Association between Performance in a Maintenance of Certification Program and Disciplinary Actions against the Medical Licenses of Anesthesiologists.

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: In 2000, the American Board of Anesthesiology (Raleigh, North Carolina) began issuing time-limited certificates requiring renewal every 10 yr through a maintenance of certification program. This study investigated the association between performance in this program and disciplinary actions against medical licenses. METHODS: The incidence of postcertification prejudicial license actions was compared (1) between anesthesiologists certified between 1994 and 1999 (non-time-limited certificates not requiring maintenance of certification) and those certified between 2000 and 2005 (time-limited certificates requiring maintenance of certification); (2) within the non-time-limited cohort, between those who did and did not voluntarily participate in maintenance of certification; and (3) within the time-limited cohort, between those who did and did not complete maintenance of certification requirements within 10 yr. RESULTS: The cumulative incidence of license actions was 3.8% (587 of 15,486). The incidence did not significantly differ after time-limited certificates were introduced (hazard ratio = 1.15; 95% CI, 0.95 to 1.39; for non-time-limited cohort compared with time-limited cohort). In the non-time-limited cohort, 10% (n = 953) voluntarily participated in maintenance of certification. Maintenance of certification participation was associated with a lower incidence of license actions (hazard ratio = 0.60; 95% CI, 0.38 to 0.94). In the time-limited cohort, 90% (n = 5,329) completed maintenance of certification requirements within 10 yr of certificate issuance. Not completing maintenance of certification requirements (n = 588) was associated with a higher incidence of license actions (hazard ratio = 4.61; 95% CI, 3.27 to 6.51). CONCLUSIONS: These findings suggest that meeting maintenance of certification requirements is associated with a lower likelihood of being disciplined by a state licensing agency. The introduction of time-limited certificates in 2000 was not associated with a significant change in the rate of license actions.

Outcomes of notifications to health practitioner boards: a retrospective cohort study.

BACKGROUND: Medical boards and other practitioner boards aim to protect the public from unsafe practice. Previous research has examined disciplinary actions against doctors, but other professions (e.g., nurses and midwives, dentists, psychologists, pharmacists) remain understudied. We sought to describe the outcomes of notifications of concern regarding the health, performance, and conduct of health practitioners from ten professions in Australia and to identify factors associated with the imposition of restrictive actions. METHODS: We conducted a retrospective cohort study of all notifications lodged with the Australian Health Practitioner Regulation Agency over 24 months. Notifications were followed for 30-54 months. Our main outcome was restrictive actions, defined as decisions that imposed undertakings, conditions, or suspension or cancellation of registration. RESULTS: There were 8307 notifications. The notification rate was highest among doctors (IR = 29.0 per 1000 practitioner years) and dentists (IR = 41.4) and lowest among nurses and midwives (IR = 4.1). One in ten notifications resulted in restrictive action; fewer than one in 300 notifications resulted in suspension or cancellation of registration. Compared with notifications about clinical care, the odds of restrictive action were higher for notifications relating to health impairments (drug misuse, OR = 7.0; alcohol misuse, OR = 4.6; mental illness, OR = 4.1, physical or cognitive illness, OR = 3.7), unlawful prescribing or use of medications (OR = 2.1) and violation of sexual boundaries (OR = 1.7). The odds were higher where the report was made by another health practitioner (OR = 2.9) or employer (OR = 6.9) rather than a patient or relative. Nurses and midwives (OR = 1.8), psychologists (OR = 4.5), dentists (OR = 4.7), and other health practitioners (OR = 5.3) all had greater odds of being subject to restrictive actions than doctors. CONCLUSIONS: Restrictive actions are the strongest measures health practitioner boards can take to protect the public from harm and these actions can have profound effects on the livelihood, reputations and well-being of practitioners. In Australia, restrictive actions are rarely imposed and there is variation in their use depending on the source of the notification, the type of issue involved, and the profession of the practitioner.

It's time to rebrand progressive discipline to structured achievements.

The concept of progressive discipline has traditionally been communicated as a common way to address performance issues in the U. S. workforce. In practice, progressive discipline is all too often implemented as a negative, demoralizing process that leads--or is threatened to lead--to the termination of employment. This article challenges a change in the way progressive discipline is managed and communicated from a negative, threatening perspective to one that involves a series of structured achievements that are effective in helping employees meet or exceed the requirements of the job.

What to do if you are referred to the NMC.

If you are subject to an investigation by a professional regulator, you need to be informed about the process and act quickly. This article outlines the process and offers some advice on how best to navigate it.

Fostering collaboration in the medical practice: twenty-five tips.

It's a given that collaboration is an important aspect of medical practice management. But achieving genuine collaboration among the members of your medical practice team may not be as simple as it seems. This article suggests 25 practical strategies for medical practice employees and their managers to help them create and foster collaboration in their medical practices. Tips for collaborative goal setting, communication, ground rules, task delineation, sustainability, problem solving, and anticipating and handling problems are all described. In addition, this article offers a four-step strategy for dealing with a domineering collaborator and a five-step strategy for dealing with a collaboration slacker. This article also includes a 20-question self-quiz to help you and your employees evaluate your collaborative work style. Finally, this article describes 10 common collaboration pitfalls and the strategies you and your staff can use to avoid falling victim to them.

Remediation: a necessary function for employers to correct incompetence regarding clinical professional registered nurse practice.

Remediation for the professional licensed registered nurse is a topic sparsely written about in the nursing literature. The provision of remediation, however, is a common tool used to address registered nurse practice issues. This article seeks to describe the various stakeholders' roles in remediation and recommends that nurses in management roles should ensure the provision of remediation for registered nurses when warranted.

Are we treating professionalism professionally? Medical school behavior as predictors of future outcomes.

BACKGROUND: Seminal papers on medical professionalism demonstrate a link between medical school behavior and future disciplinary action by medical boards. Other groups have studied whether negative comments on a student's Dean's letter predict problems as residents. Various groups have tried to provide concrete examples of professionalism, including a number of offenses of questionable demerit, such as taking food from a talk that one ultimately does not attend, or criticizing the internal medicine residency curriculum for being overly focused on inpatient medicine at the exclusion of outpatient medicine. SUMMARY: The seminal studies linking professionalism to future board disciplinary action are reviewed here. Overwhelmingly, the studies demonstrate weak associations with little predictive power. Thus, professionalism scores are much more likely to wrongfully cast doubt on ultimately un-censured physicians than they are to identify problem ones. Additionally, the body of literature identifying concrete examples of unprofessional conduct is growing. Such papers stretch the definition of professionalism to include acts of dubious wrongdoing, and thus, misinterpreted, may lead to false conclusions, e.g., taking food from a talk one is not attending is a predictor of board disciplinary action. A central challenge with professionalism is identified here. If professionalism is used both as a tool to evaluate students, and a competency to be taught, a tension arises. Some professional activities, such as witnessing error and self-regulation, inherently involve speaking up. However, if students are penalized for vague and subjective ideas of professionalism, are we deterring this important trait? Current directions in professionalism education and assessment are in need of clarification. CONCLUSIONS: The link between medical school behavior and future conduct is weak. The use of such factors in promotion decisions is more likely to be arbitrary and unfair rather than genuinely identify problem physicians. There is a core tension between teaching and evaluating professionalism. What counts as professionalism is in need of definition and meaningful validation.

Just culture-changing the environment of healthcare delivery.

Although errors cannot be totally eliminated, they can be reduced by adopting a system of accountability that requires employees to self-report errors in the interest of patient safety. Traditional laboratory accountability systems are based on a culture of blame, focusing on punishing individuals, and with little emphasis on learning lessons from the errors. Under a just culture laboratory accountability system, if factors in the environment or process contributed to an error, the individual should not be punished. Rather, they and the system can both identify improvements for processes so that this type of error does not reoccur. Using this approach, laboratory services can be made safer for current and future patients.

Managing problem employees: a model program and practical guide.

This article presents a model program for managing problem employees that includes a description ofthe basic types of problem employees and employee problems, as well as practical recommendations for. (1) selection and screening, (2) education and training, (3) coaching and counseling, (4) discipline, (5) psychological fitness-for-duty evaluations, (6) mental health services, (7) termination, and (8) leadership and administrative strategies. Throughout, the emphasis on balancing the need for order and productivity in the workplace with fairness and concern for employee health and well-being.

Does the risk of reprisal prevent nurses blowing the whistle on bad practice?

BACKGROUND: Despite the introduction of legislation to protect people who report poor or unsafe practice, whistleblowing can still have serious consequences for nurses. AIM: To review the literature on whistleblowing in healthcare, and explore the barriers to reporting poor practice. METHOD: Studies focusing on whistleblowing in healthcare were used to assess the safety of incident reporting, and to determine what prevented nurses from reporting poor practice. RESULTS: Four major themes were identified as the main barriers to whistleblowing in healthcare: experience of the nurse; confidentiality and reporting processes; incident severity; and personal beliefs. CONCLUSION: Reprisal for whistleblowing remains a major concern for nurses. Patient safety could be improved by prioritising confidentiality and creating an environment where nurses feel safe to report poor practice.

From blaming to proactively changing the future: the leader's safety challenge.

Simplifying to the point of blaming limits learning and the ability to prevent similar occurrences in the future. Often, the characteristics of the blame culture are very subtle and what appears to be valuable work is actually a subtle sign of the blame game. Leaders must change the language to a proactive, future preventative state rather than focusing on the past and looking for single causes of events. Many nurses have left their positions because they have chosen not to work in a culture of blame. Eliminating all forms of blame is essential for excellence in patient care outcomes and loyalty of staff.

Using a mock board of pharmacy disciplinary hearing to teach concepts related to administrative law, addiction, empathy, and professionalism.

BACKGROUND AND PURPOSE: The purpose of this project was to impact pharmacy students' personal and professional development through simulation of a board of pharmacy disciplinary hearing regarding addiction. EDUCATIONAL ACTIVITY AND SETTING: The mock board hearing was conducted as part of the required curriculum. Faculty obtained materials from a prior board hearing. The actual respondent, lawyer, former executive director, and a board agent participated. Students served as board members and president, asked questions of the witnesses, and deliberated per board procedure. After the event, student learning and perceptions were assessed through knowledge-based, opinion-based questions, and open-ended questions. FINDINGS: Of the 141 students who attended the event, 97% completed the assessment. The average score on the knowledge-based questions was 95%. Ratings of perceptions and reflections of the experience were used in tandem to understand the experience. In general, students indicated the experience was positive and impactful towards their education. Students indicated they felt that the experience allowed them to better understand addiction and empathize with someone called before the board. In fact, there were fundamental differences in perceptions regarding the "addicted person," going from a penalizing and stigmatized perspective to one of caring and compassion. SUMMARY: Students were knowledgeable about the board and its regulatory process after the event. More than knowledge, students indicated fundamental changes in their views of addiction. Other institutions may consider implementing similar exercises to engender empathy and professionalism regarding drug addiction and regulatory compliance.

Counseling: establishing a culture of forgiveness.

Counseling "problem employees" can be a painful experience for everyone involved. The counseling process often fails because forgiveness is not a part of organizational culture in the United States. This author stresses the need for a forgiveness plan that will enable employees to recommit to their jobs