The general meaning of reflection is about giving thought and consideration to something.  

When things go wrong at work, professionals are often asked to consider not only what went wrong, but how and why things went wrong and what they can do to take future preventative measures. Clinically, this often happens as the result on an audit or if a serious incident occurs as part of an SI review or Root Cause Analysis exercise.

Similarly, as an individual healthcare professional it is important to be able to describe what happened, evaluate what happened, analysis the cause, contributory factors and impact on yourself and others so that steps can be taken, and measures put in place to highlight triggers and prevent any recurrence. 

This is often easier to achieve in competence cases rather than misconduct cases, particularly where there has been an element of dishonesty, but it is not impossible.

Insight is about being able to see or understand something clearly.  

Where things have gone wrong, assurances will need to be demonstrated that there will be a negligible risk and that any ongoing risk can be adequately managed.

It is a well-established fact that simply saying sorry is not enough. Insight and remediation must be genuine and demonstrable. 

Factors that can be relevant to genuine insight include evidence that the professional has considered the concern, understood what went wrong and accepted they should have acted differently by for example demonstrating that they fully understand the impact or potential impact of their performance or conduct.

Demonstrating remorse involves taking responsibility and exhibiting regret for their actions. This could include evidence that the professional has:

• been open and honest about their wrongdoing and apologised;
• undertaken appropriate remediation.

The dictionary definition of remediation is righting a wrong or correcting a fault.

Remediation in regulatory proceedings is where the professional actively addresses concerns about their behaviour, skills, performance, or health. Remediation can take a number of forms:

• participating in training, supervision, coaching and/or mentoring
• attending courses relevant to the concerns raised, for example maintaining boundaries, ethics, or English language courses
• evidence that shows what the professional has learnt following the events that led to the concerns being raised, and how they have applied this learning in their practice
• evidence of good practice in a similar environment to where the concerns arose.

The quality of the steps taken to remediate the concerns is key to assessing the impact it has had or is capable of having. Remediation should be:

• relevant – in that the steps taken to remediate have directly addressed the concerns identified
• measurable – in that there is objective evidence available that helps understand what has been done and what, if anything, is left to be done, and
• effective – in that there is enough information for the tribunal to see how any learning has been assessed and/or applied and its impact or success.