There are no indicators for this criterion. Clinical autonomy is important to protect the safety and quality of healthcare, and could be considered in relation to Criterion 1.4.1 Consistent evidence-based practice. Together, these criteria mean that GPs should be free to make decisions about patient care as long as they make ethical decisions, use good clinical judgement and draw on the best available evidence for each patient. This is also consistent with the basic principles of Aboriginal community controlled health services, such as integrated, holistic care and self-determination.
Below is a description of the ways in which an Aboriginal community controlled health service can ensure that its GPs (and other health professionals) are free to make decisions about clinical care, based on evidence. Not all of these good practices are required by the Standards, but they illustrate the many practical and creative things that ACCHSs can do to ensure they deliver services of high safety and quality to their community.
The health service has well-developed systems and processes in place to enable GPs and other members of the healthcare team to exercise discretion in making independent clinical judgements for their patients within the context of evidence-based care, and as appropriate to their role in the team. These systems and processes include:
a system for ensuring that all healthcare staff qualifications have been checked and are current (credentialing)
a system for ensuring that all healthcare staff have the skills and experience to do the job they have been given (defining scope of practice)
the consistent use of recommendations from agreed clinical guidelines as appropriate for the service’s patient population
awareness and understanding of relevant codes of professional conduct
the development of a service-specific code of practice that incorporates critical elements of all relevant external codes of conduct. This is the service’s key resource for identifying and communicating expectations regarding the healthcare team’s professional and ethical obligations for delivering safe, quality healthcare to the community.
There is a policy outlining the kinds of clinical decisions that can be made by different members of the healthcare team, and which decisions need to be referred to the senior clinician. This policy also emphasises that the board has decision-making powers in relation to a range of areas, but it must not interfere with the ability of the GPs and other health professionals to make the most appropriate clinical decisions for their patients.
Some decisions are made after discussion with the whole healthcare team. These decisions include:
- duration and scheduling of appointments
supplies and equipment used by the health service.
There are regular clinical staff team meetings to share and discuss matters affecting autonomous decision-making as appropriate to each team member’s role. For the remote health centre, these meetings are held by teleconference.
In addition to oversight of longer-term care such as care plans, regular clinical supervision is undertaken with each member of the healthcare team. This is where GPs and nurses or health workers discuss clinical and other issues relating to their current patients and programs. For the remote health centre, these supervision sessions are held by teleconference.
All of the above discussions include consideration of how and when traditional medicines or other accepted forms of treatment can be administered alongside those covered by clinical guidelines.
GPs understand the importance of working within a multidisciplinary team, and they all participate fully in this process. They ensure that processes are in place for appropriate decision-making by other members of the healthcare team when they are not present, and that issues or concerns are followed up as soon as possible. When it is important that other team members understand their exercise of clinical autonomy, the GPs will explain their decision in a team meeting.