Work Place Module II - Essay Example

? Work Place Module II Table of Contents Introduction 3 Aim of the project 3 Methodology 4 Action plan 5 Political accountability 5 Financial accountability 6 Legal accountability 7 Managerial accountability 7 Consumer/customer accountability 8 Current accountability arrangements of NHS 9 Barriers to implementation of accountability in NHS 12 Effects of accountability 15 Conclusion 18 Recommendations 19 Bibliography: 20 Introduction Accountability has become a key issue in various sectors. It entails procedures and processes through which individual parties take responsibilities for their activities. Accountability in healthcare provision, parties involved can be held accountable for; professional competence, financial performance, public health promotion, legal and ethical conduct, community benefit, and financial performance (Dowdle 2006). Some people may argue that accountability is a myth that can not be elucidated due to the complexity of procedures involved and evaluation criteria. However, compliance evaluation may involve formal and informal procedures. In general, accountability is crucial to governance because it ensures public organisations perform in a professional manner in order to offer value for money in the line of public service provision (Dowdle 2006). With regard to accountability in the health care sector, this paper will focus on NHS. In essence, NHS has the role of improving health of the local population in the UK. However, NHS has to be accountable for its service delivery to the people (Cooper 1995). NHS Board is accountable to the department of health. The government is required to provide a statement of NHS accountability clearly describing its responsibility and accountability. NHS provides a range of services, which some of them are accrued from different organisations, not forgetting the department of health under which NHS is accountable to (Cooper 1995). Aim of the project This project aims at assessing, evaluating, and documenting the concept of accountability in public organisations. Specifically, the study will focus on NHS, and how it exercises accountability in its operations. To achieve this, study will assess the current accountability arrangements of NHS and evaluate the extent to which it is employed. It is apparent that not a single entity can be argued to comprehensively exercise accountability. Therefore, it will be essential to assess some of the barriers that hinder employment of accountability in NHS. In the long-term, this project benefit both the NHS, the public, and also to me as a student. Through the findings and recommendations of this project, NHS will be able to utilize the information contained in it in order to evaluate its performance in terms of accountability, and various ways through which it can improve as it will be stipulated in the recommendations. Other public organisations can also benefit from the findings of this paper. There is no difference in accountability exercised or required in NHS and accountability exercised or required in other public organisations. Therefore, the government may find it crucial to implement recommendations of this project, in advising other public institutions on how to institute and maintain accountability. On the same note, the public will also benefit from this project in that the project will elucidate on matters concerning how the public can ensure that the government and its institutions are accountable for their actions. For example, the public will be enlightened about consumer/customer accountability. Most people lack the idea of how the government can be made accountable for their service deliveries especially on matters pertaining health service delivery. It is argued that public organisations should ensure that the public gets the value for money in health provision. It is also my strong believe that this project will be of importance to me especially in my studies. I will have not only acquired report writing skills, but I will also have gained a grasp of what accountability entails. The project will help me to improve on issues pertaining accountability in my work place. Methodology This research utilizes a synthesis of observation, personal experience, internet research, textbook research, and class hand-outs and discussions in ascertain accountability arrangement in NHS, the extent to which they are employed, barriers to implementation, and possible ways of improving accountability in NHS and other public organisations. Barriers to achievement Although the researcher utilized all available and necessary tools and techniques in order to obtain and prepare the current report, there are some possibilities of lack of implementation of some recommendations of the paper. For example, one of the recommendations at the rear end of the project is that “Legislations need to be enacted in order to offer the NHS with coherent, sustainable and accountable structure, which will offer the process of NHS reform”. With this recommendation, there is a possibility that a recommendation would take a long time to implement or even fail to be implemented due to the nature of procedural processes involved in enacting reforms. This is hampered by intriguing politics involving such matters. Action plan Task Start Finish Project planning 16/04/2012 18/04/2012 Consult with the tutor and employer 19/04/2012 22/04/2012 Data collection 23/04/2012 01/05/2012 Data analysis and combination 02/05/2012 6/05/2012 Project report submission 08/05/2012 08/05/2012 Political accountability Political accountability can not be ignored at all costs. It is a vital type of public accountability in the UK and other democracies. This kind of accountability is put into effect by voters who within their rights and powers vote in members of parliament, councilors and other members of the government. These persons are held accountable by the public on maters pertaining their election mandate and promises (Dowdle 2006). In relation to NHS, political accountability is applicable where the elected politicians are accountable to public for responsiveness of accountability relevant to NHS performance. In UK, politicians are accountable to the public for their actions in a term of 5 years in office (Cooper 1995). In this regard, people have the right to ensure that the government performs and that it is accountable to itself and the public. If the government would wish to be successful in subsequent campaigns, they must ensure that they satisfy the public for them to have public support (Ferlie 2007). However, in order to maintain executive accountability, the media, parliament and courts have to keep the government on its toes (Dowdle 2006). Financial accountability Just like any other type of accountability, financial accountability involves someone being held accountable for financial management to the public. In this regard, budgetary control forms the best techniques of controlling, management and finance (Ferlie 2007). Orgarnisations can only be successful if persons mandated to manage them do not engage in misuse of money and funds of the organisations (Dowdle 2006). Sometimes decisions taken to fund projects or use funds in the organisation is also subject to explanation of actions taken. This also goes in line with an explanation of what has been done, or not done, and why. In regard to financial accountability in NHS, different individuals and bodies of NHS are accountable for the way they spend funds allocated to them (Cooper 1995). For example, in situations where a clinical center seems to have insufficient or substandard services, the management of the clinical center has to give an account of why the center is in such a situation. In most cases, financial matters are considered to create problems in operations of NHS. For example, when funds allocated for purchasing medicine in health care centers is misappropriated, the consequences are that patients will lack medicine in the centers, and this may lead to general poor quality of services in these centers (Dowdle 2006). Legal accountability Legal accountability is a concept that no individual or institution can argue against. It is applicable in the context of transparency and trustworthiness (Dowdle 2006). For public institutions to practice good governance there is a need to exercise legal accountability. In this regard, the NHS is accountable for its administrative duties and provision of services. NHS is subject to scrutiny by agencies such as supervisory agencies, auditors or courts (Cooper 1995). In events of administrative deviance, disasters, or policy failures, NHS officials can be forced to appear before penal courts, or even to make testimonies before parliamentary committees (Greener and Books 2009). In this regard, the NHS has the responsibility of making regular judicial and legal reviews. Under legal accountability, individuals or entities can petition decisions or conduct of NHS as an organisation or their workers (Ferlie 2007). Therefore, it is true to argue that legal accountability enhances the quality of health care services provided by the NHS. Both the NHS officials and workers are compelled to perform their duties as required. They clearly understand that they are held accountable to the public for their work. On the same note, the local authorities have the responsibility of ensuring that issues related to health of the people are well articulated upon (Ferlie 2007). For example, failure by the local authorities to have necessary arrangements for disposal of waste would lead to risking the health of the people, and which would amount to legal intervention (Dowdle 2006). Managerial accountability In any organisation, management ensures efficiency and success of the organisation. This involves the ability by management to offer quality and quantity standards to its customers. For public organisations, government intervention is critical in ensuring that public service managers implement their roles (Dowdle 2006). Public service managers should be accountable for their actions in the running of the organisation. Importantly, this is evaluated by use of performance management and measures. Leadership styles and traits are very crucial in any organisation. When management fails to lead from the front and use of correct leadership style, studies have indicated that organisations with such management tend to perform poorly (Dowdle 2006). In regard to NHS, management of different bodies of NHS plays a critical role in ensuring that there is harmony in all these bodies in order to offer quality services to people (Cooper 1995). For example, when a certain health care center is faced with poor management, there is a likelihood that coordination of funds, supervision of workers among other things tends to be difficult, thus, quality of services in such a center becomes of poor quality. It is, therefore, vital for NHS to employ persons of integrity and competence in order to facilitate smooth running of NHS facilities. Consumer/customer accountability Consumers in this case are the public who service NHS through taxes, and who receives the health service provision. This type of accountability is vital because it ensures that the consumers get the value for money (Dowdle 2006). The focus in consumer accountability should focus on moving the concept of supply-lead to consumer-lead or demand-led concept. This way, NHS will have to focus on what the public needs rather than what NHS have for them (Cooper 1995). NHS should prioritise on customer priorities. In relation to NHS and its facilities, patients in this case are the consumers of services offered by NHS. Much of consumer accountability in health care involves interaction between physicians, nurses or other workers. When physicians fail to attend to patients as required; therefore, it can be argued that there is no accountability in that hospital (Dowdle 2006). In health care centers where there is no consumer accountability, patients complain of negligence by clinicians, discrimination, use of abusive language, and refusal for treatment by clinicians. It is, therefore, vital that NHS employ persons who can be accountable for their duties and behaviors towards patients. Current accountability arrangements of NHS Currently, accountability arrangements in the health system are such that commissioning consortia are accountable: upwards to the NHS commissioning Board in terms of performance on outcomes and money, locally to overview and scrutiny committees and health and well-being boards, at a practice level to the patients (Cooper 1995). Additionally, the NHS commissioning board is accountable to the secretary of states. Foundation trusts have to be accountable to their governors and members. On the other hand, local authorities are accountable to their electorates. Nonetheless, these arrangements have recently been restructured by government reforms, which substitute the new commissioning consortia, the NHS commissioning board and health and well being boards for the existing PCTs, strategic health authorities and strategic partners (Dowdle 2006). Concerning governance and transparency in decision making, concern have been raised about these components. It is upon NHS commissioning board to develop guidance on commissioning consortia. Concerns of many people are about the lack of place by legislation on responsibilities on commissioning consortia (Greener and Books 2009). This has led to a notion that the government lacks proper and effective governance in place (Cooper 1995). It can be argued that NHS would be seen to exercise accountability if the government would include a requirement for commissioning consortia, which complies with the principles of public life, which stipulates on the following seven principles: Selflessness- this requires that holders of public office must act solely for the interest of the public (Cooper 1995). They should not be fastened to this principle for them to gain financial and other benefits for their own sake or other individuals. Integrity- this principle requires holders of public office not to place themselves under any other obligations to external individuals or organisations that might insert some influence in the performance of their official duties (Cooper 1995). Objectivity- this principle requires that holders of public office should make a choice on merits when carrying out official duties, public appointments, recommending individuals for rewards and benefits, or when awarding contracts (Cooper 1995). Accountability- this principle requires holders of public office have to be accountable for their duties to the public. They are also required to avail themselves whenever they are called upon for any scrutiny appropriate regarding their official duties (Cooper 1995). Openness- this principle requires holders of public office to be as open as possible while undertaking their official duties. They are also required to truthfully give reasons for various decisions made. However, they can only restrict information when the matter under scrutiny is for the wider public demands (Cooper 1995). Honesty- this principle requires holders of public office to declare any private interest that may relate to their public duties. They can accomplish this by making sure that they resolve any conflicts emanating from such an interest in order to protect the public interest (Cooper 1995). Leadership- this principle requires holders of public office promote and support all the above stated principles, and exercise all necessary leadership traits: they should lead by example (Cooper 1995). In some past years, there has been concern about the lack of effective and comprehensive democratic accountability of the NHS especially at the local level. The public has high expectations that the NHS, having been funded through national taxation, the NHS should undoubtedly deliver adequate and consistent health services across the country. Currently, the government appoints the secretary of states for health who is accountable to parliament for NHS delivery (Cooper 1995). Therefore, it can be argued that, at national level, there is an exercise of democratic accountability. Additionally, through reforms, the government has managed to distance politicians from extensive decision making at national level. However, this is yet to be put in practice since the government is still under political pressure and public expectations (Dowdle 2006). Nevertheless, even if the local commissioning consortia are free to make commissioning decisions based on the views and priorities of the locals, there is a lot of concern regarding the degree of variation across the country in relation to variability of access to services (Paul 1995). In fact, a more specific concern is about the legitimacy of the suggested local variation. According to the health and social bill currently before the parliament, provides that the secretary of state and the department will be responsible for setting the outcomes to be achieved through the NHS outcomes framework (Ferlie 2007). On the same note, the NHS commissioning board will have the overall responsibility and be accountable, for delivery of those outcomes. Barriers to implementation of accountability in NHS Barriers to implementation of accountability in the NHS fraternity involve various issues ranging from managerial, service delivery, political and financial issues (Dowdle 2006). Focusing on managerial and service delivery, there has been concern over the issue of clinical officers being involved in multiple duties. It has been argued that most of the clinical officers working in the public hospitals are also formally employed by universities (Dowdle 2006). They undertake teaching practices in the universities, are involved in research works, and others have administrative and management duties in the university. In this regard, it is arguably true to say that service delivery in public health centers is primarily affected by the fact that the clinical officers are insufficient and unavailable (Dowdle 2006). It would be vital if the NHS consider drawing a clear line for clinical officers in terms of their duties as employees of NHS. It would be necessary for the officers to concentrate on one line of profession. However, this does not rule out the fact that clinical officers need some training programs that would intensify their competence in service delivery. Nonetheless, such programs need to be designed by NHS, whereby the officers are allowed to advance their knowledge through research and other support they can obtain from the universities (Cooper 1995). Moreover, it is true to argue that for clinical officers to be involved in university duties and the clinical duties simultaneously there is a possibility that one of the institutions may influence the delivery of services for the other (Dowdle 2006). For example, clinical officers working for universities may be influenced by research findings carried out in the university in performing his or her duties. Perhaps, they may decide to carryout some experimentation discovered in the university by subjecting them to patients. This does not only breach ethical issues in clinical services, but also poses a risk of the wellbeing and life of the patient (Ferlie 2007). Therefore, it is true to argue that the NHS creates barriers to implementing accountability by allowing clinical officers to work for universities and healthy institution at the same time (Dowdle 2006). Clinical officers should remain in medical practices unless they want to quit as clinical officers. Additionally, for persons involved in the management of public health centers and are involved in administrative duties, in universities and other institutions equally poses risks of underperforming health institution (Cooper 1995). People involved in multiple duties at different institutions may find it difficult to deliver to the two institutions. There is also a risk of influence of performance of one institution from external forces. Moreover, there is a potential challenge in terms of the NHS funding services offered by clinical officers and their research and teaching duties in the universities (Greener and Books 2009). This raises concerns on financial accountability, whereby such funds tends not be accounted for properly. With such deliberations, it is vital for the NHS communicate to their staff about their responsibilities and their categorical line of duties. Although there is a need to have clinical academics working in collaboration with clinical officers, NHS should ensure that the two are accountable to them for their clinical duties assigned to them (Dowdle 2006). For clinical academics, their codes of practice should be accountable to relevant NHS body. It is also apparent that barriers to implementation of accountability in NHS also occur, as a result, of barriers to clinical engagement. Clinical engagement is achieved as a result of developing care pathways (Dowdle 2006). To a larger extent, this depends on the engagement and involvement of both clinical service providers and managers. It is argued that engagement of all staff is vital because it ensures proposed aims and objectives of the organisation are achieved (Tan 2001). Although the concept of care pathways has been cited to have intensified in NHS, it is necessary to consider its degree of application. There is a need to have a clinician engagement. Barriers to clinical engagement may happen at the staff and healthcare organisation or may be influenced by external factors. These barriers are argued to be related to clinical knowledge, attitudes and behaviors (Tan 2001). In regard to knowledge, studies have indicated that clinicians have difficulties following publication of guidelines (Cooper 1995). On the other hand, attitude barriers emanates from guideline disagreement and lack of applicability to certain clinicians. It has also been argued that clinicians may have negative attitudes towards various measure of standardisation of healthcare through the use of pathways (Dowdle 2006). For example, even though clinicians may find some guidance provided by path ways necessary, they may also feel that the guidance is impossible or threaten clinical autonomy. The situation is worsened when clinicians are excluded from the decision making process and the pathways. This ends up affecting accountability levels of the clinicians. They may feel overworked and sidelined in the clinical engagement (Dowdle 2006). The feelings of being neglected by clinicians are channeled to patients. Clinicians lack morale in their work, and obviously, this is evidenced by the quality of health services they give to the patients. Therefore, consumer accountability is compromised in such a situation. It is also obvious that when there is no clinical engagement in any health institution, there tends to be a problem with the management (Dowdle 2006). Clinicians would always disagree on issues emanating through pathways, especially if they were not involved and engaged in the process. It is, therefore, necessary for NHS to ensure that there is adequate clinical engagement when making decisions related to service delivery. Nonetheless, clinicians should be aware that they are accountable to NHS who in turn is accountable to the public. Effects of accountability Accountability in NHS is vital in ensuring that patients receive quality health care services. Accountability compliance has both direct and indirect effects to patients, healthcare worker, and the general public. Accountability measures ensure that health workers improve their working standards, thus, assuring patients and public safety (Cooper 1995). Measure of accountability also tends to help the NHS in evaluating and understanding the kind of service standards to offer to patients, and the working conditions needed by health care workers in order to achieve their goals. Accountability exercised by NHS ensures that there is a balanced level of standards national wide and at a local level. Accountability measure also helps the health care worker to do their job properly, do the right things, and behave properly (Dowdle 2006). This is considered to be essential to protect patients and the general public from harm. The same case applies to the health care workers, measures of accountability protects them from consequences related to their failure to perform their duties properly. Studies have indicated that people who exercise accountability are happy with their work. For things they are unable to do, they can easily and comfortably justify and explain them to their employer, patients, and the general public (Greener and Books 2009). Accountability ensures that health care workers stick to duties assigned to them, and any likelihood of misfortunes arising from unspecified duties enables the NHS to adjust their responsibilities of delegating duties accordingly (Cooper 1995). At the same time, accountability motivates health care workers to consult with colleagues about something they are not sure about. They feel accountable for their actions, and this makes them to have further research. The end results of such moves are appealing, and always lead to the provision of quality health care services to patients. Moreover, people who are accountable know themselves well, and they clearly know what they are not able to do (Dowdle 2006). This way, they are able specialize on what they are capable of, and would find it necessary to seek for special training in areas that they are not expert. Accountability ensures that the health care workers perform their duties as required, and this helps prevent physical and mental harm to patients. Accountability makes clinicians recognise every patient’s feeling and emotions (Dowdle 2006). This is arguably true because clinicians are compelled to treat patients politely taking in to account their conditions. This goes hand in hand with application of objectivity, whereby clinicians treat all patients with equality (Cooper 1995). Accountability ensures that clinicians are not influenced by their personal feelings when attending to patients. This means that issues of sex, age, or any form of ethnicity are not a consideration when treating patients. Managerial accountability ensures that those in health care leadership are accountable for their duties, which are mandated to undertake. As a result, there tends to be effective running of the institution. This also means that there is harmony between various departments in the institutions (Dowdle 2006). Management accountability also ensures that issues related to clinical engagement are comprehensively looked at. Clinicians are involved and engaged in decisions regarding their clinical duties. This form of accountability ensures that issues related to patients are addressed accordingly. Political accountability plays a key role in ensuring that those elected by the people are accountable to the public for their duties appointed to perform. Accountability gives the public powers to question any decisions by the elected members concerning running of health care institutions (Greener and Books 2009). MPs and councilors are supposed to ensure that public institutions deliver quality service to the people. When politicians are accountable for their work, they put the government to task over issues related to NHS performance. They ensure that the public is involved in decisions making process in collaboration with NHS at a local level (Cooper 1995). Financial accountability in NHS ensures that all the funds allocated for various projects are accounted for. NHS runs with support from funds gotten from public through taxation. Therefore, those, in budgetary positions in NHS and other bodies allied to it, ensures that these funds are spent as stipulated (Dowdle 2006). When there is financial accountability, budgetary staff ensures that the customer gets the value for money. They ensure that funds are directed to the right projects. Mismanagement of funds is minimised as there is strict scrutiny and auditing of the institution accounts. Following enactment of the 1998 human rights act, clinicians are compelled to ensuring that their work does not affect the patient’s physical or mental well-being, as described in articles 2 and 3. Accountability challenges clinicians to lookout on issues that might endanger the well-being of the patient (Greener and Books 2009). The same case applies to issues pertaining patient’s private or family life as stipulated in article 8. Accountability also ensures that NHS doers not affect with the clinician’s and other health care worker’s freedom of expression (Dowdle 2006). Clinicians as workers have a freedom of expression. This helps NHs improve their working conditions. In regard to rights covering NHS workers, NHS is compelled by law to against unlawful pay and deductions of the workers (Paul 1995). They must ensure equal pay with reasonable working hours and breaks, holidays, and recognise workers unions. When NHS abides to these laws, they ensure accountability prevails. In turn, the NHS workers perform their duties as required, with minimal problems (Cooper 1995). It can, therefore, be argued that all forms of accountability ensure provision of quality health care services. Conclusion Accountability entails procedures and processes through which individual parties take responsibilities for their activities. Accountability in healthcare provision, parties involved can be held accountable for; professional competence, financial performance, public health promotion, legal and ethical conduct, community benefit, and financial performance. In political accountability, politicians are held accountable by the public on maters pertaining their election mandate and promises. In relation to NHS, political accountability is applicable where the elected politicians are accountable to public for responsiveness of accountability relevant to NHS performance. Financial accountability involves someone being held accountable for financial management to the public. In regard to financial accountability in NHS, different individuals and bodies of NHS are accountable for the way they spend funds allocated to them. Legal accountability is applicable in the context of transparency and trustworthiness. In this regard, NHS is subject to scrutiny by agencies such as supervisory agencies, auditors or courts. Managerial accountability involves the ability by management to offer quality and quantity standards to its customers. In regard to NHS, management of different bodies of NHS plays a critical role in ensuring that there is harmony in all these bodies in order to offer quality services to people. In consumer accountability, focus should involve moving the concept of supply-lead to consumer-lead or demand-led concept. Current accountability in NHS is dependent of different bodies of NHS, and their duties. Each body is accountable to another body, and the same case applies to workers of NHS. However, in general, the NHS commissioning board is accountable to the secretary of states, who in turn is accountable to the parliament, and then the parliament is accountable to the public. Barriers to implementation of accountability in the NHS fraternity involve various issues ranging from managerial, service delivery, political and financial issues. Accountability compliance has both direct and indirect effects to patients, healthcare worker, and the general public. Accountability exercised by NHS ensures that there is a balanced level of standards national wide and at a local level. Studies have indicated that people who exercise accountability are happy with their work. Accountability ensures that the health care workers perform their duties as required, and this helps prevent physical and mental harm to patients. Managerial accountability ensures that there is effective running of the institution. Political accountability ensures that those elected by the people are accountable to the public for their duties elected to perform. Financial accountability in NHS ensures that all the funds allocated for various projects are accounted for. Recommendations NHS bodies should effectively inform NHS clinical officers and clinical academics to whom they are accountable for duties assigned to them. This way, it would be uncomplicated to regard clinical academics as holding two part time jobs and accountable to two different employers. The government should ensure that NHS is free from political interference in its day to day operations. However, the NHS should be made accountable both to patients and the government, which represents the democratic voice of the public. NHS should, thus, focus and prioritise on needs and choices of patients. Legislations need to be enacted in order to offer the NHS with coherent, sustainable and accountable structure, which will offer the process of NHS reform. There is also a need to establish a health watch national wide and at the local level, which will act as patients’ watchdog. The primary care trusts need to produce an annual health improvement plan, which, together with local authorities will govern service planning and contracts within healthcare suppliers. Bibliography: Cooper, L., 1995. Voices off: tackling the democratic deficit in health. London: Institute for Public Policy Research. Dowdle, W. M., 2006. Public accountability: designs, dilemmas and experiences. Cambridge [u.a.]: Cambridge Univ. Press. Ferlie, E., 2007. The Oxford handbook of public management. Oxford [u.a.]: Oxford Univ. Press. Greener, I. and Books, D., 2009. Healthcare in the UK: understanding continuity and change. Bristol: Policy. Paul, S., 1995. Strengthening Public Accountability: New Approaches and Mechanisms. Bangalore: Public Affairs Centre. Tan, K. H., 2001. Health management information systems: methods and practical applications. Gaithersburg, Md.: Aspen Publishers. Read More