1. Incompetent professionals | Kopenhagen 17 september 2013 Incompetent professionals New policy of The Dutch Healthcare Inspectorate Dr. Paul J Zwietering, MD, PhD, senior inspector

2. Incompetent professionals | Kopenhagen 17 september 2013 2 Dutch Health Care Inspectorate Monitoring quality of: health care institutions medical products individual professionals

3. Incompetent professionals | Kopenhagen 17 september 2013 3 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

4. Incompetent professionals | Kopenhagen 17 september 2013 4 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

5. Role Dutch Health care inspectorate ‘System’ monit.Functioning Incident Suboptimal functioning monitoring Dysfunctioning

6. Responsibilities in case of dysfunctioning prevention detection intervention monitoring Inspectorate ‘field’ establishing

7. 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”

8. Initiatives Dutch Health Inspectorate Monitoring peer responsibility and governance in institutions Indirect by monitoring steering on functioning Indicators on use of instruments as appraisal in monitoring Questions 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

9. Stimulating (1) Health care training institutes: Train and assess all Canmeds For trainer and student/professional Lifelong 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 Canmeds Further development of visitation instruments Career development?

10. 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

11. 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

12. Incompetent professionals | Kopenhagen 17 september 2013 12 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 able or not willing to solve the situation including misabuse of drugs, sexual abuse and illness

13. 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?