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Administrative Safeguards to Limit the Risk of Professional Misconduct


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By Gary R. Schoener

Published in: Health & Medicine, Education
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Administrative Safeguards to Limit the Risk of Professional Misconduct

  1. 1. Administrative Safeguards to Limit the Risk of Professional Misconduct Gary R. Schoener Licensed Psychologist & Executive Director Walk-In Counseling Center Minneapolis, Minnesota
  2. 2. Learning From Experience Walk-In Counseling Center <ul><li>Problem of the rare circumstance or event for the administrator </li></ul><ul><li>What is the Standard of Care for administrators/supervisors? What a reasonable and prudent admin. would do in the same/similar circumstances </li></ul>
  3. 3. A few important notes <ul><li>When faced with possible legal risk, remember that the key is to do your best thinking and get consultation </li></ul><ul><li>The most important courtroom is the mirror in your home into which you look in the morning and evening </li></ul>
  4. 4. <ul><li>Practical training re: boundaries with videotapes, role play, presentations by offenders and victims; </li></ul><ul><li>Trainee impairment: have an outside assessment done; plan rehabilitation & review student’s future; </li></ul><ul><li>Abusive faculty: those with “regal bearing” who “can do no wrong” are bad models. </li></ul><ul><li>Trainees benefit from learning from faculty of their own mistakes </li></ul>Issues in Training
  5. 5. Staff Selection & Hiring <ul><li>Job application – specifically ask about: </li></ul><ul><ul><li>Past Terminations/Resignations </li></ul></ul><ul><ul><li>Past Complaints of any type </li></ul></ul><ul><ul><li>Past lawsuits </li></ul></ul><ul><li>Direct check with Medical Council or Regulatory Authority with whom they were registered in past </li></ul>
  6. 6. <ul><li>Obtain a broad release permitting you to interview anyone about their work history, skills, character and ethics ; </li></ul><ul><li>Ask for and provide honest feedback about strengths & weaknesses ; </li></ul><ul><li>Ask reference to specifically reflect on the specific job and what reservations they might have ; </li></ul><ul><li>Be clear with applicant about the major challenges & stressors – what the “real” job is like. </li></ul><ul><li>Use role play or get a work sample. </li></ul>Staff Selection & Hiring
  7. 7. A Note on Minnesota <ul><li>In 1986, concerned about the fact that offenders seem to be able to keep getting jobs (ending each with a silence agreement), legislators passed MS 148.A – former employers are asked and must answer about any knowledge of sex with patients or attempts to have sex by applicant </li></ul>
  8. 8. Staff & Organizational Policies <ul><li>Written policy forbidding sex with patients, former patients, or their family </li></ul><ul><li>Written policy covering other boundary areas – financial dealings, etc. </li></ul><ul><li>Written policy for support staff & other non-clinical personnel </li></ul><ul><li>Sexual harassment policy </li></ul>
  9. 9. Complaint Policies <ul><li>Do you have a written policy concerning the handling of complaints? </li></ul><ul><li>Are all complaints taken seriously and treated as complaints? </li></ul><ul><li>Are complaining patients thanked for coming forward and given support? </li></ul><ul><li>Do you have a policy for referral to outside resources? </li></ul>
  10. 10. Complaint Procedures <ul><li>is there a procedure to decide whether to temporarily suspend a staff member? </li></ul><ul><li>Do you have a procedure internal review? Ethics committee, or professional standards review committee? </li></ul><ul><li>Do you have outside consultants who can be used in an investigation? </li></ul>
  11. 11. Complaint Resolution <ul><li>Is resolution reached on all complaints or does if remain moot if resignation? </li></ul><ul><li>Are complainants always given feedback? </li></ul><ul><li>Do you ask future employers who make inquiries to obtain a full release, and then truthfully answer questions? </li></ul>
  12. 12. Patients <ul><li>Are new patients given handouts which actively seek to solicit feedback? </li></ul><ul><li>Is there an easy-to-use complaint system? </li></ul><ul><li>Do you provide any information on evaluating therapy and/or professional boundaries? </li></ul><ul><li>Is there good information available on your website about these things? </li></ul>
  13. 13. Staff Orientation/Training <ul><li>Are staff given written copies of policies </li></ul><ul><li>Are policies explained to new staff? </li></ul><ul><li>Are there training sessions on boundaries at least once a year? </li></ul><ul><li>If there are incidents of misconduct, is there a session to discuss what can be learned? </li></ul>
  14. 14. <ul><li>Ensure that your supervisors are trained in supervision; have consultation group; </li></ul><ul><li>Set up supervision plan & probation for a new staff member based on their strengths and weaknesses ; </li></ul><ul><li>Review the plan periodically ; </li></ul><ul><li>Have back-up supervision & a clear standard that consultation is obtained; </li></ul><ul><li>With lacunae in training or skills, develop a plan for additional training, supervision, etc. & evaluate success </li></ul>Supervision
  15. 15. Supervision -- continued <ul><li>Automatic review of treatment which exceeds “normal” length; </li></ul><ul><li>Review of situations where clients cross boundaries or “push limits” </li></ul><ul><li>Review of situations with excessive dependency </li></ul><ul><li>Periodic review of long term treatment to ensure there are goals & progress </li></ul>
  16. 16. <ul><li>Atmosphere which encourages constructive questioning; </li></ul><ul><li>Non-threatening pathways for staff to raise concerns with supervisor/admin. </li></ul><ul><li>When staff have obvious distress and/or personal problems, is feedback given, seeking of help encouraged, and clinical duties reviewed? </li></ul><ul><li>Intervention in problem cases </li></ul>
  17. 17. <ul><li>Failing to empathize with the anxiety involved in a complaint; </li></ul><ul><li>Jumping to a premature conclusion –failing to investigate; </li></ul><ul><li>Promising a response within a time frame which is unrealistic; </li></ul><ul><li>Failing to give a simple human apology for what has happened or the apparent impact; </li></ul>Common Errors in Handling Complaints ….
  18. 18. … more common errors <ul><li>Getting so legalistic that all comfort or sense of comfort is lost; </li></ul><ul><li>Hinting at an outcome or giving false reassurance when things are uncertain; </li></ul><ul><li>Not allowing the complainant time to think over a choice; not having them talk it over with their support people; </li></ul><ul><li>Being careless in what informaiton is put out to the staff or the community. </li></ul>
  19. 19. Challenges of the Internet <ul><li>Complaints/grievances may end up being “public” on the internet </li></ul><ul><li>Great new hazards re: boundaries; </li></ul><ul><li>Be aware of your web-presence – google yourself, staff, your program; </li></ul><ul><li>If there is false information, contact site administrator to get things changed </li></ul><ul><li>Collegial discussion – develop standards </li></ul>
  20. 20. [email_address] <ul><li> </li></ul><ul><li> </li></ul>