Trust in healthcare undermined by "bad apples", new research reveals

Research news

Friday 03 November 2017

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Five apples in a row, the forth apple is rottenResearch based on analysis of 6,714 cases of professional misconduct by health and care professionals, and published today, has identified three different types of perpetrator:

  • the self-serving 'bad apple';
  • the individual who is corrupted by the falling standards of their workplace, and;
  • the depleted perpetrator struggling to cope with the pressures of life.

The study1, led by Professor Rosalind Searle from Coventry University's Centre for Trust, Peace and Social Relations, examined 6,714 fitness to practise determinations from the Professional Standards Authority's database2 covering doctors, nurses, social workers and paramedics, amongst others.

Professor Searle and her team applied cluster analysis to identify how different kinds of misconduct group together for the different professions. They also looked in more detail at cases involving sexual boundary violations and dishonesty.

Chief executive of the authority, Harry Cayton, said:

This research is the most ambitious project yet undertaken to use the information contained in the authority's database of fitness to practise determinations. In this report, Professor Searle offers us a rich and fascinating discussion of the complex and subtle interplay between individual professionals, teams, workplaces, gender and culture.

Professor Searle, who proposed this ground-breaking approach to the authority, and who is a professor of organisational behaviour and psychology, said:

In shining the spotlight on professional practice in the health sector, we're examining relationships that are often intimate in nature and based on trust and confidence between health workers and service users. It's crucial, therefore, for us to analyse where and how these taken-for-granted notions are being undermined through misconduct, and to take steps towards reducing instances of such behaviour.

The findings in our report represent important progress in understanding and tackling the issue, and in ensuring trust and confidence in the health professions is preserved.

The findings from the study have much broader implications, and go beyond the regulatory process. The authority said it was looking forward to discussing them widely, looking at how they can be used to support preventative interventions in future by regulators, employers and others.

The report – Bad apples? Bad barrels? Or bad cellars? Antecedents and processes of professional misconduct in UK Health and Social Care: Insights into sexual misconduct and dishonesty – is available here.

For further press information contact Alex Roache, senior media officer, Coventry University, on 02477655050 or email Alternatively, contact Christine Braithwaite, director of standards and policy, Professional Standards Authority for Health and Social Care at


1 Bad apples? Bad barrels? Or bad cellars? Antecedents and processes of professional misconduct in UK Health and Social Care: Insights into sexual misconduct and dishonesty (2017). The research was conducted by Professor Rosalind Searle, Dr C Rice, and Dr A A McConnell of the Centre for Trust, Peace and Social Relations at Coventry University, with additional input from Professor Jeremy Dawson, University of Sheffield. The research was funded by the Professional Standards Authority.

2 Fitness to practise determinations are the summary records of final hearings in fitness to practise cases. Each regulator notifies final fitness to practise decisions to the Professional Standards Authority and this data is contained on a database. The authority’s power to do this comes from the NHS Reform and Health Care Professions Act 2002. See below for more details or go to: