Managing pressures in practice

CSP professional adviser Gwyn Owen looks at how your professional standards could be helpful when you face potentially compromising pressures at work.

I took some time out recently to read through the queries that come into CSP’s professional advice service. One thing that struck me from some of those emails was a sense of the pressures members feel as they’re asked to do more work with few or no additional support or resources. The situations themselves vary – from being asked to provide cover for absent physiotherapy colleagues or to take on additional nursing duties to ensure adequate staffing on a ward. Another example might be a proposal to shave 10 minutes off the standard physiotherapy appointment in order to reduce numbers on the physiotherapy waiting list. 
The sense of pressure generated by a drive to do more is not limited to the NHS where the austerity measures introduced by government make headline news. It is also an issue for members providing services funded by insurance companies, charitable trusts or clients themselves. 
It seems that businesses and organisations are recognising the potential impact of increasing demands on employees’ health and wellbeing, and their capacity to deliver quality services. This can be seen from a rise in ‘healthy workplace’ initiatives, which include advice about the positive benefits of activity on health and productivity at work, access to stress management training and support to develop ‘resilience’, for example. While such initiatives have a positive impact on an individual’s ability to manage workplace demands, the benefits will be short-lived unless work is undertaken to address the root cause of the problem. 
This article explains how you can use professional standards to challenge situations where the pressure is compromising your capacity to fulfil your duty of care to service users. 

What is duty of care? 

Duty of care is defined as a legal responsibility to provide a reasonable standard of care to service users and to act in ways to protect their safety. The responsibility for fulfilling a duty of care to service users is a key expectation of professionalism and is at the heart of the CSP’s Code and Quality Assurance standards. 
In practice, fulfilling duty of care means taking responsibility to ensure that you fulfil your professional responsibility to provide a safe and effective physio service  keep your practice up to date, and undertake continuing professional development activity that supports your ongoing competence to practise do not accept delegated duties that sit outside your scope of practice do not delegate work to others unless you know that they have competence and capacity to undertake that work communicate promptly any issues limiting your capacity to fulfil your duty of care (this element is associated with the professional
responsibility known as duty to report) 
Organisations and businesses also have a duty of care to service users and to staff employed to deliver services. This means that they are required to take reasonable action to assure the health, safety and wellbeing of employees and people using the service. They are responsible for enabling staff to work safely and effectively in delivering services to the public.
The CSP’s quality assurance standards were developed to support CSP members in delivering safe and effective physiotherapy service The standards set out what is expected from individual CSP members and the services they provide. They also describe the things that need to be in place to ensure that an individual practitioner, physiotherapy team, organisation or business is able to deliver safe and effective physiotherapy service. And it is this element of the standards that makes them a potentially valuable tool for challenging situations where doing more is not possible without additional support or resources being put in place.

A partnership

Duty of care can therefore be seen as a quality assurance partnership: one that works to ensure that the right structures, systems, personnel and practices are in place to enable the workforce to deliver safe and effective service. The quality of care therefore depends on the quality of employment. If one part of the partnership fails, the other suffers – to the detriment of people using the service.

Employees’ responsibilities 

  • work in accordance with lawful orders 
  • serve your employer faithfully and honestly 
  • exercise skill and care in the performance of your work 

In return, employers should

  • take reasonable care for your safety by providing a safe working environment  
  • not act in a way that undermines trust and confidence in your working relationships 
  • not cause you physical or psychological harm by reason of the volume or character of the work imposed on you
  • not give instructions that conflict with your professional duty of care (as outlined earlier) 
When you think you have been exposed to a situation or incident that you feel compromises your professional practice, seek advice from your steward or safety rep and enlist their support.

Actions they might recommend include 

  • putting your concerns in writing to your manager or by using local reporting procedures
  • encouraging other colleagues to support your safety rep or steward in getting the problem resolved
  • if the situation demands it, or where other approaches have been unsuccessful, you might be advised to follow your employer’s grievance procedures and/or whistleblowing procedures. fl

Under pressure

Use this scenario as a CPD activity to reflect on the implications of being asked to take on extra work with few or no extra resources
CSP member Sam (not their real name) was asked to take on additional work to cover for a colleague who had been signed off sick for one month. Sam is already working to capacity juggling a heavy caseload alongside completing an MSc and caring for an older relative. The additional workload includes some practical tasks that Sam has not performed for more than two years. Sam’s manager has offered ‘support’ but has not been clear about the nature and extent of that support. 

What are the tensions in this situation?  

How could the CSP’s quality assurance  standards (see main article for more on this)
(a) support Sam to challenge the request?  
(b) help Sam, the CSP steward and manager to find an alternative solution? 

CSP resources

Gwyn Owen

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