“Bad apples” and other perpetrators behind professional misconduct

AN analysis of misconduct among health and care professionals by the Professional Standards Authority has found that not all perpetrators are simply "bad apples".

Researchers from Coventry University examined 6,714 fitness to practise determinations from the PSA database covering doctors, nurses, social workers, paramedics and others. They identified three different types of perpetrator: the self-serving “bad apple”, the individual who is corrupted by the falling standards of their workplace, and the “depleted perpetrator” struggling to cope with the pressures of life.

Cluster analysis was used to identify how different kinds of misconduct group together for the different professions and the researchers also looked in more detail at cases involving sexual boundary violations and dishonesty.

The aim of the research was to offer a more nuanced multi-dimensional perspective of wrongdoings and offer recommendations to aid regulators and employers to improve detection of perpetrators and ameliorate the occurrence of these behaviours within health organisations.

In analysing cases of misconduct the researchers found examples of a typical group of “bad apple” perpetrators characterised by premeditated and strategic wrongdoing, often involving either multiple offences against the same targets or across multiple targets.

In addition they also identified “bad barrels” arising in poor workplace environments, which included inappropriate sexual talk/behaviour within an informal organisational climate, or collectives which supported, for example, faking qualifications and references for staff members.

A third group comprised individuals subject to the influence of stress and strain in misconduct. The researchers cite recent studies showing that stress can increase an individual’s “moral disengagement”, which then increases subsequent levels of “deviance”.

Lead researcher Professor Rosalind Searle at Coventry University's Centre for Trust, Peace and Social Relations, said: "In shining the spotlight on professional practice in the health sector, we're examining relationships that are often intimate in nature and based on trust and confidence between health workers and service users. It's crucial, therefore, for us to analyse where and how these taken-for-granted notions are being undermined through misconduct, and to take steps towards reducing instances of such behaviour."

"The findings from the study have much broader implications and go beyond the regulatory process. We look forward to discussing them widely, looking at how they can be used to support preventative interventions in future by regulators, employers, and others."

PSA Chief Executive, Harry Cayton said: "This research is the most ambitious project yet undertaken to use the information contained in the Authority's database of fitness to practise determinations. In this report, Professor Searle offers us a rich and fascinating discussion of the complex and subtle interplay between individual professionals, teams, workplaces, gender and culture."

Link: Bad apples? Bad barrels? Or bad cellars? Antecedents and processes of professional misconduct in UK Health and Social Care: Insights into sexual misconduct and dishonesty