Good medical practice

Domain 3: Colleagues, culture and safety

Introduction

Culture is determined by the shared values and behaviours of a group of people. Everyone has the right to work and train in an environment which is fair, free from discrimination, and where they’re respected and valued as an individual. 

Good medical professionals communicate clearly and work effectively with colleagues in the interests of patients. They develop their self-awareness, manage their impact on others, and do what they can to help create civil and compassionate cultures where all staff can ask questions, talk about errors and raise concerns safely.

Treating colleagues with kindness, courtesy and respect

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You must treat colleagues3  with kindness, courtesy and respect.

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‘Colleagues’ includes anyone you work with, whether or not they are a medical professional.

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To develop and maintain effective teamworking and interpersonal relationships you must:

  1. listen to colleagues
  2. communicate clearly, politely and considerately
  3. recognise and show respect for colleagues’ skills and contributions
  4. work collaboratively with colleagues and be willing to lead or follow as the circumstances require.
50

When you are on duty you must be accessible to colleagues seeking information, advice, or support. 

51

You must be compassionate towards colleagues who have problems with their performance or health. But you must put patient safety first at all times. 

Contributing to a positive working and training environment

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You must help to create a culture that is respectful, fair, supportive, and compassionate by role modelling behaviours consistent with these values. 

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You should be aware of how your behaviour may influence others within and outside the team.

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You should be aware of the risk of bias, and consider how your own life experience, culture and beliefs influence your interactions with others, and may impact on your decisions and actions. 

55

You must show respect for, and sensitivity towards, others’ life experience, cultures and beliefs. 

56

You must not abuse, discriminate against, bully, or harass anyone based on their personal characteristics, or for any other reason. By ‘personal characteristics’ we mean someone’s appearance, lifestyle, culture, their social or economic status, or any of the characteristics protected by legislation – age, disability, gender reassignment, race, marriage and civil partnership, pregnancy and maternity, religion or belief, sex and sexual orientation.

57

You must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress. What we mean by acting ‘in a sexual way’ can include – but isn’t limited to – verbal or written comments, displaying or sharing images, as well as unwelcome physical contact. You must follow our more detailed guidance on Maintaining personal and professional boundaries.

58

If you witness any of the behaviours described in paragraphs 56 or 57 you should act, taking account of the specific circumstances. For example, you could:

  1. check in and offer support to anyone targeted or affected by the behaviour, and/or let them know that you feel that the behaviour you witnessed is unacceptable 
  2. challenge the behaviour by speaking to the person responsible – either at the time, if safe to do so, or at an appropriate time and place
  3. speak to a colleague and/or consider reporting the behaviour in line with your workplace policy and our more detailed guidance on Raising and acting on concerns about patient safety. Before you report the behaviour you witnessed, try and make sure that the person who was targeted is aware of, and supports, your intention to report it.

We recognise some people may find it harder than others to speak up4  but everyone has a responsibility – to themselves and their colleagues – to do something to prevent these behaviours continuing and contributing to a negative, unsafe environment.

4

See our ethical hub advice on Speaking up.

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If you have a formal leadership or management role and you witness – or are made aware of – any of the behaviours described in paragraphs 56 or 57, you must act. You must:

  1. make sure such behaviours are adequately addressed 
  2. make sure people are supported where necessary, and 
  3. make sure concerns are dealt with promptly, being escalated where necessary.

Demonstrating leadership behaviours

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You must follow our more detailed guidance on Leadership and management for all doctors.

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You must make sure that all colleagues whose work you are overseeing have appropriate supervision. 

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You must be accurate, fair and objective when writing references, and when appraising or assessing the performance of colleagues, including locums and students. You should not leave out any information relevant to your colleagues’ competence, performance, and conduct.

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You should be willing to offer professional support to colleagues, including students, for example through mentoring, coaching, teaching or training. This type of support is especially important for those new to practice in the UK, those returning from a period away from practice, and those who cannot easily access support.

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If part of your role is helping staff access training, development and employment opportunities, you should do this fairly. 

Contributing to continuity of care

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Continuity of care is important for all patients, but especially those who may struggle to navigate their healthcare journey or advocate for themselves. Continuity is particularly important when care is shared between teams, between different members of the same team, or when patients are transferred between care providers. 

  1. You must promptly share all relevant information about patients5  (including any reasonable adjustments and communication support preferences) with others involved in their care, within and across teams, as required.
  2. You must share information with patients  about: 
    1. the progress of their care 
    2. who is responsible for which aspect of their care
    3. the name of the lead clinician or team with overall responsibility for their care.
  1. You must be confident that information necessary for ongoing care has been shared: 
    1. before you go off duty 
    2. before you delegate care, or 
    3. before you refer the patient to another health or social care provider.
  1. You must check, where practical, that a named clinician or team has taken over responsibility when your role in a patient’s care has ended.
5

If a patient lacks capacity, information should be shared with those with legal authority to make decisions on a patient’s behalf.

Delegating safely and appropriately

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You must be confident that any person you delegate to has the necessary knowledge, skills and training to carry out the task you’re delegating. You must give them clear instructions and encourage them to ask questions and seek support or supervision if they need it. 

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If a task is delegated to you by a colleague but you’re not confident you have the necessary knowledge, skills or training to carry it out safely, you must prioritise patient safety and seek help, even if you’ve already agreed to carry out the task independently. 

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You must follow our more detailed guidance on Delegation and referral.

Recording your work clearly, accurately, and legibly

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You must make sure that formal records of your work (including patients’ records) are clear, accurate, contemporaneous6  and legible. 

6

Contemporaneous means making records at the same time as the events you are recording, or as soon as possible afterwards.

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You should take a proportionate approach to the level of detail but patients’ records should usually include:

  1. relevant clinical findings
  2. drugs, investigations or treatments proposed, provided or prescribed 
  3. the information shared with patients 
  4. concerns or preferences expressed by the patient that might be relevant to their ongoing care, and whether these were addressed
  5. information about any reasonable adjustments and communication support preferences
  6. decisions made, actions agreed (including decisions to take no action) and when/whether decisions should be reviewed
  7. who is creating the record and when.
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You must keep records that contain personal information about patients, colleagues or others securely, and in line with any data protection law requirements and you must follow our guidance on Confidentiality: good practice in handling patient information.

Keeping patients safe

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You should be familiar with, and use, the clinical governance and risk management structures and processes in any organisation that you work for or are contracted to.

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To help keep patients safe you must:

  1. contribute to confidential inquiries7  
  2. contribute to adverse event recognition
  3. report adverse incidents involving medical devices (including software, diagnostic tests, and digital tools) that put the safety of a patient or another person at risk, or have the potential to do so
  4. contribute to incident reviews and/or investigations 
  5. report suspected adverse drug reactions
  6. respond to requests from organisations monitoring public health.

When providing information for these purposes you must follow our guidance on Confidentiality: good practice in handling patient information.

7

A confidential inquiry (or enquiry) is a method of investigating adverse events without attributing blame. Examples include NCEPOD - National Confidential Enquiry into Patient Outcome and Death, CIPOLD (Confidential Inquiry into Premature Deaths of People with Learning Disabilities) and Confidential Enquiry into Maternal Deaths MBRRACE-UKNPEU.

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You must take up any post you have accepted, work any shift you have agreed to, and work your contractual notice period before leaving a job, unless the employer has reasonable time to make other arrangements or your personal circumstances prevent this. 

Responding to safety risks

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You must act promptly if you think that patient safety or dignity is, or may be, seriously compromised. 

  1. If a patient is not receiving basic care to meet their needs, you must act to make sure the patient is cared for as soon as possible, for example by asking someone who delivers basic care to attend to the patient straight away.
  2. If patients are at risk because of inadequate premises, equipment or other resources, policies or systems, you should first protect patients and put the matter right if that’s possible. Then you must raise your concern in line with your workplace policy and our more detailed guidance on Raising and acting on concerns about patient safety.
  3. If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body, or us. If you are still concerned, you must report this, in line with your workplace policy and our more detailed guidance on Raising and acting on concerns about patient safety.
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If you have a formal leadership or management role, you must take active steps to create an environment in which people can talk about errors and concerns safely. This includes making sure that any concerns raised with you are dealt with promptly and adequately, in line with your workplace policy and our more detailed guidance on Raising and acting on concerns about patient safety.

Advice on speaking up 

This ethical hub topic gives advice and sets out tools to speak up, raise concerns and whistle blow in line with the processes set out in the professional standards.

Managing risks posed by your health

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You should avoid seeking medical care from a family member or anyone you work closely with. If you are registered with a general practitioner this should be someone outside your family and your workplace.

78

You should try to take care of your own health and wellbeing, recognising if you may not be fit for work. You should seek independent professional advice about your fitness for work, rather than relying on your own assessment. 

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You must consult a suitably qualified professional and follow their advice about any changes to your practice they consider necessary if:

  1. you know or suspect that you have a serious condition that you could pass on to patients
  2. your judgement or performance could be affected by a condition or its treatment. 

You must not rely on your own assessment of the risk to patients.

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You should be immunised against common serious communicable diseases (unless contraindicated).