Ethical Responsibilities

Ethics are beliefs, standards, and motivations for behaviours that are valued by you as an individual or valued by a group.

While you will have your own ethical framework, all organisations and employers will have expectations regarding the way you are to carry out the tasks and duties inherent to your role.

An ethical framework for practice management may include any of the following:

• A code of ethics/practice/code of conduct
• Organisational policies and procedures
• Partnership agreements and memorandums of understanding
• Interagency and service collaboration agreements
• Information sharing protocols
• Conduct, complaints, and discipline procedures
• Commitment to reporting, monitoring and accountability practices
• Supervision and mentoring
• An oversighting/governing professional structure
• Training and professional development
• Professional accreditation

Having a thorough understanding of the ethical principles, codes, and practices of your organisation is vital to your practice, and will:

• Provide you with guidelines for appropriate practice
• Assist in your decision-making
• Help you to maintain a high standard of behaviour and practice
• Improve your effectiveness
• Help you successfully navigate ethical dilemmas.

Practice Standards

Practice standards refer to “what is required for effective, professional and accountable practice on a daily basis for workers operating in a particular field” (Department of Justice and Attorney-General, 2021, para. 5). Failure to meet practice standards may result in disciplinary or ‘fitness to practice’ hearings against an individual practice manager or whole organisation. In cases in which practice managers fail to meet minimum practice standards; they may also be liable for legal charges of negligence by clients.

As a practice manager, it is important for you to familiarise yourself with relevant national standards of practice, as well as any practice standards established within your own organisation, as this will help to ensure that you carry out your duties ethically and responsibly. Practice managers may also use practice standards to reflect upon and assess their practice and determine aspects that they could improve on. Joining a professional organisation can help ensure you keep up to date with required standards.

Policy Frameworks

There are also a range of national/state frameworks that specifically set out practice standards relevant to service delivery in particular sectors. As we touched on earlier in this module, practice management work spans across a wide variety of allied health sectors, including (but not limited to) physiology, occupational therapy, podiatry, psychology, general practice etc. Examples of corresponding framework documents include:

• Disability - National Standards for Disability Services.
• Mental health – National Safety and Quality Health Service Standards
• State/territory standards, e.g.
  • QLD community and disability services - Human Services Quality Framework.
  • NSW children and family services – Practice Framework Standards for child protection and out of home care practitioners.
  • The Allied Health Clinical Governance Framework – provide support for allied health professionals to fully engage in clinical governance.

These practice standards and national/state policy frameworks can be used to inform organisations on how they can establish their own practice standards for use within their field of discipline – these are often communicated through organisational policies and procedures as well as code of conduct. As a practice manager, it is important for you to familiarise yourself with relevant national standards of practice, as well as any practice standards established within your own organisation, as this will help to ensure that you carry out your duties ethically and responsibly.

Codes of Ethics and Practice

The Australian Association of Practice Management (AAPM) is one of the professional bodies that seek to guide health administrators, medical receptionists, practice managers and other related professions in Australia, and you will be eligible to join this body once you have successfully completed your relevant qualification. The AAPM has developed a Code of Ethical Conduct, which outlines ethical principles (often referred to as code of ethics) and how these should be implemented in practice (otherwise referred to as code of practice).

Essentially, Codes of Ethics generally outline the core ethical principles that members are expected to abide by, while Codes of Practice set out guidelines about how allied health professionals should deliver services so that their practice reflects ethical principles. Failing to adhere to an ethical code can lead to a disciplinary hearing or expulsion from membership.

Practice managers are responsible for protecting the rights of clients. The key responsibilities, adapted from AAPM’s Code of Ethical Conduct include:

1. Respecting the basic rights of clients: clients have a right to receive service with integrity, respect, and dignity.
2. Respecting the client’s right to privacy and confidentiality:  clients deserve for their privacy and confidentiality to be respected.
3. Prioritising client safety and well-being client communication and care should be presented in an open and effective way to promote health, wellbeing and safety.
4. Delivering competent service: practice managers have a responsibility to deliver quality service through supervision and continual professional development and education where relevant.

Some of these principles are supported by legislation; others are predominantly expressed in ethical codes and practice standards.

Many organisations write their own code of conduct as well which means they are all slightly different and generally reflect the values that the organisation believes to be most important. The purpose of a code of conduct is to outline the organisation’s expectations about their staff’s performance and behaviour by indicating standards of governance, standards of behaviour and behaviours that are considered unacceptable. Organisations should also clearly set out the consequences for failing to comply with code of conduct as well as processes to determine, monitor and enforce these.

Overall, ethical frameworks are integral to the practice of practice management and are vital for protecting both client interests and the integrity of the sector. Although you may have the best intentions of conducting yourself responsibly and ethically as a practice manager, you are likely to face ethical dilemmas throughout your career – these ethical standards can help you appropriately address such dilemmas. The following case study offers an example of an ethical dilemma.

The above case study provides just one example of the types of ethical dilemma you may come across in your work. In reality, ethical dilemmas may take many forms and will often consist of ‘grey areas’ in which there is no clear-cut solution. In many cases, practice managers will need to draw upon the experience and advice of their supervisor to help them manage ethical dilemmas.

There are several critical considerations for ethical practice management. We will discuss the most important of these now.

Duty of Care Principles and Practices

All practice managers have a duty of care towards their clients, which means that they must take all reasonable steps to avoid clients coming to harm through their actions or failure to act. Often an organisation will have a policy document that defines duty of care and outlines how a staff member can fulfil their duty of care requirements. An example of this is set out in the following extract.

Negligence

In discussing duty of care, one must also consider the concept of negligence. Put simply, negligence means failing to act according to a reasonable standard of care, resulting in injury or loss to the client. This concept only applies to relationships where a duty of care exists, such as in the relationship between a practice manager and their client. Note that while duty of care is not in any legislation, negligence of duty of care can attract legal consequences under common law. Another aspect to consider here is what ‘reasonable standard of care’ means for the profession in question. In the event of a negligence lawsuit, the court will need to determine what standard of care to apply in order to determine whether a practice manager’s actions are negligent or not. This involves consideration of the practice standards commonly accepted by the profession.

As a practice manager, it is extremely important for you to ensure that you are always taking the safety and wellbeing of your clients into consideration, and that you are not negligent in your duty of care responsibilities. The following extract explains the concept of ‘negligence’ and the factors involved in determining whether a practice manager’s actions are negligent or not (i.e., malpractice).

As you can see in the above case study, Sally fulfilled her duty of care to Brad by informing her supervisor of Brad’s self-harming behaviour and arranging for an appropriate referral. However, if Sally had failed to act in response to Brad’s disclosure, and that failure to act had resulted in Brad becoming injured or suffering harm, Sally would likely be considered to have been negligent.

While negligence focuses on failure to fulfil duty of care where it should be, dignity of risk is another practice consideration that focuses on over-protecting client to the extent that hinders their right to self-determination.

Dignity of Risk

The term ‘dignity of risk’ is used in relation to allied health as part of a recognition that a client may need to take appropriate risks to grow, develop, and add meaning to their lives.

Dignity of risk is tied up with duty of care. Practice managers have a responsibility to prevent clients from coming to harm; however, clients also have the right to take risks, fail, and learn from their mistakes. If practice managers act to prevent every conceivable type of risk, their clients may not get the opportunity to experience some of the same life events as their peers.

Australian health and community services tend to err on the side of caution when it comes to risk, whereas dignity of risk introduces the concept that a little risk in life is enriching and promotes learning. The extract below refers to disability workers, however, it is equally relevant for practice managers in relation to balancing dignity of risk with duty of care.

Ultimately, practice management principles and codes of ethics highlight the importance of empowerment. Practice managers should presume that clients are competent in assessing and acting on their own interests. However, there will be times as a practice manager when you need to consider your duty of care and dignity of risk, so that you are not negligent. To balance the risks involved, a practice manager may need to help the client consider the risk they are proposing to take. In order to assess and balance your duty of care and dignity of risk responsibilities, you should support client to consider the following points:

1. Assess the possible harm and see how likely it will be to occur and, if it does occur, to what extent the harm would be.
2. Assess the likely benefits that the client might gain from the activity and the extent of these benefits.
3. Actively look for ways to reduce the risk of harm without losing the benefits of the activity.
4. Assess the possible harm against the benefit.

Managers and supervisors need to monitor their staff to ensure that they are behaving appropriately and professionally at all times. Additionally, individual practice managers need to ensure that their actions are focused on protecting their clients from unacceptable risks and harm, and that they are not engaging in illegal or unethical behaviours. If, as a practice manager, you ever have doubts or suspicions about the legality of yours or another colleague’s actions, you should always make sure to report it and seek advice from your supervisor or manager.

Practitioner-Client Boundaries

One of the most difficult balancing acts practice managers perform is being friendly and empathetic while maintaining professional boundaries with clients.

It is the practice manager’s responsibility to establish and maintain professional boundaries from the outset of working with any clients. This is important for protecting clients’ right to safety and wellbeing and eliminate potential of exploitation within such relationship. On the other hand, maintaining these boundaries serve to protect the worker’s right and avoid violation arising from a client’s behaviour (e.g., a client may request to become friend with the practice manager on social media platform).

Practice managers should be alert to signs of boundary violations, some of which are outlined in the extract below.

Due to the broad variety of work contexts, professional boundaries of a practice manager will generally be determined by the organisation that you are working in. Take “receiving calls at home from the client” for example, if you work in crisis services and you are rostered to be on-call to address any client emergencies, you will likely be receiving calls from client at home. In this case, it will not be considered an unethical conduct. As such, organisations must make sure that they develop policy and procedures and/or code of conduct to provide clear, specific information on staff behaviours that are appropriate and inappropriate. It is the workers’ responsibilities to make sure that abide by these standards.

Work-Role Boundaries

Another important consideration relating to boundaries is the scope of work role. In general, a practice manager’s role is to support clients with assessment, accessing services, and/or advocacy. Practice managers do not usually act on behalf of or make any decisions for a client.

Essentially, practice managers must develop a clear understanding of what is and is not within their role, as set out by their organisation. They must also identify when a task or issue may be out of their role and/or expertise. Practice managers must be vigilant about establishing clear roles and boundaries from the outset and maintaining consistency throughout their work with clients.

Typically, the scope of your role is set out by your position description. Your organisation should provide clear guidelines around what is within your scope, and what needs to be referred on to the manager or other appropriate practitioners/services. For example, when it comes to developing policies and procedures, a practice manager may be engaged in consultation, research, and drafting a policy, as well as finalising, implementing, and distributing the policy document. It may also be your responsibility, as a practice manager, to review and approve administrative requests, such as a client requesting a fee reduction. Realistically, the organisational guidelines may not cover all possible client requests or situations; in these cases, or where scope of practice outlines otherwise, the practice manager may need to report or refer to a supervisor or manager.

Continuing Professional Development

Practice managers have an ethical responsibility to continually add to their knowledge and skills in order to remain uphold current best practice and standards. Practice managers may work with clients with vastly different challenges and issues, as is the nature of working with people. As a practice manager, you will likely start out in your career with some knowledge and training; however, as you gain more experience, you will quickly realise that there is always more to learn.

Some general strategies which may be useful for continuing your professional development as a practice manager include:

• Asking about internal training opportunities offered by your organisation.
• Engaging in professional training and development courses offered by professional associations or accredited training services (e.g., T.
• Engaging in self-study or educational courses through an approved provider (e.g., e-learning, certificates, diplomas).
• Attending professional workshops, seminars, conferences, and lectures.
• Engaging in self-directed learning activities (e.g., TED Talks, YouTube, Google Scholar).
• Reading books, journal articles, websites, and professional blogs, and listening to podcasts.

Typically, organisations will have professional development or education requirements in place to make sure that their staff receives sufficient and updated training required to carry out work in a safe and ethical manner. In some cases, training may be a legal requirement, for example, if First Aid Certificate is required for a role, the organisation must ensure that the staff renew their qualification periodically. In other cases, training may be required to improve ethical compliance, such as learning about the evidence-based practices within the sector.

Overall, as employees, you have a right to be provided with training required to carry out your duties; as such, your employer is responsible to allow access to relevant development/training opportunities. However, it is your responsibility to make sure you fulfil these requirements within time frame and keep track your learning. If this is not done, your employer may have the right to dismiss staff who fail to comply. Often, organisations will have a training register to document and monitor whether staff has completed their professional development requirements. It is important that you figure out what those requirements are for your specific role and context.

Unlike the legislative requirements, ethical considerations are not usually as clear-cut; ethical responsibilities of a practice manager will largely depend on their work context and the responsibilities they have to others in your workplace, clients, as well as the broader community. As you begin your career as a practice manager (or any role you may undertake in life), it is important to take time to identify and determine the ethical framework that applies to your specific role and work context.

To begin with, consider the range of documents and principles we have discussed up to this point of the module. Fundamentally, human rights and legal considerations will be the foundation to understanding your ethical responsibilities. On top of that you must be familiar with the code of ethics or ethical principles that guide your role, including those that we have discussed earlier on. For example, you may refer to the Code of Ethical Conduct developed by the AAPM or the code of conduct and policies and procedures in your organisation.

You will also need to consider what is and isn’t within your scope of practice. For example, an elderly client tells you about a potential financial abuse that they are experiencing from a family member. It may not be in your role nor expertise to address this issue directly; however, you still have an ethical responsibility to refer this client to an appropriate support and/or to report this issue as per your organisational procedures. In this situation, working ethically involves considering how the way you respond and the actions you take could impact on this client’s wellbeing.

Taking this to a broader level; administrative decisions made on the organisational level, such as in service delivery, policies and procedures, and approach towards ethical issues, can have wider impacts to relevant workers, clients, and the broader community. Let’s imagine that due to lack of funding, an organisation reduces the number of staff but asks all remaining staff to increase their workload to meet the service requirements. Workers are experiencing high level of frustration, disappointment, and burnout, affecting the quality of support clients receive. Some clients had to be turned away due to lack of availability and become more reluctant about seeking assistance in the future. All of these impact on the clients and their families and support network who are already under tremendous pressure. Overall, the broader community has lost its confidence in the allied health service and is now struggling to address its people’s needs and pressing societal issues.

This is of course an overly simplistic, hypothetical example, as there are likely to be more complex factors at play. However, it illustrates the importance for managers and decision-makers of health and community service organisations to evaluate their responsibilities to workers, clients, and the broader community in every service decision they make. Ethical principles remain important throughout every aspect of the organisation’s operations. For this reason, following a structured approach in making ethical decisions, such as the decision-making model that we discuss below, can be beneficial for meeting ethical requirements. This model can be useful for a practice manager who is facing an ethical dilemma in client work as well when considering legal or ethical responsibilities in addressing an issue so as to develop a justifiable, appropriate course of action.

Ethical Decision-Making

Below is a simple model for ethical decision-making which can help guide practice managers when planning actions or making a decision. As you will notice, legal and ethical obligations are naturally embedded as part of the considerations as they are fundamental to supporting good decision-making. In addition, you will also need to consider what your responsibilities and duties are to workers, clients, and the broader community who may be impacted.

Modelling Ethical Behaviour

It is also worth mentioning that ethical principles are not only for situations when a decision needs to be made or an ethical dilemma is encountered. Ethical values and principles need to be embedded into our day-to-day life. As a practice manager, clients and your co-workers will be watching what you are doing and how you respond to situations. How you approach your ethical responsibilities will likely influence those guided by you. Imagine that you are working with another team leader who favours one worker over the others. What impacts might this have on the morale of the team, and subsequently their capacity to collaborate for quality services? If a practice manager is not complying with their own code of conduct, what impacts do you think that will have on their clients? Would they be perceived as trustworthy and professional?

In other words, one way to uphold ethical practice is to make sure that you demonstrate ethical behaviours, whichever role you may take in the organisation. This is why most organisations would require their staff members, management, and volunteers to behave in accordance with code of conduct, to promote an ethical culture in the organisation. Your code of conduct is likely to cover not only behaviours when carrying out client or service activities, but also how you present as an employee in front of co-workers and members of the public.

Practice managers often work with vulnerable clients who may be dealing with difficult life circumstances and who may not have had positive role models in their life. Behaving authentically and ethically helps you to set a good example for your clients and colleagues and helps them to aspire to higher standards in their own work and personal lives. Ethical work practices also often have the added benefit of helping you to gain the respect and trust of clients and colleagues, thus enabling you to work more effectively with them. This is demonstrated in the case study below.

In this section of the module you have learned about the ethical framework of practice management, including how codes of ethics and codes of conduct inform ethical practice. You have also learned about some of the key ethical considerations that practice managers need to be aware of, including how to maintain professional boundaries, as well as how professional development help to ensure that work practices remain ethical. Essentially, ethical principles need to be embedded into every aspect of allied health, not merely in client-facing roles. The leaders in the organisation must become ethical role models to implement an ethical culture among workers which promotes a commitment to ethical practices. This includes following structured decision-making model to make sure they have considered responsibilities to all workers, clients, and the broader community. In the next section, you will learn more about how policies and procedures are used to support and monitor compliance with the legal and ethical requirements we have discussed so far.

• Australian Association of Practice Management Ltd (AAPM). (2022). Code of Ethical Conduct. 2nd Ed. https://www.aapm.org.au/Portals/1/AAPM%20Code%20of%20Ethical%20Conduct_FINAL_12OCT22.pdf
• Australian Institute of Company Directors. (2019). Principle 9: Conduct and compliance. http://aicd.companydirectors.com.au/resources/not-for-profit-resources/not-for-profit-governance-principles/principle-9-conduct-and-compliance
• Department of Justice and Attorney-General. (2023). Practice principles, standards and guidance. https://www.justice.qld.gov.au/about-us/services/women-violence-prevention/violence-prevention/service-providers/practice-principles-standards-guidance#:~:text=Practice%20standards%3A,are%20expected%20to%20be%20conducted
• Australian Human Rights Commission. (n.d.) Workplace discrimination and harassment policy template. https://humanrights.gov.au/our-work/employers/workplace-discrimination-and-harassment-policy-template
• Community Door. (2018a). Introduction. In Section 2: Working within an ethical framework. Queensland Council of Social Service.
• Community Door. (2018b). Professional boundaries. In Section 2: Working within an ethical framework. Queensland Council of Social Service. https://etraining.communitydoor.org.au/resources/etraining/units/chccs301a/section2/section2topic05.html
• Community Door. (2018c). Working within an ethical framework. In Section 2: Working within an ethical framework. Queensland Council of Social Service. https://etraining.communitydoor.org.au/resources/etraining/units/chccs301a/section2/section2topic10.html