New Professional Performance Framework for patient safety

28 Nov 2017

The community in Australia has high levels of trust in doctors and expects medical practitioners to provide safe care to patients. The Medical Board of Australia has designed a Professional Performance Framework to ensure that all registered medical practitioners practise competently and ethically throughout their working lives.

The Professional Performance Framework will support doctors to take responsibility for their own performance and encourage the profession collectively to raise professional standards and build a positive, respectful culture in medicine that benefits patients and doctors.

The Professional Performance Framework has five pillars:

1. Strengthened continuing professional development (CPD) requirements.
2. Active assurance of safe practice.
3. Strengthened assessment and management of medical practitioners with multiple substantiated complaints.
4. Guidance to support practitioners.
5. Collaborations to foster a culture of medicine that is focused on patient safety, based on respect and encourages doctors to take care of their own health and well-being.

The final report of the Expert Advisory Group on revalidation

The Board has previously announced that it is committed to developing a process that supports medical practitioners to maintain and enhance their professional skills and knowledge and remain fit to practise medicine. It used the term ‘revalidation’ for this process and appointed an Expert Advisory Group to provide it with expert advice.

The EAG, chaired by Professor Elizabeth Farmer, has delivered its final report, released today. The Professional Performance Framework is the Board’s response to that report.

The EAG’s recommendations are designed to improve public safety. They recommend an integrated approach that will help improve public safety and better identify and manage risk in the Australian healthcare setting by:

• maintaining and enhancing the performance of all doctors practising in Australia through efficient, effective, contemporary, evidence-based CPD relevant to their scope of practice, and
• proactively identifying doctors who are either performing poorly or are at risk of performing poorly, assessing their performance and if necessary, supporting their remediation. The EAG identified that age, professional isolation and multiple complaints are all risk factors for poor performance.

The Board has accepted the evidence provided by the EAG and its recommendations, including to not adopt the term ‘revalidation’ as this does not accurately describe the Board’s approach.

The Professional Performance Framework

The Board’s Professional Performance Framework is evidence-based, integrated and builds on existing initiatives. It will be implemented progressively, with some elements already in place and others requiring significant planning, consultation and development.

‘We have designed a framework that will justify and strengthen the trust that the Australian community has in their doctors. It is focussed on patient safety and will support doctors to provide high quality care throughout their working lives,’ said Board Chair Dr Joanna Flynn AM.

‘Nothing is going to change tomorrow for individual doctors. We will be consulting widely and seeking expert advice on many elements of the framework,’ Dr Flynn said.

Under the five pillars of the Professional Performance Framework:

1. Strengthened CPD includes practitioners:
   1. having a ‘CPD home’ and participating in its CPD program
   2. ensuring their CPD is relevant to their scope of practice and based on their own professional development plan, and
   3. completing at least 50 hours of CPD per year that includes reviewing their performance, measuring their outcomes and educational activities.
2. Active assurance of safe practice involves identifying practitioners at risk of poor performance and managing that risk. The Board expects that the vast majority of doctors with identified risk factors will demonstrate their ability to provide safe care to patients and remain in active clinical practice.
   
   The EAG has identified increasing age as a risk factor for poor performance. The Board is proposing to require practitioners who provide clinical care to have peer review and health checks at the age of 70 and three yearly thereafter. The outcome of health checks and peer reviews will not be reported to the Board unless there is serious risk to patients.
   
   The EAG also identified professional isolation as a risk factor. The Board plans to provide guidance to help practitioners identify the hallmarks of professional isolation and manage the risk from it, including by increasing peer-review in their CPD.
3. Strengthened assessment and management of medical practitioners with multiple substantiated complaints includes formal peer review of performance for practitioners with multiple substantiated complaints.
4. Guidance to support practitioners involves the Board continuing to develop and publish clear, relevant and contemporary professional standards to support good medical practice. This includes a revised Code of conduct, as well as revised and new registration standards.
5. Collaborations to foster a positive culture of medicine that is focused on patient safety, based on respect and encourages doctors to take care of their own health and well-being. This includes the Board working with the profession and others to reshape the culture of medicine and build a culture of respect. It also includes encouraging doctors to take care of their own health and wellbeing and to support their colleagues; and urging governments and other holders of large data to make it accessible to individual practitioners to support practice improvements.

Implementation

There is a lot of work to be done before the Professional Performance Framework is implemented. While many of the elements are in place already or only require fine tuning, others will require more substantial work. The Board is committed to working in partnership with the medical profession and others in the health sector to implement the Professional Performance Framework. It is also committed to ongoing consultation about the various elements.

To implement the Professional Performance Framework, the Board will:

1. Consult on and propose to Australia’s Health Ministers a revised registration standard for continuing professional development.
2. Consult on and propose to Australia’s Health Ministers a new health related registration standard to provide assurance that doctors can continue to provide safe care to patients throughout their working lives.
3. Strengthen its assessment and management of notifications to better manage medical practitioners subject to multiple substantiated complaints.
4. Work with stakeholders to develop and implement models for peer review of performance.
5. Commission clinical advice on what constitutes a practical and effective health check for doctors aged 70 years and over.
6. Commission ongoing research and evaluation to ensure this work is effective, evidence based and fair.
7. Foster partnerships and collaborations to promote a culture of medicine that is focused on patient safety, based on respect and encourages doctors to take care of their own health and well-being.

For more information

• Read the statement on Building a professional performance framework  (260 KB,PDF), Word version (140 KB,DOCX)
• Read a snapshot of the Pillars of the Professional Performance Framework  (106 KB,PDF), Word version  (87.3 KB,DOCX)
• Read the Final report of the Expert Advisory Group on revalidation  (1.50 MB,PDF), Word version (1.22 MB,DOCX)
• Read more on the Board’s website
• For media enquiries: (03) 8708 9200