Speaking up in practice

An individual may be concerned about the personal consequences of drawing attention to an issue in the working environment.

Could they be ignored – or worse, targeted – as a result of drawing attention to failures in practice?

For locum optometrists, there can be a fear that speaking up will result in a break down in the relationship with a practice and a loss of work.

OT spoke with locum optometrists and the AOP’s head of clinical and regulatory, Henry Leonard, for guidance on how to navigate this challenging area of practice.

The view from practice

Locum optometrist, Rebecca Rushton, shared with OT that locum optometrists have “far less” job security than employed optometrists and can easily be replaced by a practice.

“In some environments you don’t want to be seen as being 'difficult',” she said.

“I've worked in some places that have told me that 'the other optometrist doesn't have a problem so why do you?',” Rushton shared.

Issues that would raise red flags with Rushton include situations where patient safety is compromised or where staff welfare is not looked after.

“If my concerns weren't taken seriously, I wouldn't work again at the practice. I don't want to be involved in poor practice and can't support a business which doesn't align with what I believe to be right,” she emphasised.

Like Rushton, locum optometrist Hassnain Safdar shared that a lack of job security can result in pressure on locum optometrists not to be seen as ‘awkward’ by raising concerns.

“One can often feel obliged to comply with how the practice operates in fear of losing work,” he said.

"However, locums must be mindful of their own limits and where they draw the line if boundaries are crossed,” Safdar emphasised.

Safdar ensures that when a practice is booked he outlines his expectations.

Locum optometrists often work in a variety of settings and can sometimes provide valuable insight into areas for improvement, which may not be obvious to other staff at the practice

Situations that would present a concern for him would be an expectation to take walk-ins on top of a fully booked clinic, a lack of lunch break, or constant sales pressure.

Safdar shared that he would decline to see further patients if he thought that it was compromising care.

“I wouldn't hesitate to leave the practice, although this hasn't ever happened,” he said.
 
Locum optometrist, James Brawn, shared that there is a legitimate fear among some locums that speaking up about substandard or dangerous working practices could be to the locum’s own detriment.

As well as the potential for days working in practice to be cancelled, Brawn highlighted the reputational risk.

“You may be seen as a troublemaker which could make finding future work as a locum more difficult,” he said.

Brawn shared that if he observes ways of working that compromise patient safety, he raises his concerns with the practice owner or director.

“In one memorable case, this resulted in the owner completely overhauling the staffing, and changing several systems within the store. However, I have also had an owner inform me that she no longer wished to maintain my locum services,” he said. 

Equipment and referrals

AOP head of clinical and regulatory, Henry Leonard, shared that concerns around equipment and follow-up tests or referrals are among the issues that locums may be presented with.

“A common query from AOP members is how to manage patients when a piece of equipment, such as a tonometer or slit-lamp, is unavailable,” he said. 

Leonard shared that in this situation, it may be possible to continue the clinic by keeping a list of patients who will need to return once the equipment is fixed and ensuring that these patients are followed up appropriately.

“However, this can be more difficult for locums, who may not know if or when they will be returning to the practice, and it’s sometimes necessary to make an internal referral transferring responsibility for following up these patients to another practitioner,” he said.

Leonard added that if a piece of equipment is out of action for a long time, and the practice does not seem to be taking steps to rectify the situation, it may be necessary to raise this formally as a potential patient safety issue.

Leonard emphasised that it is important for both individual practitioners and practices to have processes in place to make sure patients are followed up appropriately, and that referrals are processed correctly and promptly.

“If practitioners identify situations where follow-up tests are being overlooked, or referrals aren’t being processed properly, it may be necessary to raise a concern,” he said.

A professional duty

Leonard highlighted that General Optical Council registrants have a duty to protect and safeguard patients, colleagues and others from harm under Standard 11, and ensure a safe environment for patients under Standard 12.

“Aside from a moral obligation to speak up, practitioners could be criticised if they choose to ignore concerns, which could then put their own registration at risk,” he said.

AOP members can contact the regulatory team for confidential advice on any situation in the workplace, Leonard emphasised.

“We can talk things through and discuss potential ways to resolve these issues, whilst protecting our member’s individual interests,” he said.

In addition, the AOP Peer Support Line is available for both members and non-members to confidentially talk through workplace issues with a trained, empathetic peer.

How can employers respond to concerns?

Leonard emphasised that employers should listen carefully to any concerns raised by locums or other staff members.

“Locum optometrists often work in a variety of settings and can sometimes provide valuable insight into areas for improvement, which may not be obvious to other staff at the practice,” he said.

Leonard shared that in some situations issues can be addressed by introducing new practice policies or putting time aside for additional staff training.

“Employers should try to treat concerns in a constructive way, by using them as a learning opportunity to improve the service they offer, rather than as a criticism of how the practice is bring run,” Leonard shared.

“If changes are necessary, employers should keep the practitioner updated on progress, so they know their concerns have been taken on board, and appropriate action has been taken to address them.”