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Recertification of healthcare professionals – threat or opportunity for healthcare organisations?
Grant Phelps MBA FRACP FRACMA GAICD
Associate Professor of Clinical Leadership, Deakin University
ACHSM Conference Canberra August 2013
Assumptions
It’s happening to Doctors Other craft groups likely
Terminology doesn’t matter Critical issue is “fitness to practice”
The professions have a critical role Standards, Tools, and maybe assessment
Wont apply to clinicians in training Not yet “fit to practice” independently
Must be based in performance, not competence Does do vs. Can do
Why performance?
Provide an assurance to the public Public presume that doctors are performing and that they are
being monitored
Very essence of professionalism The health system exists for the public
Trust of the public is earned, not automatically given
Trust is based in performance ….”the lived experience”…
The vast majority of doctors are ‘good enough’ (and are trying to be better……)
Understanding performance
Work context is criticalTeam based care modelsCollective accountability vs individual accountability
Clinical ‘governance’ and organisational accountability
Engaged clinicians are more effective clinicians
How Clinicians See it
Clinician
Profession Provider Organisation
Patient
Government
CommunityPurchaser Organisations
Smith P et al WHO European Ministerial Conference on Health Systems 2008
Ministerial review of Victorian public health medical staff 2007
Poor moraleDisengagementPoorly valuedThreat to staff retention and patient safety
Declining commitment to public sectorNeed for clinical leadership
Morey, S., Barraclough, B. and Hughes, A. (2007)
Knowledge vs. Performance?
Knowledge deteriorates with time Wisdom increases with experience
Is there fundamental knowledge that every clinician should have?
Compliance obligations Core attributes of professionalism Practice changes significantly over time What do you examine??
What matters to patients is performance
That’s about quality
Why not self assessment?
A recertification cycle
Recertification
Ongoing performance assessment
Multiple inputs
Improvement opportunities
The work Context
• Organisation• Scope of Practice• Peer group• Patient mix• Community• Clinical practice
Design Principle #1:Recertification must be based in a meaningful demonstration of performance
MustTruly reflect performance of an individualBe based in continuous improvement Be verifiable – i.e. evidence based Peer based – judging technical qualityInvolve consumers – judging service quality and professionalism
#2 Peer based assessment
Peers are well placed to judge technical performance
Context is criticalPeers need insight and reflection too
But …. Peers tend to up rate colleagues “There but for the grace of God go I…”
Doctors and the work context?
59,000 on specialist registersMajority of specialists have a hospital appointment ( 60% of FTE are in public hospitals)
Of doctors working in private practice 70% in group practices 30% in solo practices
161 specialists in remote practicePhysicians approximately 34% of specialist workforce
?? 55 genuinely geographically isolated physiciansAIHW Medical Workforce 2011
Other design principlesEmbedded in & reflect work processes
make it easy to do it right is based in the work of the clinician Not ‘one size fits all’
Minimise negative impact, maximise benefit
Avoids replication Properly resourced Manage the poor, celebrate the good
Meets regulatory and college requirements e.g. by supporting professional learning
Supports organisational engagement by and with clinicians
Highly engaged employees are 50%
more likely to exceed expectations
Companies with highly engaged staff
outperform firms with disengaged staff By 54% in employee retention
By 89% in customer satisfaction
By fourfold in revenue growth
“Creating the best workplace on earth”
Goffee R, Jones G. Harvard Business Review May 2013
Engagement is…?
“Engagement relates to the
degree of discretionary effort
employees are willing to apply in
their work in the organisation”
Alimo-Metcalfe B. , J. of Health Org Management 2008
Engagement of Doctors
Better patient and organisational outcomes
Mortality rates Infection ratesComplaints Financial outcomesBetter leadership
The business of Health Care is…
The clinician patient interaction
Supported by ManagementInfluenced by policy
This is where value is created….. or lost
www.health.vic.gov.au/clinicalengagement
Recertification
Questions remain..#1 Who manages this?
Hospital setting Clinical leaders External clinical leaders
Community setting Groups of peers Nominal head External clinical leaders
Properly appointed, clear duties and processes
#2 Role of the professions & craft groups?
Self reflectionTeam based learning
External rater feedback
#3 What about the truly isolated clinician?
? Is this a viable practice styleRole for the professions in supporting these colleagues
? Insist on peer groupBroker their conversations & peer groupsProvide toolsIdentify medical leaders
Grey areas
Training and support in having performance conversations
Engaging the professionsRisk adjustment for contextual factors
Leadership Culture …..resourcing….
Consumer input?What will the community accept?
Summary Demonstrating ‘good enough’ performance
Demonstrable professionalism Our commitment to the community Must guide recertification
Existing organisational approaches Acceptable Performance in an organisational context should be
evidence of Performance sufficient for demonstration of ‘fitness to practice’
Opportunity to drive engagement by focusing systems on core business of organisations AND clinicians
If based in continuous improvement it will improve patient care and organisational outcomes
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