Performance Assessment and Medical Regulation Dr Fiona Joske Practitioner Member, Medical Board of Australia IPAC 2013
Medical Board of Australia New scheme for regulation of Health Practitioners in Australia Performance assessment Revalidation
National Registration and Accreditation Scheme NRAS
Structure
Before Eight States and Territories with different laws & standards > 85 health profession boards 66 Acts of Parliament After One national scheme 10 (now 14) health profession boards National Law model Local variation in 4 jurisdictions 5
Health Professions July 2010 chiropractors dental care (including dentists, dental hygienists, dental prosthetists and dental therapists), medical practitioners nurses and midwives optometrists osteopaths pharmacists physiotherapists podiatrists psychologists July 2012 Aboriginal and Torres Strait Islander health practitioners Chinese medicine practitioners medical radiation practitioners occupational therapists
Role of National Boards Set national standards, codes and guidelines Determine requirements for registration Approve accredited programs of study Oversee assessment overseas trained practitioners Oversee investigation of notifications Set registration fee and develop Health Profession Agreement with AHPRA
Role of AHPRA Provide support and administrative services to National Boards and committees, through one organisation with a National office and State/Territory offices Establish annual Health Profession Agreements with each National Board re registration fees and services AHPRA provides Employ staff, enter contracts, manage property (which Boards cannot do)
Performance programs in NSW NSW Medical Council Performance vs. Disciplinary Pathway Performance interviews Performance assessments Performance review panels Counselling performance Compliance monitoring
Health Practitioner Regulation National Law Act 2009 (the National Law) Section 170 When can the Board require a performance assessment? If the Board reasonably believes, because of a notification or for any other reason that the way the practitioner practises the profession is or may be unsatisfactory.
Health Practitioner Regulation National Law Act 2009 (the National Law) Section 171 Appointing an assessor/assisting an assessor/paying an assessor Registered health practitioner, a member of the health profession for which the National Board is established, not a member of the Board. That assessor may ask another health practitioner to assist the assessor in carrying out the assessment. The assessor s fee for carrying out the assessment is to be paid out of the National Board s budget.
National Law Appointing and paying assessor Notifying practitioner Powers of assessor Providing report and discussing it with practitioner including willingness to change Board decisions/actions
MBA Performance Assessment A number of PAs have been conducted since national scheme commenced Aim for remediation as opposed to discipline where possible Less stressful to practitioner and less costly for the Board 13
Identified Issues National coordinator / National consistency Lack of experience in some jurisdictions Assessor training Briefing of assessors Tools and Proformas Legal challenges seen as punitive 14
Valid and defensible Assessing the Performance of Doctors for Regulatory Purposes A desktop review of literature, policy and practice - Professor Liz Farmer
Guidelines - Performance assessment Performance assessment is not generally an alternative to investigation of a notification Performance assessment is not appropriate: - for suspected unprofessional conduct (reckless, unethical, willful, criminal) - where a practitioner s health may be impaired. 16
Triggers/indications Multiple, relatively minor, notifications suggesting unsatisfactory practice Concern about performance expressed by an external body Concern about performance raised during an investigation Failure to progress satisfactorily through IMG pathways 17
Core Performance Assessment Activities Pre-visit questionnaire Introductory interview Medical record review Direct observation of consultations and/or procedures Structured clinical practice interview 18
Assessment tools Other tools Review of CPD profile Psychological testing Simulated consultations Virtual skills laboratory Peer and Staff interviews Other - as recommended by the assessors 19
Next steps for the Medical Board of Australia Integration of PA into notification processes PA become business as usual Internal workshops continue - develop an agreed national process for performance assessment for medical practitioners Assessor training Reporting results/national data set Further development of tools (e.g. multi-source feedback) National coordinator / National consistency 20
The Revalidation Conversation Current CPD program Workshop with Stakeholders Presentations Discussion paper