CHCLEG 003 – Assignment 1 Task 3 - Project PDF

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Summary

Manage Legal and Ethical Compliance...

Description

1. List all the key legal and ethical obligations that apply to the organisation and its staff members and briefly describe each which applies.

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Work Health and Safety Act 2011 No 10 o

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Australian Information Commissioner Act 2010 o

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Provides a framework to protect the health, safety and welfare of all workers at work; and the health and safety of all other people who might be affected by the work.

Promote and uphold people’s rights to access government-held information and have their personal information protected. Confidentiality and record management.

Health Practitioner Regulation Act 2009 No 86 & AHPRA o

A national registration and accreditation scheme for: The regulation of health practitioners… and to provide for the protection of the public by ensuring that only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered.

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The Privacy Act 1988 & The Australian Privacy Principles o Standards for the collection and handling of personal information. The APP’s are comprised of a code of conduct for privacy of personal information.

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Health Administration Act 1982 o This act covers any information that is provided or recorded within the health system. Basically, information cannot be disclosed without the consent of the person to whom the information relates or for the purpose of legal proceedings, such as a court order or subpoena that allows access to health information on a client.

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RACGP Standards for General Practices (5th edition) & Ethical Behaviour in General Practice o o

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Developed for the purpose of protecting patients from harm by improving the quality and safety of health services. Set of principles by which it stands in supporting general practitioners to maintain high quality ethical practice (RACGP Values for General Practice).

The Privacy and Personal Information Protection Act o

Privacy principles dealing separately with collection, storage, use and disclosure of personal information.

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The Public Health Act 1999 o This Act also relates to disclosure of information without consent. The most important confidentiality provision of this Act is the part that deals with HIV/AIDS related information.

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Australian Commission on Safety and Quality in Health Care (ACSQHC) o

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Anti-Discrimination Act 1977 No 48 o

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They lead and coordinate improvements in safety and quality in health care; and support healthcare professionals, organisations and policy makers who work with patients and carers.

It is unlawful to discriminate on the basis of a number of protected attributes including age, disability, race, sex, intersex status, gender identity and sexual orientation in certain areas of public life, including education and employment

Australian Medical Association Code of Ethics 2004. Editorially Revised 2006. Revised 2016. o Essential for setting and maintaining the very high standards of ethical behaviour that society expects from the medical profession.

2. To meet with the requirements of applied legal and ethical obligations, what specific job roles should be created in compliance department and how the people in those roles can update their knowledge in relating to compliance issues or changing legislations? -

Senior Management Compliance Manager Line Managers Health and Safety Representative o

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Hold in-house trainings, staff meetings, presentations, newsletters, memos, via company’s official intranet, webpages or using the emails or other communication tools. Provide them access to hard copies of policies and procedures as relevant ensuring that the information is current, reliable and valid. Provide staff a platform to discuss and ask queries and questions about legislations, regulations and statutory requirements and opportunities to discuss compliance requirements relating to their work role. Books, journals, newspaper articles, websites, internet Accessing libraries Talking to relevant personnel Getting information from industry representatives, union and industry associations Contact the relevant government department for revised policy updates

3. When and why legal advice is needed?

If you are not sure of any component of legal or regulatory requirements relating your own role or business, it is always a good idea to get a specialist legal advice on the areas of compliance and legal management. As specialists have specialised skill and knowledge on particular area of their field and have greater understanding of the current and most recent information relating to laws to the specific field, and hence can better support the managers or organisation in meeting their legal obligations.

4. Should organisation have policies and procedural guidelines on managing ethical issues? If so, what kind of issues should be addressed in that policy? Yes, the organisation should have policies and procedural guidelines on managing ethical issues. Kinds of issues that should be addressed are: -

Patient care Protection of patient information Patients with limited, impaired or fluctuating decision-making capacity Patients’ family members, carers or significant others Clinical Teaching Fees Professional Conduct Working with colleagues and other health care professionals Managing conflicts of interest Responsibility to society Health equity and human rights o Provide care impartially and without discrimination on the basis of age, disease or disability, creed, religion, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, criminal history, social standing or any other similar criteria.

5. What records is the organisation required to keep?

Personal health information, healthcare records research records, financial records and audits both paper based and electronic (data records).

6. What steps can be taken to ensure that staff members are complying to their legal and ethical obligations?

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Self-assessment/ monitoring: Organisation can conduct self-assessment check of legal and ethical compliance. Continuous monitoring: This is a means by which monitoring is made an ongoing activity versus a periodic, discrete one. Conducting internal and external audits: Internal audit can be organised on timely manner by the audit committee or relevant personnel within the organisation, where they can check and review all the legal and regulatory requirements and documentation or alternatively audit can be done externally through the use of a third party or external professional. Workplace inspections and conducting quality assurance activities. For e.g. Level of monitoring. 3 levels being Standard, Performance Watch and Intrusive: o

Standard monitoring applies to those health services with no significant performance concerns.

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Performance Watch applies to those health services with emerging performance deterioration. Under this level there is scope to intensify monitoring and increase the regularity of performance meetings between the department and the health service.

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Intensive monitoring applies to those health services with significant and continuous under performance. Within this level the scope and frequency of monitoring intensifies.

7. What are possible breaches related to legal or ethical conduct that organisation can face? -

Accessing and reading unnecessary patients medical history and records Accessing information that is not required and needed to their job Accessing information on family, friends stored in electronic or hard copy files Using unauthorised shared passwords Signing for another person's signature Lost keys First aid requirements are not kept up to mark WHS requirements are not kept up to mark Withholding information Theft Budgetary manipulation Taking credit improperly

8. What would the consequence of non-compliance be? -

Disciplinary action for the employee who breached legislation

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Infringement notices on the organisation

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Reduction or termination of government funding Poor reputation for the organisation Work health and safety (WHS) legislation provides for a range of corrective processes and enforcement options, including provisional improvement notices issued by health and safety representatives (HSRs), improvement and prohibition notices and on-the-spot fines issued by the WHS regulator’s inspectors, and prosecutions that could result in heavy fines or other penalties. WorkCover NSW may undertake inspections, investigations or compliance audits, and may issue a letter of caution, warning that a breach of WHS legislation has been detected. Inspectors can issue improvement or prohibition notices if they believe breaches of the Act have occurred or are occurring.

9. What should the organisation do if breaches occur? Any breaches must be reported to relevant personnel or immediate supervisor/manager in the first instance as breaches can affect clients, work health and safety of the workforce or can affect organisational reputation. Other than breaches, any unsafe work practices must be reported to health and safety representatives. When you recognise another worker’s unethical act, your first option is to confront the worker yourself and discuss the issue. If that is not successful you may need to report the unethical conduct to someone in higher authority. You will certainly need to report the conduct if the rights of others, as outlined in the code of ethics, are not being respected.

10. How staff member can report the issue relating to breach or unethical act? When reporting unethical conduct, you need to be clear:    

Who was involved When the incident(s) occurred and who else was present The grounds on which you believe the conduct to be unethical, and What other actions you have taken e.g. Spoken to the person. When considering reporting unethical conduct, you need to access your agency’s policy and procedures to know who to direct the report to. Have managers encourage staff members to report any breach of work place practices to the relevant personnel immediately. You must advise staff on the process for raising issues related to non- compliance, which includes the following steps:

1. Documenting the problem objectively 2. Referring the matter to the team leader, supervisor or manager

3. Making a written statement to management for further improvement actions 4. Identifying possible consequences of non-compliance 5. Develop an action plan necessary to resolve the issue 6. Seeking and confirming agreement on a timeframe for resolution 7. Communicating the process of reporting to staff members in team meetings, induction, updating it in organisational policies and procedures

11. How organisation can get accreditation, name the bodies through this can be achieved.

The organisation can get accreditation by meeting the requirements of defined criteria or standards. By competence and integrity in a specified subject or area of expertise. By achieving a satisfactory assessment in various services ensuring regulations are applied and standards are being met. By abiding by legislation that is relevant to the organisation. Range of bodies that provide accreditation are: -

Australian General Practice Accreditation Limited( AGPAL) The Australian Council on Healthcare Standards Quality Innovation Performance( QIP), part of AGPAL group

12. How organisation can maintain the knowledge of compliance requirements? There are numerous ways to develop and maintain knowledge of current and emerging legal requirements and ethical issues: -

Books, journals, newspaper articles, websites, internet Accessing libraries Talking to relevant personnel Getting information from industry representatives, union and industry associations Contact the relevant government department for revised policy updates The updated information on legal and ethical information can be communicated to employees at meetings, presentations, newsletter, memos and intranet communications and through formal and informal training. Such changes should be reflected in updated organisational policies and procedures.

13. How the process of continuous improvement can help the organisation in keeping up with their compliance requirements?

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It helps to improve the quality of services the organisation provides. It helps to build a culture within the organisation to ensure it continues to change and adapt to the needs of the patient. It helps the organisation to work towards and strive to maintain the highest standards in line with legal and ethical requirements as they are updated. Provides a way to continuously work at clarifying issues or problems. Being a more structured and managed approach to improvement, it enables the organisation to more accurately check and measure if actions really did result in improvements....