Autonomy, Accountability, and Professional Practice: Contemporary Issues and Challenges
Whiteford, Gail, New Zealand Journal of Occupational Therapy
Contemporary society holds numerous challenges to professionals. These include coping with the information explosion, responding to heightened consumer awareness and demands on services, and in meeting ever increasing regimes of compliance within an era of mangerialism and accountability. This article explores these issues and posits some responses for professionals including developing robust communities of practice to enhance context specific knowledge generation and in enhancing the political profile and representation of professional groups within decision making fora.
Postmodernism, autonomy, regimes of compliance, communities of practice, politicisation
Whiteford, G. (2007). Autonomy, accountability, and professional practice: Contemporary issues and challenges. New Zealand Journal of Occupational Therapy, 54(1), 11-14
My objectives in this article are three fold: First to consider the broad terrain of professionalism both statistically and conceptually, then to consider some of the challenges to professionalism paying particular attention to knowledge development, competency and accountability. Finally I will posit some suggestions or strategies for the future, including the politicization of our professional agendas.
Professions in New Zealand: Scanning the terrain
The 2001 Census (Statistics New Zealand, 2006) revealed that there were 217, 000 professionals in New Zealand and, according to the Standard Classification of Occupations, these professionals fall into 70 broad categories. As a more specific breakdown in numbers, the Census identified that there were 60,000 teachers and 14,000 university and vocational education teachers.
As for health professionals, there were 31,000 nurses and 12,000 other health professionals and 9,000 medical practitioners who include anaesthetists, surgeons and specialists. The Census also identified 9,000 barristers and solicitors and other legal professionals as well as 18,500 accountants--of interest one of the fastest growing professions which may tell you something about the times in which we live and work. With respect to regulation, there are currently 19 Registration Authorities, and just to focus in on one area, in 2005 there was a total of 1124 complaints made to the Health and Disability Services Commissioner with most related to deficiencies in assessment and treatment, lack of care coordination, poor communication and inadequate record keeping. So, whilst this data may give us some indication of the quantum of professionals currently in the country (or at least those we have not lost to better paid overseas destinations), who is a 'professional' and what characterises a profession?
What does it mean to be a professional?
In 1906 George Bernard Shaw suggested that professionalism as a concept is, in fact, a form of protectionism, stating that "all professions are conspiracies against the laity" (Catto, 2005, p. 315) which, being a fairly disparaging view of professionals, signals a sense of differentiation at best, and elitism at worst. But if professionals are distinct in their own right, what makes them so? Definitions abound on what constitutes professionalism from Bosser et al's (1999) statement that a "profession is autonomous, self-directing and embodies trustworthiness through adherence to ethics and knowledgeable skill" (p.117) to a more recent and perhaps fluid version that "professional practice is about doing, knowing, being and becoming" which is characterised as being "people centred, purposeful, based on informed action, individual, located in a specific context" (Ewing & Smith, 2001, p. 16). Phillips more recently presents a definition more focussed on the attributes and actions of the individual practitioner in suggesting that "the essence of professionalism is to be able to call upon the honour, probity and principled judgement of the practitioner" (Catto, 2005, p. …