REVIEW OF THE BUSINESS PRACTICE POLICY – HPCSA
The CPF received an official request from the HPCSA regarding business practice policy:
REQUEST FOR SUBMISSIONS ON THE REVIEW OF THE BUSINESS PRACTICE POLICY
The Health Professions Council’s Committee on Business Practices is in the process of reviewing the Business Practice Policy and has called for submissions from all Professional Boards.
The Committee on Business Practice requested the Professional Boards to provide inputs and/or comment specifically on the following areas –
- Employment of practitioners
- Managed care
- Undesirable Corporate Ownership
- Franchising – having touting & canvassing as subsections under this heading Group practices.
Types of business models that should be considered by the committee Possible amendment of ethical rule 8A and 18.
Committee of the Professional Board for Psychology RESOLVED Professional Please submit your input in writing to NcumisaM@hpcsa.co.za or LiliosaM@hpcsa.co.za by no later than 27 July 2018.
CPF Responded to this request after deliberation among the exco. The following response was submitted:
02 August 2018
To: The Professional Board for Psychology, HPCSA
RE: Recommendations to the Code of Ethics revision
In addition to responses already submitted on 30 may, and which are copied in below, the CPF submits further comments particularly addressing the code items 8A and 18.
General comments submitted 30 may 2018
The matters addressed in the current code are largely recognised as remaining valid. However, there are a number of issues which either could be improved by revisiting for detail and clarity, or have not been addressed at all. The comments below do not attempt to provide detail as it is recognised that this will need to be done in a collaborative process with representation from various stakeholders.
In addition to the code being presented as a list of instructions, it may be useful to extend the preambles to a richer discussion around the process of dealing with ethical issues. Frequently psychologist face ethical dilemmas which are not clearly spelled out in any way in the code due to more than one ethical issue being involved. Guidelines as how to approach such matters may be useful.
Besides the main matters addressed by the current code of ethics in the eleven sections, the CPF propose that the following matters be addressed as either new issues or be fleshed out in a revision:
The matters concerning patients referred by a third party:
The issues surrounding patients in public hospitals for both treatment and research purposes.
The issues surrounding patients in institutions, organisations and referred by agencies for both treatment and research purposes.
In both the above instances it seems that it is not always fully understood that patients, registered members of institutions, and research participants should not have their personal information which may be kept on institutional records, available to anyone for any reason without their consent. While this is the main issue, there may be circumstances which need to be dealt with in the detail.
Recognition of the divided responsibilities on the part of the professional, between 3rdparties who refer and the patients or research participants themselves.
Sharing of information between 3rdparties and the professional psychologist. There is often pressure on the psychologist in these circumstances to share information and the complexity of ethical issues may need to be recognised in the code.
Referral from one practitioner to another and issues that arise when the initial professional does not cut ties with the client/patient.
Psycho-legal and forensic matters:
Guidance for professionals as how to conduct themselves and how to process ethical decisions when acting in psycho-legal and forensic matters.
The need for impartiality and measures to protect impartiality could be recognised in the code.
What constitutes “tampering: with evidence? The need for clarity of role within a psycho-legal situation.
Who can provide expert witness in a court? How to manage expert witnesses who give evidence beyond their scope?
Use of electronic equipment, technology, and telecommunications in professional engagements:
This includes the use of and sensitivity to issues surrounding social media.
Making use of telecommunications to conduct professional sessions with patients and research participants from a distance.
Management of ethical and professional violations:
The establishment of informal processes among professional peers prior to disciplinary hearings conducted by the Board. Specified cases of a serious nature could be directed immediately to the Board.
Scope of practice adherence and how to manage transgressions when they become known.
The need to provide evidence of treatment mode outcomes:
Professional psychologists may be required to provide evidence that the treatment modes employed have a reasonable measure of outcome reliability. This can be done by referring to research.
Employment of assistants in a practice set up:
The provision for non-HPCSA registered persons to work in a professional environment as an assistant who may assist with confidential files, assessment materials, accounts and other sensitive information. It is unrealistic to expect professionals to employ other professionals to assist in administrative work which may involve handling confidential or sensitive material. Suitably trained and trusted individuals should be able to be employed to conduct such administrative work which would include the handling of psychometric test material.
New submissions 02 August 2018
Code items 8A and 18:
Sharing of Rooms
“8A. A practitioner shall not share his or her rooms with a person or entity not registered in terms of the Act.”
Rule 8A would seem to be redundant if all other ethical practices as identified in the policy are followed: for example, ethics regulations regarding referrals etc.
Multidisciplinary practices would enable groupings of professional providers such that other health care providers who would normally be part of the referral chain may more readily collaborate. This would allow multidisciplinary Mental Healthcare teams/practices to be established, establishing a more accessible wholistic treatment system for patients where required. It is recommended that such decisions about multidisciplinary practices and appropriate referrals should be left to the professionals.
This may be accompanied by alternative rules regarding reimbursement models. Furthermore it is recommended that a consultation process with professionals in private practice should be conducted on this matter.
“18. (1) A practitioner shall accept a professional appointment or employment from employers approved by the council only in accordance with a written contract of appointment or employment which is drawn up on a basis which is in the interest of the public and the profession.
(2) A written contract of appointment or employment referred to in sub-rule (1) shall be made available to the council at its request.”
The second part of item 18(1) remains vague. The question is asked by whose judgement is the assessment “in the best interest of the public and profession” made?
With regards to the employment of psychologists, it is strongly urged that the head of departments where the departments are psychology specific, should be a psychologist. To put that in general terms: the head of a department in an organisation, especially a government organisation such as a hospital, should always be discipline specific to the department purpose.
There may be a need to distinguish someone who actively takes charge of the management of the profession /discipline, from a head that manages the operation of health services. However, it is not seen to be beneficial to either patient care nor to the profession that a person outside the discipline be appointed as chief of the discipline in any organisation. If there are post and financial issues driving such decisions, these should be sorted out at a higher level.