Standards of Care and Due Diligence

 

Dear Direct Service Practitioners,

 

Leaders, supervisors and organisations need to be mindful of safe practice when delivering services to clients and to ensure that there are policies in place for accountability for services. These policies will guide practice and prevent harm to clients. The details should be in a protocol or standard operating procedure that is reviewed regularly in order to stay relevant. It should take into consideration the latest developments and changes in the operating environment.

 

Exercising Standards of Care

For those who are delivering direct services and working with vulnerable persons, there are often situations where an agency, a service or a program is required to show evidence that it has exercised a particular standard of care. This can happen when there is an enquiry or incident. For example, an inquiry or report may require evidence that a program is providing the appropriate care and appropriate plan for the right client based on an accurate assessment of the needs and risks. Appropriate here would mean care and plans that are safe, ethical and effective. To do this, there should be a clear appreciation of the profile of the person, group or community in need, and an assessment of the bio-psycho, social and spiritual dimension of the person, group or community. This will help in drawing up a holistic plan which should be followed up by those who possess the appropriate knowledge and skills. It is also necessary that there is ongoing review of the plan to adapt to fresh circumstances. So how would we show evidence of appropriate care and due diligence in a plan? We could do this in the following way – Show case notes or relevant procedure and policy documents and provide a sample of the actual documentation; (ii) Describe and explain the process of how an assessment is made and (iii) Show how the plan is followed up and revised with fresh information.

 

Documentation is integral to safe practice

Good questions with regard to such evidence include how current the guidance and standard operating procedure is and the level of supervision or oversight of the practice and service standard. The documentation should show that there is proper assessment, a plan that is followed and reviewed, and evaluation of interventions and outcome with some form of supervision. Assessment and evaluation must be made by persons with the appropriate knowledge, skills and judgment. In the case of a program, each requirement or cluster of requirements will aim to confirm one key domain in the standard of care or a key concern such as safeguarding the dignity of the person. It is important to explain the understanding behind a particular practice and how the practice complies with the standard of care or protection.

 

Evidence should also show the interrelationships that support the clients. Documentation should show communication and respect for the clients; (ii) accountability of staff and the program and (iii) attention to the care, safety and welfare of the clients. Documentation is used for communication purposes among those involved in the care or protection of the client. It establishes the facts and circumstances related to the care given and assists in the recall of details in a specific situation. It is important to note that too much, too little or wrong documentation can cause harm. As such, documentation should be clear, concise, factual, objective, timely and legible. Evaluation should reflect the knowledge and skills gained from good training as part of ensuring safe standards of practice and accountability.

 

Showing due diligence

Integral to due diligence is decision making by the appropriate level of authority or professional practice. By this we mean that an appropriate person is assigned a specific level of decision making. These decisions should be made based on a set of principles that are documented. Good practice begins with taking time to ask good questions. It continues with documenting the planning, implementation and decision making process. The thinking behind key decisions made on the case direction and the persons involved in the decision making process should also be clearly recorded. Safe practice is about being professionally and ethically accountable and delivering services to clients right to the last mile. Due diligence demands that the person with the right level of training and experience or expertise is assigned to the appropriate complexity of the case.

 

How a practitioner can ensure accountability

One way to do this is to ensure that as a practitioner, you are supported by your agency through a protocol that sets out clear roles, responsibilities and accountability. This should be accompanied by adequate training and complemented by regular supervision. As practice decisions are based on the application of knowledge, skills and professional judgment depending on the clients’ characteristics, it is useful that decisions for complex situations are made through consultation and collective wisdom. As a professional, there is a need to be professionally accountable and it is good for us to be sure of what this might look like. In some situations, there is a clear need to comply with statutory or regulatory requirements, while at other times, dilemmas may arise which require discussions with a supervisor.

 

Being clear about your role, the level of professional judgment required and your power in decision making will help in coping with the stress that resides in the tension between speedy compliance and professional dilemma. Being accountable is not only good practice but also helps to manage the stress in carrying the caseload and shouldering the responsibility. As a practitioner, it is important to ask for information, appropriate training and supervision to enable you to be accountable for your practice and service to clients. Self-directed professional development, support from the agency and clarity about roles and responsibilities can help to fend off premature burn out in areas that are more demanding of professional practice.