Joint Conference of IPAC CPE 4th 6 September...
Transcript of Joint Conference of IPAC CPE 4th 6 September...
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Joint Conference of
IPAC
&
CPE
4th – 6th September 2014
Druids Glen Resort, Co. Wicklow, Ireland
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Raising Concerns About Poor Performance
- Matching Public Expectations and Professional Practice
Paul Kavanagh, Lorna Farren,
Simon O'Hare, & Caroline Spillane, Medical Council of Ireland.
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Overview
• Why we did this piece of work?
• How did we do it?
• What did we find?
• So, what next?
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Overview
• Why we did this piece of work?
• How did we do it?
• What did we find?
• So, what next?
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Safe, high quality care
Good doctors
Good systems
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Responding to concerns
Setting expectations for doctors
Developing and maintaining good
practice
Controlling entry to practice
Good Professional
Practice
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What is the Medical Council going to do
about this? - Performance
assessment and remediation
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One or more concerns
Whole of performance
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Why did we do this?
• What do the public and doctors think about professionalism – discourse about “what it means to be a good doctor”
• Understand attitudes and behaviours related to “responding to concerns”.
• Inform strategy 2014-2018
• Enhance our role in concern response
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Overview
• Why we did this piece of work?
• How did we do it?
• What did we find?
• So, what next?
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How did we do it?
• Three consecutive omnibus public survey waves 2011-2013.
• Single doctor survey 2013. - Simple random sample of 2,500 doctors with valid
emails (89%) present survey via online system.
- Response rate was 28%.
• Questions content drawn from work by Roland et al BMJ Qual Safety 2011
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Table 1: Characteristics of respondents to doctors’ survey 2013
Characteristic Survey Responses Annual Retention 2012
Male 61.5% 60.3%
Female 38.5% 39.7%
Mean age (standard deviation) 44.5 years (11.5 years) 45.1 years (12.7 years)
Irish graduates 65.8% 65.1%
Working full-time 80.9% 83.1%
Practising in Ireland only 80.6% 74.7%
Specialist Division 49.1% 44.3%
General Division 36.1% 42.0%
Trainee Specialist Division 13.8% 12.2%
Working in general practice 26.1% 31.0%
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Doctors survey respondents
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Overview
• Why we did this piece of work?
• How did we do it?
• What did we find?
• So, what next?
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Trust
Experience
Building blocks of trust
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Figure 1: For each different type of people, would you tell me whether you generally trust them to tell the truth or not (% “trust to tell the truth”, 2011-2013)?
91%
88%
85%
80%
76%
75%
75%
62%
58%
58%
44%
42%
42%
40%
18%
92%
89%
78%
70%
77%
64%
76%
52%
67%
53%
37%
35%
41%
40%
15%
88%
79%
72%
61%
63%
71%
64%
50%
41%
45%
25%
32%
37%
27%
12%
0% 20% 40% 60% 80% 100%
Doctors
Teachers
Professors
Scientists
Television News Readers
Judges
The Gardai
Clergymen/Priests
The Ordinary Man/Woman on the street
Civil Servants
Pollsters
Trade Union Officials
Journalists
Business Leaders
TDs
2013 2012 2011
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Figure 2: How would you rate the experience you have with the doctor that you attend most often, 2011-2013?
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Communication Shared decision
making Confidentiality
Open disclosure Raising concerns Maintaining
competence and quality assurance
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Figure 3: In relation to the doctor you attend most often how confident would you be that ... (very confident and fairly confident combined, 2013)?
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Figure 4a: To what extent do you agree or disagree that doctors should report all instances of significantly impaired or incompetent colleagues to relevant authorities (completely agree %)?
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Figure 4a: “Responding to concerns” versus “safeguarding confidentiality” (% completely agree)
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ireland UK USA
"Responding toconcerns"
"Safeguardingconfidentiality"
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Figure 5: In the last 3 years, have you had direct personal knowledge of a doctor who was impaired or incompetent to practise medicine in your hospital or practice?
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14%
19%
17%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Ireland UK USA
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Figure 6: If you did have direct personal knowledge of a doctor who was impaired or incompetent to practise medicine in your hospital or practice, in the most recent case did you… (% Yes – more than 1 option allowable)
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18%
36%
41%
17%
66%
73%
72%
60%
65%
0% 20% 40% 60% 80%
Stopped referring my patients
Had a personal discussion withthe doctor
Reported the doctor to arelevant individual/body
USA
UK
Ireland
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Figure 7: If you did not report the doctor was it because… (% Yes – more than one option allowable)
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44%
19%
25%
14%
26%
34%
14%
20%
12%
0% 10% 20% 30% 40% 50%
I thought nothing would happen
I thought it was someone else'sjob
I was afraid of retribution
USA
UK
Ireland
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What did we find?
• Public expect “responding to concerns” as an attribute of medical professionalism − Expectation varies by concern type.
• “Responding to concerns” is an attribute of professionalism among doctors − but more disputed and some contextual variation.
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What did we find?
• “Responding to concerns” behaviours among Irish doctors less “patient-centric” − Behaviours vary by context.
• Perception that nothing will happen is a perceived barrier among Irish doctors − Perceptions vary by context.
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Overview
• Why we did this piece of work?
• How did we do it?
• What did we find?
• So, what next?
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So, what next?
• Good doctors practising in good systems – safe, high quality care
• Professional attitudes & behaviours are shaped by context …. Professional attitudes & behaviours shape context
• Limit focus of medical regulator to individual practice … limit effectiveness
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Training and practice setting
Healthcare team
Patient-doctor
relationship
Wider political, social & cultural environment
Lesser et al, JAMA. 2010
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So, what next?
• Informing good practice through defining expectations − Revise Professional Code
• Fostering good practice through education, training and lifelong learning − Oversight of educational bodies and programmes
• Inform and engage on informal and hidden curriculum − Learning and practice environments
− Wider policy agenda
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