The 15 National Boards regulating registered health practitioners in Australia are responsible for registering practitioners and students (except for in psychology, which has provisional psychologists), setting the standards that practitioners must meet, and managing complaints and concerns (notifications) about the health, conduct or performance of practitioners.
The Australian Health Practitioner Regulation Agency (AHPRA) works in partnership with the National Boards to implement the National Registration and Accreditation Scheme, under the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law).
The core role of the National Boards and AHPRA is to protect the public.
This code has been developed by most National Boards under section 39 of the National Law.
This code seeks to assist and support registered health practitioners to deliver effective regulated health services within an ethical framework. Practitioners have a duty to make the care of patients or clients their first concern and to practise safely and effectively. Maintaining a high level of professional competence and conduct is essential for good care.
The code contains important standards for practitioner behaviour in relation to:
Making decisions about healthcare is the shared responsibility of the practitioner and the patients or clients (or their representative).
Relationships based on openness, trust and good communication will enable practitioners to work in partnership with their patients or clients. An important part of the practitioner–patient/client relationship is effective communication, in all forms, including in person, written and electronic.
Practitioners have ethical and legal obligations to protect the privacy of people requiring and receiving care. Patients or clients have a right to expect that practitioners and their staff will hold information about them in confidence, unless information is required to be released by law or public interest considerations.
Practitioners need to obtain informed consent for the care that they provide to their patients or clients. Caring for children and young people brings additional responsibilities for practitioners.
Good practice involves genuine efforts to understand the cultural needs and contexts of different patients or clients to obtain good health outcomes. Practitioners need to be aware that some patients or clients have additional needs and modify their approach appropriately.
When adverse events occur, practitioners have a responsibility to be open and honest in communication with patients or clients to review what has occurred.
In some circumstances, the relationship between a practitioner and a patient or client may become ineffective or compromised and may need to end.
Good relationships with colleagues and other practitioners strengthen the practitioner–patient/client relationship and enhance care.
Practitioners have a responsibility to contribute to the effectiveness and efficacy of the healthcare system.
Minimising risk to patients or clients is a fundamental component of practice. Good practice involves understanding and applying the key principles of risk minimisation and management to practice.
Maintaining and developing a practitioner's knowledge, skills and professional behaviour are core aspects of good practice.
Teaching, supervising and mentoring practitioners and students is important for the development of practitioners and for the care of patients or clients. It is part of good practice to contribute to these activities, and provide support, assessment, feedback and supervision for colleagues, practitioners in training and students.
Underpinning this code is the assumption that practitioners will exercise their professional judgement to deliver the best possible outcome for their patients.
This code seeks to assist and support practitioners to deliver appropriate, effective services within an ethical framework. Practitioners have a professional responsibility to be familiar with this code and to apply the guidance it contains.
This code will be used:
Practitioners must always act in accordance with the law. The code is not a substitute for the provisions of the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law), other relevant legislation and case law. If there is any conflict between the code and the law, the law takes precedence. Practitioners need to be aware of and comply with, the standards, guidelines and policies of their National Board.
The code does not address in detail the range of general legal obligations that apply to practitioners, such as those under privacy, child protection and antidiscrimination legislation; responsibilities to employees and other individuals present at a practice under workplace health and safety legislation; and vicarious liability for employees under the general law. Practitioners should ensure that they are aware of their legal obligations and act in accordance with them.
This code is not an exhaustive study of professional ethics or an ethics guide. It does not address the standards of practice within individual health professions or disciplines. These standards of practice are generally found in documents issued by the relevant National Boards and/or professional bodies.
While good healthcare respects the rights of patients or clients, this code is not a charter of rights (an example of a charter is the Australian charter of healthcare rights issued by the Australian Commission on Safety and Quality in Health Care.
The focus of this code is on good practice and professional behaviour. It is not intended as a mechanism to address disputes between professional colleagues, e.g. in relation to termination of business relationships and disputes over patients or clients.
While individual practitioners have their own personal beliefs and values, there are certain professional values on which all practitioners are expected to base their practice. These professional values apply to the practitioner’s conduct regardless of the setting, including in person and electronically, e.g. social media, e-health etc.
Practitioners have a duty to make the care of patients or clients their first concern and to practise safely and effectively. They must be ethical and trustworthy. Patients or clients trust practitioners because they believe that, in addition to being competent, practitioners will not take advantage of them and will display qualities such as integrity, truthfulness, dependability and compassion. Patients or clients also rely on practitioners to protect their confidentiality.
Practitioners have a responsibility to protect and promote the health of individuals and the community.
Good practice is centred on patients or clients. It involves practitioners understanding that each patient or client is unique and working in partnership with patients or clients, adapting what they do to address the needs and reasonable expectations of each person. This includes cultural awareness: being aware of their own culture and beliefs and respectful of the beliefs and cultures of others, and recognising that these cultural differences may impact on the practitioner–patient/client relationship and on the delivery of services. Good practice also includes being aware that differences such as gender, sexuality, age, belief systems and other anti-discrimination grounds in relevant legislation may influence care needs, and avoiding discrimination on the basis of these differences.
Effective communication in all forms underpins every aspect of good practice.
Professionalism embodies all the qualities described here and includes self-awareness and self-reflection. Practitioners are expected to reflect regularly on whether they are practising effectively, on what is happening in their relationships with patients or clients and colleagues, and on their own health and wellbeing. They have a duty to keep their skills and knowledge up to date, refine and develop their clinical judgement as they gain experience, and contribute to their profession.
Practitioners have a responsibility to recognise and work within the limits of their competence and scope of practice. Scopes of practice vary according to different roles; for example, practitioners, researchers and managers will all have quite different competence and scopes of practice. To illustrate, in relation to working within their scope of practice, practitioners may need to consider whether they have the appropriate qualifications and experience to provide advice on over the counter and scheduled medicines, herbal remedies, vitamin supplements, etc.
Practitioners should be committed to safety and quality in healthcare (see the Australian Commission on Safety and Quality in Health Care and references section at the end of this code).
Australia is culturally and linguistically diverse. We inhabit a land that, for many ages, was held and cared for by Aboriginal and/or Torres Strait Islander Australians, whose history and culture have uniquely shaped our nation. Our society is further enriched by the contribution of people from many nations who have made Australia their home.
Practitioners in Australia reflect the cultural diversity of our society and this diversity strengthens the health professions.
There are many ways to practise a health profession in Australia. Practitioners have critical roles in caring for people who are unwell, assisting people to recover and seeking to keep people well. This code focuses on these roles. For practitioners with roles that involve little or no contact with patients or clients, not all of this code may be relevant, but the underpinning principles will still apply.
There are several conditions or situations in which patients or clients may have limited competence or capacity to make independent decisions about their healthcare; for example, people with dementia or acute conditions that temporarily affect competence and children or young people, depending on their age and capacity (see Section 3.5 Informed consent).
In this code, reference to the terms ‘patients or clients’ also includes substitute decision-makers for patients or clients who do not have the capacity to make their own decisions. These can be parents or a legally appointed decision-maker. If in doubt, seek advice from the relevant guardianship authority.
Care of the patient or client is the primary concern for health professionals in clinical practice. Providing good care includes:
Maintaining a high level of professional competence and conduct is essential for good care. Good practice involves:
Making decisions about healthcare is the shared responsibility of the treating practitioner and the patient or client who may wish to involve their family, carer/s and/or others. Practitioners have the responsibility to create and foster conditions for this to occur. (Also see Section 1.4 Substitute decision-makers.)
Practitioner decisions about access to care need to be free from bias and discrimination. Good practice involves:
Treating patients or clients in emergencies requires practitioners to consider a range of issues, in addition to the provision of best care. Good practice involves offering assistance in an emergency that takes account of the practitioner’s own safety, skills, the availability of other options and the impact on any other patients or clients under the practitioner’s care, and continuing to provide that assistance until services are no longer required.
Relationships based on respect, trust and good communication will enable practitioners to work in partnership with patients or clients.
A good partnership between a practitioner and the person they are caring for requires high standards of personal conduct. This involves:
An important part of the practitioner–patient/client relationship is effective communication. This involves:
Practitioners have ethical and legal obligations to protect the privacy of people requiring and receiving care. Patients or clients have right to expect that practitioners and their staff will hold information about them in confidence, unless release of information is required by law or public interest considerations. Good practice involves:
Informed consent is a person’s voluntary decision about healthcare that is made with knowledge and understanding of the benefits and risks involved. A useful guide to the information that practitioners need to give to patients is available in the National Health and Medical Research Council (NHMRC) publication General guidelines for medical practitioners in providing information to patients. The NHMRC guidelines cover the information that practitioners should provide about their proposed management or approach, including the need to provide more information where the risk of harm is greater and likely to be more serious and advice about how to present information.
Good practice involves:
Caring for children and young people brings additional responsibilities for practitioners. Mandatory reporting of child abuse and neglect is legislated in all states and territories in Australia. Practitioners have a responsibility to be aware of the mandatory reporting requirements in their state or territory.
Good practice involves an awareness of the cultural needs and contexts of all patients and clients, to obtain good health outcomes. This includes:
Some patients or clients (including those with impaired decision-making capacity) have additional needs. Good practice in managing the care of these patients or clients includes:
When adverse events occur, practitioners have a responsibility to be open and honest in communication with a patient or client to review what has occurred and to report appropriately (also see ‘open disclosure’ at Section 6.2(a)). When something goes wrong, good practice involves:
Patients or clients have a right to complain about their care. When a complaint is made or a formal notification is received by a Board, good practice involves:
Practitioners have a vital role in assisting the community to deal with the reality of death and its consequences. In caring for patients or clients towards the end of their life, good practice involves:
In some circumstances, the relationship between a practitioner and a patient or client may become ineffective or compromised and may need to end. Good practice involves ensuring that the patient or client is informed adequately of the decision and facilitating arrangements for the continuing care of the patient or client, including passing on relevant clinical information.
Good practice includes recognising the potential conflicts, risks and complexities of providing care to those in a close relationship, for example close friends, work colleagues and family members and that this can be inappropriate because of the lack of objectivity, possible discontinuity of care and risks to the practitioner or patient. When a practitioner chooses to provide care to those in a close relationship, good practice requires that:
Where practitioners are considering treating multiple patients or clients simultaneously in class or group work, or more than one individual patient or client at the same time, practitioners should consider whether this mode of treatment is appropriate to the patients or clients involved, including whether it could compromise the quality of care (see also Section 3.4 Confidentiality and privacy and Section 3.5 Informed consent).
When closing or relocating a practice, or when an employed practitioner moves between practices, good practice involves:
Good relationships with colleagues and other practitioners strengthen the practitioner–patient/client relationship and enhance patient care.
Good care is enhanced when there is mutual respect and clear communication between all health professionals involved in the care of the patient or client. Good practice involves:
Delegation involves one practitioner asking another person or member of staff to provide care on behalf of the delegating practitioner while that practitioner retains overall responsibility for the care of the patient or client.
Referral involves one practitioner sending a patient or client to obtain an opinion or treatment from another practitioner. Referral usually involves the transfer (in part) of responsibility for the care of the patient or client, usually for a defined time and a particular purpose, such as care that is outside the referring practitioner’s expertise or scope of practice.
Handover is the process of transferring all responsibility to another practitioner.
Many practitioners work closely with a wide range of other practitioners, with benefits for patient care.
Effective collaboration is a fundamental aspect of good practice when working in a team. The care of patients or clients is improved when there is mutual respect and clear communication as well as an understanding of the responsibilities, capacities, constraints and ethical codes of each other’s health professions. Working in a team does not alter a practitioner’s personal accountability for professional conduct and the care provided. When working in a team, good practice involves:
Good patient care requires coordination between all treating practitioners. Good practice involves:
Practitioners have a responsibility to contribute to the effectiveness and efficiency of the healthcare system.
It is important to use healthcare resources wisely. Good practice involves:
There are significant disparities in the health status of different groups in the Australian community. These disparities result from social, cultural, geographic, health-related and other factors. In particular, Indigenous Australians bear the burden of gross social, cultural and health inequity. Other groups may experience health disparities including people with intellectual or physical disabilities, those from culturally and linguistically diverse backgrounds and refugees. Good practice involves using expertise and influence to protect and advance the health and wellbeing of individual patients or clients, communities and populations.
Practitioners have a responsibility to promote the health of the community through disease prevention and control, education and, where relevant, screening. Good practice involves:
Risk is inherent in healthcare. Minimising risk to patients or clients is an important component of practice. Good practice involves understanding and applying the key principles of risk minimisation and management in practice.
Good practice in relation to risk management involves:
The welfare of patients or clients may be put at risk if a practitioner is performing poorly. If there is a risk, good practice involves:
Maintaining and developing knowledge, skills and professional behaviour are core aspects of good practice. This requires self-reflection and participation in relevant professional development, practice improvement and performance-appraisal processes to continually develop professional capabilities. These activities must continue through a practitioner’s working life as science and technology develop and society changes.
Development of knowledge, skills and professional behaviour must continue throughout a practitioner’s working life. Good practice involves keeping knowledge and skills up to date to ensure that practitioners continue to work within their competence and scope of practice. The National Law requires practitioners to undertake CPD. Practitioners should refer to the National Board’s registration standard and guidelines on CPD for details of these requirements.
In professional life, practitioners must display a standard of behaviour that warrants the trust and respect of the community. This includes observing and practising the principles of ethical conduct.
The guidance contained in this section emphasises the core qualities and characteristics of good practitioners outlined in Section 1.2 Professional values and qualities.
Professional boundaries allow a practitioner and a patient/client to engage safely and effectively in a therapeutic relationship. Professional boundaries refers to the clear separation that should exist between professional conduct aimed at meeting the health needs of patients or clients and a practitioner’s own personal views, feelings and relationships which are not relevant to the therapeutic relationship.
Professional boundaries are integral to a good practitioner–patient/client relationship. They promote good care for patients or clients and protect both parties. Good practice involves:
Practitioners need to be aware of and comply with any guidelines of their National Board in relation to professional boundaries.
Practitioners have statutory responsibility under the National Law to report matters to the National Boards: please refer to the Board’s guidelines on mandatory reporting and sections 130 and 141 of the National Law. They also have professional obligations to report to the Boards and their employer/s if they have had any limitations placed on their practice. Good practice involves:
Maintaining clear and accurate health records is essential for the continuing good care of patients or clients. Practitioners should be aware that some National Boards have specific guidelines in relation to records. Good practice involves:
Practitioners have a statutory requirement to ensure that practice is appropriately covered by professional indemnity insurance (see the Board’s professional indemnity insurance registration standard).
Advertisements for services can be useful in providing information for patients or clients. All advertisements must comply with the provisions of the National Law on the advertising of regulated health services, relevant consumer protection legislation, and state and territory fair trading Acts and, if applicable, legislation regulating the advertising of therapeutic goods.
Good practice involves complying with the National Law (explained in the Board’s guidelines on advertising of regulated health services) and relevant Commonwealth, state and territory legislation and ensuring that any promotion of therapeutic products is ethical.
When a practitioner is contracted by a third party to provide a legal, insurance or other assessment of a person who is not their patient or client, the usual therapeutic practitioner–patient/client relationship does not exist. In this situation, good practice involves:
The community places a great deal of trust in practitioners. Consequently, some practitioners have been given the authority to sign documents such as sickness or fitness for work certificates on the assumption that they will only sign statements that they know, or reasonably believe, to be true. Good practice involves:
When providing curriculum vitae, good practice involves:
Also see Section 10.3 Assessing colleagues in relation to providing references for colleagues.
Practitioners have responsibilities and rights relating to any legitimate investigation of their practice or that of a colleague. In meeting these responsibilities, it is advisable to seek legal advice or advice from a professional indemnity insurer. Good practice involves:
Patients or clients rely on the independence and trustworthiness of practitioners for any advice or treatment offered. A conflict of interest in practice arises when a practitioner, entrusted with acting in the interests of a patient or client, also has financial, professional or personal interests or relationships with third parties which may affect their care of the patient or client.
Multiple interests are common. They require identification, careful consideration, appropriate disclosure and accountability. When these interests compromise, or might reasonably be perceived by an independent observer to compromise the practitioner’s primary duty to the patient or client, practitioners must recognise and resolve this conflict in the best interests of the patient or client.
Practitioners must be honest and transparent in financial arrangements with patients or clients. Good practice involves:
As a practitioner, it is important to maintain health and wellbeing. This includes seeking an appropriate work–life balance.
Health practitioners have a responsibility to assist their colleagues to maintain good health. Good practice involves:
Teaching, supervising and mentoring practitioners and students is important for their development and for the care of patients or clients. It is part of good practice to contribute to these activities and provide support, assessment, feedback and supervision for colleagues, practitioners in training and students. It also adds value to the supervisor’s practice through engagement with the person being supervised and their learning needs. There are a range of supervision models being adopted in the health professions, including coach, mentor and shadow.
Assessing colleagues is an important part of making sure that the highest standards or practice are achieved. Good practice involves:
Students are learning how best to care for patients or clients. Creating opportunities for learning improves their clinical practice and nurtures the future workforce. Good practice involves:
Research involving humans, their tissue samples or their health information is vital in improving the quality of healthcare and reducing uncertainty for patients and clients now and in the future, and in improving the health of the population as a whole. Research in Australia is governed by guidelines issued in accordance with the National Health and Medical Research Council Act 1992 (Cth). Practitioners undertaking research should familiarise themselves with and follow these guidelines.
Research involving animals is governed by legislation in states and territories and by guidelines issued by the NHMRC.
Being involved in the design, organisation, conduct or reporting of health research involving humans brings particular responsibilities for practitioners. These responsibilities, drawn from the NHMRC guidelines, include:
Practitioners should refer to the NHMRC publications listed above for more guidance.
When practitioners are involved in research that involves patients or clients, good practice includes:
The Australian Commission on Safety and Quality in Health Care’s website provides relevant guidance on a range of safety and quality issues. Information of particular relevance to health practitioners includes:
The National Health and Medical Research Council’s website provides relevant information on informed consent and research issues.
Health Workforce Australia’s website provides information on a range of health workforce issues, including resources on clinical supervision.
The Therapeutic Goods Administration’s website provides relevant information on therapeutic goods.
Electronic means any digital form of communication, including email, Skype, internet, social media, etc.
Providing care includes, but is not limited to any care, treatment, advice, service or goods provided in respect of the physical or mental health of a person, whether remunerated or pro bono.
Practice means any role, whether remunerated or not, in which the individual uses their skills and knowledge as a practitioner in their regulated health profession. For the purposes of this code, practice is not restricted to the provision of direct clinical care. It also includes using professional knowledge in a direct non-clinical relationship with patients or clients, working in management, administration, education, research, advisory, regulatory or policy development roles and any other roles that have an impact on safe, effective delivery of health services in the health profession.
Patient or client includes all consumers of healthcare services.
Social media describes the online and mobile tools that people use to share opinions, information, experiences, images, and video or audio clips and includes websites and applications used for social networking. Common sources of social media include, but are not limited to, social networking sites such as Facebook and LinkedIn, blogs (personal, professional and those published anonymously), WOMO, True Local and microblogs such as Twitter, content-sharing websites such as YouTube and Instagram, and discussion forums and message boards.