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Institutionalised Professional Negligence - Dr Mark Burgin

19/07/19. Dr. Mark Burgin BM BCh (oxon) MRCGP explains how the systems set up to protect the public from professional negligence are responsible for growing negligence in institutions.

Regulating complex systems requires that the regulator or manager understands that institution well enough to avoid any perverse outcomes.

Professionals working within those complex systems attempt to maximise three outcomes; efficient use of resources, best outcomes possible and minimising harm.

Individual professional’s performance is rarely easy to capture as they respond to the challenges in front of them and determine priorities from their own understanding.

Few professionals will fail in all situations but many professionals will fail when stressed and most professionals will fail when the system is highly dysfunctional.

The definition of professional negligence is that they have failed to perform to the standards required of them, which assumes that those standards are correct.


The way that a professional reaches their aims is based upon theories both taught during training and developed whilst working, based upon experience.

Where there is a single right answer the task can be delegated as it does not require a professional judgement as to what is likely to work in that given circumstance.

Professionals therefore face at least 2 options, either of which can be right, that need to be compared with the situation to determine the correct choice.

If there was a single correct approach to determining which option is right the task could be delegated and would not require the professional.

Substituting professional judgement with a guideline will frequently fail and will create stress in those professionals who are force to follow an incorrect standard.

Raising Concerns

Professionals learn how systems work from the inside, seeing what works and what does not, so whilst their view may be limited they are unique in understanding the system.

Professionals are often active in raising concerns about the system from lack of resources, workforce planning and barriers to them performing their roles.

When those managing the system are not collecting the right data they may dismiss these concerns as empire building or doomsaying rather than investigate the issues.

The failures of regulators to get a grip upon these problems means that over time the system adapts, creating perverse outcomes to get around the limitations.

These adaptations inevitably involve compromise and stress in the professionals and, as corners are cut, it is unavoidable that elements of poor performance will creep into the system.


Any new regulation in a professional area will restrict both beneficial and harmful behaviours and create an opportunity for gaming of the system to avoid its effects.

The more bodies that are involved in the regulation of a professional group the more their rules will conflict with each other and put pressure disproportionately on higher performing professionals.

Regulators are generally resistant to criticism that their actions are not effective because they judge their own performance and choose measures that support their view.

Few, if any, bodies have access to systems analysts (a branch of mathematics) so the regulations will continue to expand as they try to deal with the side effects of other rules.

Regulation distorts professional behaviours (and emotions) more in recent times as managers are able to collect the data required to monitor adherence to those regulations.


Professionals can follow the rules even when it will harm those they are serving, bend the rules, leave the profession or can speak out against those rules.

If systems appear over-complex, contradictory, overlapping, expensive and ineffective they probably are, and they will impair the ability of professionals to do their job.

It is naive to assume that highly intelligent and experienced professionals will not learn how to get things done and share these ideas despite the obstructions built into the system.

There does not appear to be any previous claim in the literature that there is Institutionalised Professional Negligence in the UK or any claim that ill-conceived regulation is the cause.

This article uses systems analysis to warn that attempts to improve a system cause perverse outcomes and professional stress which can lead to institutional level negligence.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website

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