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Recertification of healthcare professionals – threat or opportunity for healthcare organisations? Grant Phelps MBA FRACP FRACMA GAICD Associate Professor.

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Presentation on theme: "Recertification of healthcare professionals – threat or opportunity for healthcare organisations? Grant Phelps MBA FRACP FRACMA GAICD Associate Professor."— Presentation transcript:

1 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



4 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

5 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”…

6 The caring professions are changing  From craft based practice  Individual doctors working alone  Handcrafting a customised solution for each patient  Based on a core ethical commitment to the patient  Vast personal knowledge gained from training and experience  To profession based practice  Groups of peers in a shared setting  Using coordinated processes ( e.g. protocols / standing orders)  Adapted for individual needs  Professional autonomy is a myth  Understanding performance in the context of this myth


8 The vast majority of doctors are ‘good enough’ (and are trying to be better……)

9 Understanding performance  Work context is critical  Team based care models  Collective accountability vs individual accountability  Clinical ‘governance’ and organisational accountability  Engaged clinicians are more effective clinicians

10 The organisational context: “No-one runs hospitals”  Major disconnect between corporate and clinical governance  Clinical decisions drive corporate outcomes  Command and control style ill equipped for clinical environment  Doctors frustrations reflect limited organisational power Menadue J. RACMA Quarterly March 2008

11 How Clinicians See it Clinician Profession Provider Organisation Patient Government Community Purchaser Organisations Smith P et al WHO European Ministerial Conference on Health Systems 2008

12 Ministerial review of Victorian public health medical staff 2007  Poor morale  Disengagement  Poorly valued  Threat to staff retention and patient safety  Declining commitment to public sector  Need for clinical leadership Morey, S., Barraclough, B. and Hughes, A. (2007)

13 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

14 Why not self assessment?

15 A recertification cycle The work Context Organisation Scope of Practice Peer group Patient mix Community Clinical practice

16 Design Principle #1: Recertification must be based in a meaningful demonstration of performance  Must  Truly reflect performance of an individual  Be based in continuous improvement  Be verifiable – i.e. evidence based  Peer based – judging technical quality  Involve consumers – judging service quality and professionalism

17 #2 Peer based assessment  Peers are well placed to judge technical performance  Context is critical  Peers need insight and reflection too  But …. Peers tend to up rate colleagues  “There but for the grace of God go I…”

18 Doctors and the work context?  59,000 on specialist registers  Majority 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 practice  Physicians approximately 34% of specialist workforce  ?? 55 genuinely geographically isolated physicians AIHW Medical Workforce 2011

19 Other design principles  Embedded 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

20 Who is the medical workforce?  95,330 registered doctors ( MBA 2013)  89.6% in workforce (HWA 2102)  58,978 on specialist registers  23,200 GP’s  35,978 non GP specialists  RACP 34% of the specialist workforce  8655 Adult Physicians  2132 Pediatricians  1478 Other HWA Doctors in focus 2012 / Medical Board of Australia 2013

21  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

22 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



25 Engagement of Doctors  Better patient and organisational outcomes  Mortality rates  Infection rates  Complaints  Financial outcomes  Better leadership



28 The business of Health Care is… The clinician patient interaction Supported by Management Influenced by policy This is where value is created….. or lost



31 Recertification

32 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

33 #2 Role of the professions & craft groups?  Self reflection  Team based learning  External rater feedback

34 #3 What about the truly isolated clinician?  ? Is this a viable practice style  Role for the professions in supporting these colleagues  ? Insist on peer group  Broker their conversations & peer groups  Provide tools  Identify medical leaders

35 Grey areas  Training and support in having performance conversations  Engaging the professions  Risk adjustment for contextual factors  Leadership  Culture  …..resourcing….  Consumer input?  What will the community accept?

36 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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