Blog > Small problems in health and care, can be prevented from becoming big ones, by addressing them in a prompt and rehabilitative way – Carol Christensen-Moore


Small problems in health and care, can be prevented from becoming big ones, by addressing them in a prompt and rehabilitative way – Carol Christensen-Moore

“Making a mountain out of a mole hill”, “blowing a situation out of proportion”, whichever way you choose to phrase it, it is common knowledge that when mismanaged or left unresolved, small problems can be exaggerated and made worse. In any workplace this can have significant consequences, particularly in a health and social care environment, where, potentially, the impact on staff competence levels could be truly life-threatening.

Recently, debate surrounding events such as the NHS’s post-Francis “duty of candour”, have fuelled interest in the role of engagement in competence, and supports new understanding of the challenges present in promoting and putting into practice values-based models of competence.

Today I am taking part in a panel discussion which will tackle this very subject, and launching the Health and Care Professions Council (HCPC) report ‘preventing small problems from becoming big problems in health and care.’ Intended to further understanding of the various factors that impact the competence of health and social care professionals, and in turn the quality of care being delivered. The study findings go some way towards bridging the gap between staff experiences, professional competency, and healthcare managers’ comprehension of the relationship between the two. Providing the High-level data, and insight needed, for managers to understand, respect and respond to their feedback.

Our research uncovered a very nuanced and fluid understanding of competence amongst practitioners and stakeholders. When it came to the impact of engagement versus disengagement on staff competence, there wasn’t a consensus as to a link between the two.

Though participants in the study saw potential for disengagement to lead to mistakes or incompetent practice, they thought this would be unlikely. They did agree, however, that a disengaged professional was unlikely to be ‘going the extra mile’.


Triggers for disengagement

Triggers for disengagement and external threats to competence reported by participants were strikingly similar. By far, the most reported threat to competency cited by participants were workload pressures, or dysfunctional teams and management systems:

  • Workload pressures
  • Operating outside scope of practice
  • Under-utilising skills
  • Professional isolation
  • Lack of autonomy
  • Lack of support for CPD
  • Poor or infrequent supervision
  • Poor management
  • Dysfunctional relationships
  • Personal circumstances (bereavement, divorce, financial pressures)
  • Blame culture
  • Working patterns


Possible ways of preventing problems

Patients, professionals and stakeholders also reported very similar ways of preventing small problems from becoming big problems, including access to clinical supervision and specialist assistance when required, professional networks and reflective practice:

  • Being valued
  • Good team dynamics
  • Good supervision
  • Regular appraisal and performance management
  • Buddying schemes
  • Mentoring
  • Preceptorship
  • Team building exercises
  • Professional networks
  • Reflective practice
  • Self-awareness
  • Keeping up to date
  • No blame culture

The study’s observations surrounding triggers for disengagement and how to minimise a problem’s impact, not only stimulate debate around the role of engagement in staff competence, but support healthcare managers in implementing the best staff support systems. For example, by developing good professional networks and ensuring good supervisory structures. In any case, finding ways of addressing small problems promptly, in a rehabilitative rather than adversarial way, would be good first steps.

*The publication includes a literature review conducted by Professor Zubin Austin of the University of Toronto and our empirical work with patients, HCPC registered professionals and stakeholders.




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