Incompetent professionals | Kopenhagen 17 september 2013

Incompetent professionals

New policy of The Dutch Healthcare Inspectorate

Dr. Paul J Zwietering, MD, PhD, senior inspector

Incompetent professionals | Kopenhagen 17 september 20132

Dutch Health Care Inspectorate

Monitoring quality of:

health care institutions

medical products

individual professionals

Incompetent professionals | Kopenhagen 17 september 20133

Inducement

A few very serious cases with a lot of:

• Political attention

• Media notice

• Discontent about the inspectorate

Less tolerance and more call for repression in policy and society about healthcare workers who make mistakes

• Dysfunctioning spearhead inspectorate policy

Incompetent professionals | Kopenhagen 17 september 20134

Risk groups

•Working in a solo practice (less feedback)•Older professionals• Close relation to patients (GP, psychiatrist, physiotherapist)• Earlier measures•Working in an institution in/with:• Reorganisation• Financial problems• A culture of lack of transparency

Role Dutch Health care inspectorate

‘System’ monit. Functioning

Incident Suboptimal functioningmonitoring

Dysfunctioning

Responsibilities in case of dysfunctioning

prevention

detection

intervention

monitoring

Inspectorate

‘field’

establishing

Initiatives Dutch Health Inspectorate

•Setting up an expert unit about dysfunctioning

•Formulating a new definition of incompetence

• Invitational conferences with professional organisations

•Getting a covenant with professional organisations

•Publications about dysfunctioning

•Improvement of sharing judicial information

•Zero tolerance of “conspiracy of silence”

Initiatives Dutch Health Inspectorate

Monitoring peer responsibility and governance in institutions

Indirect by monitoring steering on functioningIndicators on use of instruments as appraisal in monitoringQuestions on recruitment policies

Monitoring Incidents => when patient safety is at stake(suboptimal and dysfunctioning)

– Assessment of system: was there steering on functioning– Assessment of individual: indication of structural

shortcomings in all competences (“soft”)

Stimulating other organisations

Stimulating (1)Health care training institutes:

Train and assess all CanmedsFor trainer and student/professionalLifelong education (on all Canmeds)Strict go/no go decisions in incompetent students

Professional Associations:Further development of instruments to assess/measure functioning(co) develop and structure programs of education on all CanmedsFurther development of visitation instrumentsCareer development?

Stimulating (2)

Health care organisations/Boards:

Focus and steering on functioning, a.o. performance appraisal, education, career planning ,team responsibility,

Develop and use of recruitment policy: e.g. references, assessment, certificate of good conduct

Periodical assessment interviews

Steering on safe reporting of incidents, open safety culture, ‘peer to peer transparency’

• Visitation

• Dismissal policy

Stimulating (3)Registration Committees:• Further developing itself to an institution that registers only

demonstrably competent professionals

Ministry of Health• Facilitating (further) instrument building• Policy on admission to healthcare market• Steering on lifelong education• (role insurance companies)• New laws

• Insurance companies:• Contracting only demonstrably competent professionals/care

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New definition of an incompetent professional

A mostly structural situation of:

sub-standard competencies (canmeds) or providing sub-standard care giving,

by which patients are at risk or are damaged

and the professional is not ableor not willing to solve the situation

including misabuse of drugs, sexual abuse and illness

My questions to you:1. How do you:• detect substandard performing professionals?• establish substandard performing and dysfunctioning?• handle with conspiracy of silence?• give restrictions to a healthcare professional, how do you

sustain them?• stimulate peer responsibility and governance

2. What are your instruments to help improve the performance of substandard performing professionals?

3. How can a supervisor judge the supervisee;how can the supervisor be (held) responsible?

4. On what scale do you operate?