Fitness to practise: exploring radiation therapists’ reporting preferences for departures from optimal professional behaviour
thesisposted on 27.02.2017 by Hancock, Caroline Anne
In order to distinguish essays and pre-prints from academic theses, we have a separate category. These are often much longer text based documents than a paper.
In recent years, high profile cases from the medical and health care fields have reported practitioners who, through criminal behaviour, lack of competence or sub-optimal professional performance have failed to meet either the clinical or behavioural standards expected. Whilst gravely serious cases of less than optimal practice involving qualified health care practitioners are infrequent, there are published cases which highlight examples of sub-optimal practice amongst radiation therapists (RTs). However, in Australia these are a few and far between. The highly technical nature of the profession of radiation therapy may mean a greater emphasis is placed on the performance of equipment, machinery, and technology to the detriment of the requirement for fitness to practise (FTP) or to the professional performance of practitioners themselves. The aim of this research was to determine what radiation therapists understand about FTP and its integration into their daily work, with respect to the identification of and reporting of sub-optimal performance. A mixed method exploratory, sequential design was employed, with three initial focus group discussions undertaken to investigate the phenomena of FTP in radiation therapy. Qualitative data analysis was guided by grounded theory. The findings, specifically RTs definitions of fitness to practise (a continuum; behaviour and conduct; possession of qualification; and a state of mind) and their perceptions of the determinant classifications of FTP (impairment; competence; and values/ethics) were used to create a national online scenario-based survey. The anonymous online surveys depicting eight FTP dilemmas concerning issues related to: impairment; competence; and values/ethics were distributed to 1054 RT members of the professional association, with a response rate of 17.6% (N=185). Qualitative data analysis was undertaken and two key themes emerged. Theme 1: ‘dealing with the situation’, involved the RTs suggesting immediate responses to the dilemmas. Theme 2: the RTs’ obligation to report included the reporting preferences of RTs for each FTP dilemma (no reporting, internal mention to a senior practitioner, internal formal reporting and external formal reporting). Qualitative data was transposed into spreadsheet format and analysed quantitatively. Binary logistic regression was performed to determine whether any specific demographic characteristic (gender, number of years of clinical experience, location of clinical centre and sector of service delivery) were associated with higher odds of not reporting vs reporting and informal vs formal reporting. The strongest predictor of reporting preference was for RTs with six or more years of clinical experience. Data from the focus groups and the survey were integrated to formulate a substantive theory which encapsulated the findings of the research: Radiation therapists understanding of fitness to practise is contextually derived and subjectively interpreted, throughout the continuum of their professional working life. Radiation therapists demonstrate reluctance to report FTP issues and where reporting does occur, the number of years of professional experience of the RT is the demographic characteristic with the strongest predictive capacity for reporting preference. In summary this study has demonstrated important gaps in the understanding and implementation of FTP by all stakeholders. There needs to be a cultural shift in the profession of RT, starting with the delivery of FTP education and awareness programs for entry level students. This should then be reinforced by clinical organisations, Chief RTs/RT managers and the registration board to ensure complete professionalisation of RTs, which may in turn make RTs more accountable for their actions and those of others.