1. Remediation: When is it Gold? An Alternative Response to Complaints Claudia Skolnik Nora MacLeod-Glover Ontario College of Pharmacists Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

2. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Presentation Overview Philosophy behind Remediation ‘Nuts and Bolts’: Creating the Processes Putting it into Context –Case reviews

3. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Who are we? Investigations & Resolutions Investigation Creative processes Solution based Responsive & accountable Viewed as punitive Continuing Competency Assessment Identifying practice weaknesses Solution based Proactive & accountable Educationally based

4. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Shared Objectives Improve quality of care Reduce the risk of harm Infuse meaning into our processes & outcomes But – different “receptors” Collaboration was a natural evolution!

5. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Different Receptors of Information Regulatory Receptors of Information Registration – Entrance to Practice Practice Review /Inspections Complaint/breach Investigations

6. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Shared Processes Assessment Evaluation Remediation Enforcement

7. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona The ‘Nuts and Bolts’: Creating the Processes 1.Find your legislative authority −Complaints Committee Authority Take appropriate action not inconsistent with the laws −Discipline Committee Authority Terms, Conditions and Limitations Professional misconduct to breach a term, condition or limitation −Discipline referral Illusion of choice −Access your Quality Assurance Enforcement legislation

8. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona The ‘Nuts and Bolts’: Creating the Processes 2. Gather your facts −Adapt your investigation Gather all relevant information Not just “what?” but “why?” Anticipate Committee interest in remediation Consult with Continuing competency re: remediation opportunities

9. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona The ‘Nuts and Bolts’: Creating the Processes 3. Create your remediative solution –Obtain Remediation Assessment & Education Plan 4. Guide the Committee review –Confirm practice deficits –Consider suitability of remediation –Justify the reasonableness of the remediation

10. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona The ‘Nuts and Bolts’: Creating the Processes 5.Undertaking –Recognition of need for improvement –Definition of enforceability 6.Decision and Reasons –Demonstrate value of remediation –Accountable/reasonable

11. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona The ‘Nuts and Bolts’: Creating the Processes 7.Compliance Monitoring –Consent to information release –Follow up mechanisms –Conclusion & confirmation of success –Further enforcement if non-compliant

12. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona The ‘Nuts and Bolts’: Competency Consultation 1.Maintain your remediation tool box –Know your remediation opportunities Develop & maintain a network of educators –Review programs and assess suitability Rely on education frameworks Examine learning objectives 2.Examination of Practice Deficit –Complete a review of the investigation –Probe & obtain further information

13. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona The ‘Nuts and Bolts’: Competency Consultation 3.Analyze case to find root cause −Examine each issue addressed in investigation –Define the practice gap –Identify the remediative potential –Match the remediation recommendation to the practice gap 4.Create the Remediation Assessment & Education Plan –Includes an assessment component –Be open and creative!

14. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona The ‘Nuts and Bolts’: Competency Consultation 5.Submit to staff/Committee 6.Respond to staff/Committee questions and modify, as required 7.Address the Committee on remediation issues

15. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Putting it into Context Case Review (J.L.) 29 incidents, over 2 years, hospital setting –Dispensing errors –Poor recordkeeping –Abdication of responsibility Terminated from employment

16. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Case Review – J.L. Investigation –Gathered documentation –Interviewed co-workers –Member’s response –Obtained a continuing competency assessment

17. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Case Review – J.L. Root Causes Ineffective communication skills* Poor therapeutic knowledge management and application Rote prescription processing skills Inadequate error management skills Lacks awareness of professional accountability Remediation IPG program participation –Applied therapeutics –Communication skills –Basic Professional practice lab –Professional Practice Theory including drug information sessions and jurisprudence Effective communication strategies program Confronting Medication Errors program

18. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Case Review – J.L. Committee endorsed remediation option Negotiation (two communication programs) Undertaking – contracting terms Final Committee decision –Ordered remediation –Oral caution –Rationalize the decision and suitability of remediation

19. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Benefit Analysis – J.L. Extensive Remediation –Lengthy and expensive –Not a specified committee power Cost and time effective Avoided complicated discipline case Appropriate & meaningful

20. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Putting it into Context Case Review (N.S.) Member disciplined –Failed to identify excessive narcotic prescriptions Discipline order –Suspension –Term, condition and limitation re: remediation Failed remediation – breached condition

21. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Case Review – N.S. Negotiated attempts for compliance Failed again Is breach Discipline or Competence based? Consultation with Continuing Competence

22. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Case Review – N.S. Root Causes Lacked basic interviewing skills Deficiencies in communication skills Weak therapeutic knowledge base Remediation IPG program –Language of Patient counselling –Communication skills Therapeutic study, three of: –Print coursework –Live lectures: IPG

23. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Case Review – N.S. Obtained Education Plan Used discipline for breach as leverage Negotiated Enforceable Undertaking –Failure to result in enrolment in the QA stream Success!!!!

24. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Benefits Analysis – N.S. Effective monitoring Meaningful process Averted need for Discipline Achieved improved quality outcome!

25. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Why Remediate? Professionals come to work with intention to do good Distinguish between conduct and practice –Theft/fraud vs patient care shortcomings Principles of CQI –Quicker solutions Penalties options may not be effective

26. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Mining for success Institutional philosophy of CQI Openness to modify processes Creative interpretation of legislation Meaningful and valid remediation options Draw upon unique skills of individuals Culture of interdepartmental collaboration Educate committees and get their buy-in

27. Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona Speaker Contact Information Claudia Skolnik, Manager, Investigations & Resolutions cskolnik@ocpinfo.com Nora MacLeod-Glover, Manager, Continuing Competency nmacleod@ocpinfo.com Ontario College of Pharmacists 483 Huron Street, Toronto, Ontario M5R 2R4 Tel:416-962-4861 Fax:416-847-8282 www.ocpinfo.com