Who Is Responsible For The Outcomes Of Care In A Delegated Workforce Model?
One of the most common concerns that allied health professionals raise about employing allied health assistants is a lack of clarity around who is responsible if things go wrong. In an increasingly risk averse and litigious society, this is understandable. As a result, however, many allied health professionals (and other health professionals) choose not to delegate work that could or should be done by others workers. At a time of enormous workforce shortages, the failure to fully and efficiently delegate care can result in longer patient waiting times and reduced overall access to health services.
The purpose of this article is to help to clarify the responsibilities of different workers in a delegated model of care. This is intended to be a guide only and should not be taken as legal advice. Every employer, profession and state is likely to have their own policies and employment law that will ultimately dictate the way that specific responsibilities are addressed, however there are some common principles that are likely to apply across most jurisdictions.
Every worker in Australia works within a range of legal frameworks. These include your contract of employment, your employment Award or Agreement, and your employer’s policies. It also includes a raft of legislation covering equal opportunity, discrimination, occupational health and safety, privacy and so on.
Allied health assistants (and most other support workers and care staff and several allied health profession groups) are not regulated by the Australian Health Practitioner Regulation Agency. If those workers are a member of a professional association, such as the Allied Health Assistant National Association, then they will have agreed to adhere to a professional Code of Conduct. The respective professional associations can take disciplinary action for breeches of the professional Code of Conduct.
Duty of care and negligence
If you are an allied health assistant and you are asked to do something that you do not feel safe doing, or you may consider to be dangerous or inappropriate, you should apply the ‘lawful and reasonable’ test. You do not have to comply with any employer instruction which is either unlawful or unreasonable.
Suppose an allied health assistant is responsible for assisting a physiotherapist in providing therapy to a patient with a spinal cord injury. During one of the therapy sessions, the AHA fails to properly secure the patient’s wheelchair, causing the patient to fall and sustain further injury. This would be considered a breach of duty of care, as the AHA had a responsibility to ensure the patient’s safety and failed to do so, resulting in harm to the patient.
If an allied health assistant is accused of a breach of duty of care, the burden of proof falls on the person making the claim to show that the assistant was negligent in their duties, and that this negligence caused harm or injury to the patient.
To prove that an allied health assistant breached their duty of care, the following elements would need to be established:
- Duty: There must have been a duty of care owed by the assistant to the patient. This means that the assistant had a responsibility to act with a certain level of care and skill towards the patient.
- Breach: The assistant must have breached their duty of care. This means that they failed to meet the required standard of care, either by doing something they should not have done or by failing to do something they should have done.
- Causation: The assistant’s breach of duty must have directly caused harm or injury to the patient.
- Damages: The patient must have suffered actual harm or injury as a result of the assistant’s breach of duty.
If all of these elements can be proven, then the allied health assistant may be found guilty of a breach of duty of care. It’s important to note that the standard of care expected of an allied health assistant will vary depending on their specific role and responsibilities, as well as the context in which they are working.
In a delegated workforce model, where different individuals or teams are responsible for different aspects of care, the ultimate responsibility for the outcomes of care lies with the healthcare organization or entity that oversees the model. This organization or entity is responsible for ensuring that appropriate training, resources, and oversight are provided to those individuals or teams who are delegated to provide care.
Individuals or teams who are delegated to provide care also have a responsibility to follow established protocols, guidelines, and procedures, and to communicate effectively with other members of the care team. However, their actions and decisions are ultimately overseen and accountable to the healthcare organization or entity that oversees the delegated workforce model.
If I delegate to someone else, am I responsible for the outcomes?
Yes, as a healthcare professional, if you delegate care to someone else, you are still ultimately responsible for the outcomes of that care. While you may not be directly providing the care, you have a responsibility to ensure that the person to whom you have delegated the care is appropriately trained and qualified to perform the task, and that they are following established protocols and guidelines.
You also have a responsibility to provide adequate supervision and oversight, and to intervene or take action if necessary to ensure that the care is being provided safely and effectively. Ultimately, as the healthcare professional who delegated the care, you are accountable for the outcomes and any adverse events that may occur.
It is important to note that delegating care is a complex process that requires careful consideration of various factors, including the competence of the person to whom care is being delegated, the complexity of the task, and the potential risks and benefits of delegation. It is important to follow established guidelines and protocols for delegation and to document the process and outcomes of delegated care.
If I delegate care to someone and they make a mistake, will I be held accountable?
As the healthcare professional who delegated care to someone else, you may still be held accountable if they make a mistake. This is because you have a responsibility to ensure that the person to whom you have delegated the care is appropriately trained and qualified to perform the task, and that they are following established protocols and guidelines.
However, the extent to which you will be held accountable will depend on the specific circumstances of the mistake, the actions you took to prevent it, and your overall role in the care of the patient. If it is determined that you failed to provide appropriate training, supervision, or oversight, or that you were aware of the risks associated with delegating the task and did not take appropriate action to mitigate those risks, you may be held accountable.
It is important to note that holding someone accountable does not necessarily mean that they will be punished or face disciplinary action. In some cases, accountability may involve taking corrective action, such as providing additional training or changing established protocols to prevent similar mistakes from occurring in the future.
To minimise the risk of being held accountable for mistakes made by someone else to whom you have delegated care, it is important to carefully consider the qualifications and competence of the person, provide adequate training and supervision, and document the process and outcomes of delegated care.
Some broad principles
Principles of safe delegation for allied health assistants
- Understand the task: Before accepting any delegated task, ensure that you fully understand the scope and requirements of the task. Seek clarification if necessary, and don’t be afraid to ask questions if you are unsure about anything.
- Be aware of your scope of practice: As a support worker or allied health assistant, you have a specific scope of practice that outlines the tasks and activities you are qualified and authorised to perform. Ensure that any delegated task falls within your scope of practice and that you are adequately trained and qualified to perform the task safely.
- Follow established protocols and guidelines: Ensure that you follow established protocols and guidelines when performing any delegated task. This may include specific procedures, policies, or standards of practice that have been established by your healthcare organization or the relevant regulatory body.
- Seek guidance and support: If you have any concerns or questions about a delegated task, seek guidance and support from a healthcare professional who is authorised to provide such guidance. This may include a nurse, doctor, or other healthcare professional.
- Document your work: Keep accurate and up-to-date records of any delegated tasks you perform, including any observations, measurements, or other relevant information. This documentation can be useful for monitoring and evaluation purposes, as well as for ensuring that you are working within a safe delegation framework.
- Communicate effectively: Ensure that you communicate effectively with other members of the healthcare team, including the person who delegated the task, other support workers or allied health assistants, and any healthcare professionals who are involved in the care of the patient. This may include reporting any changes or concerns about the patient’s condition, as well as seeking guidance or support as needed.
Principles of safe delegation for an allied health professional
- Understand the task: Before delegating any task, ensure that you fully understand the scope and requirements of the task. Be clear about the expected outcome, any limitations or restrictions, and any potential risks or hazards associated with the task.
- Assess the competency of the allied health assistant: Ensure that the allied health assistant is competent and qualified to perform the delegated task. This may include reviewing their training and qualifications, observing their skills and abilities, and assessing their confidence in performing the task.
- Provide clear instructions: Provide clear and detailed instructions for the delegated task, including any relevant protocols or guidelines that should be followed. Ensure that the allied health assistant understands the instructions and is able to ask questions or seek clarification as needed.
- Supervise and monitor the task: Ensure that the delegated task is being performed safely and effectively by providing appropriate supervision and monitoring. This may include checking in with the allied health assistant periodically, observing the task being performed, and providing feedback or guidance as needed.
- Document the delegation: Keep accurate and up-to-date records of the delegated task, including any relevant instructions, observations, or feedback. This documentation can be useful for monitoring and evaluation purposes, as well as for ensuring that the delegation was performed safely and appropriately.
- Review and evaluate the delegation: After the task has been completed, review and evaluate the delegation process to identify any areas for improvement. This may include assessing the effectiveness of the delegation, identifying any challenges or issues that arose, and developing strategies to address these challenges in the future.
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