Increasing accountability pressure serious stress factor for some physicians

Some medical specialists see the risk of a possible complaint as an occupational stress factor. Although they recognize the need to be professionally accountable, they also feel the pressure this generates. PhD candidate Erik Renkema concludes that the current system of accountability is having an adverse effect. ‘The risk of a possible complaint is causing some specialists to order extra diagnostic tests, making them reticent about reporting incidents with patients and even prompting them to avoid certain treatments or patients. This behaviour was never the intention of the accountability system, which was actually designed to encourage high quality care’, says Renkema.

In his thesis, Renkema shows how professionals are torn between the increasing demand for public and professional accountability, and their own need to uphold their reputation and wellbeing. Renkema would like to see wide-reaching debate about the current culture of accountability in order to reduce the negative impact it is having on both healthcare professionals and patients. He will be awarded a PhD by the University of Groningen on 30 November.

Public and professional accountability

Many medical professionals are expected to demonstrate public and professional accountability. The aim of this context is to safeguard and improve the quality of care. In a worst case scenario, if a professional does not act in line with the agreed professional codes, he or she can be struck off. In addition, patients can call professionals to account by filing an official complaint.

Worried specialists provide more defensive care

Renkema interviewed 31 medical specialists to try to understand their thoughts and feelings about this culture of accountability, and how their attitude is affecting their professional behaviour. He was able to divide the specialists he studied into two almost identically sized groups: a cluster of professionals who are relatively more concerned and have negative thoughts about the risk of a complaint, and a cluster who seem to be less worried about this risk.

‘The way medical specialists perceive a possible complaint affects the way they behave’, says Renkema. ‘The specialists who are more concerned about a complaint being filed against them are more reluctant to discuss incidents with patients, and provide more defensive care by, for example, passing some of the responsibility to a colleague or ordering extra diagnostic tests.’

Implications for care professionals, patients, hospital managers and policymakers

According to Renkema, his findings have implications for four separate groups. ‘First, for the medical specialists themselves. My research is an invitation to reflect: how am I dealing with the present culture of accountability? How is this culture affecting me?’ It is also important for patients to think about the way they ask for healthcare, says Renkema. ‘There is a direct link between the pressure that medical specialists perceive from patients and a defensive care package.’

The Executive Boards of hospitals, which are ultimately responsible for the quality of the care provided, can also learn from his research, claims Renkema. ‘They should be offering their professionals adequate support when dealing with medical incidents and discussing complaints and incidents with patients. An incident obviously has a huge impact on the patient, but also on the specialist. In my view, there should be more focus on improving the care that has failed and less on finding a scapegoat.’ But Renkema would like to see policymakers listening to the recommendations too. ‘Medical disciplinary law is making specialists scared about being held personally responsible. This extra pressure is having an unintentional negative effect.’

For more information

• Contact: Erik Renkema, through the Communication Office: +31 (0)50 363 4444

• Renkema conducted his research in the Operations Management & Operations Research department of the Faculty of Economics and Business. The research aligns with the research lines examining quality and safety in the healthcare system (in association with the UMCG) and job crafting among professionals.

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