation and public confidence in medical profession and on your reputation)

Reflective practice

Reflective practice should be part and parcel of everyday life for healthcare professionals.

In 2019 the UK’s healthcare regulators issued a joint statement on “reflective practice”, stating:

“Reflection is the thought process where individuals consider their experiences to gain insights about their whole practice. Reflection supports individuals to continually improve the way they work or the quality of care they give to people. It is a familiar, continuous and routine part of the work of health and care professionals.”

Case examiners

Case Examiners decide whether there is a case to answer and presents opportunities for health and care professionals to close their cases at an early stage.

Evidence of reflection, and reflective practice more generally, can assist Case Examiners in their assessment of whether a health and care professional’s fitness to practise is impaired.  Clear evidence of reflection could therefore lead to a fitness to practise investigation being closed without the need for a full hearing.

Fitness to practise in the present tense

Reflection, insight and remediation is important because fitness to practise is in the present tense (also referred to as “current impairment”).  In practice, “current impairment” considers the fitness to practise of a healthcare professional at the point of consideration (i.e. case examiners or fitness to practise hearings) not the time in the past when, for example, something went wrong.  Therefore, the remediation steps taken since the time in the past is important to demonstrate fitness to practise in the present.

Insight Works Training

Developed by leading legal representatives for medical professionals facing health and social care tribunals, Insight Works Training have designed unique and practical courses with focus on impairment, reflections and remediation.

Courses are delivered by both leading healthcare experts with years of experience in mentoring and coaching who also sit on regulatory tribunal panels and, leading legal experts in the field of defence at health and social care regulatory tribunals.

Insight Works Training will help give you a clear and easy to follow understanding of the regulatory process, explanation of the central role of impairment, how to approach insight and remediation, how to evidence this at your hearing and a directed approach to presenting your learning with evidence in writing and verbally.