'Virtually daily grief'-understanding distress in health practitioners involved in a regulatory complaints process: a qualitative study in Australia.

Protection of the public is the paramount aim for health practitioner regulation, yet there has been growing concern globally on the association between regulatory complaints processes and practitioner mental health and wellbeing. The objective was to understand the experience, particularly distress, of health practitioners involved in a regulatory complaints process to identify potential strategies to minimise future risk of distress. Semi-structured qualitative interviews were conducted with health practitioners in Australia who had recently been through a regulatory complaints process, together with a retrospective analysis of documentation relating to all identified cases of self-harm or suicide of health practitioners who were involved in such a process over 4 years. Data from interviews and the serious incident analysis found there were elements of the regulatory complaints process contributing to practitioner distress. These included poor communication, extended time to close the investigation, and the management of health-related concerns. The study found external personal circumstances and pre-existing conditions could put the practitioner at greater risk of distress. There were found to be key moments in the process-triggers-where the practitioner was at particular risk of severe distress. Strong support networks, both personal and professional, were found to be protective against distress. Through process improvements and, where appropriate, additional support for practitioners, we hope to further minimise the risk of practitioner distress and harm when involved in a regulatory complaints process. The findings also point to the need for improved partnerships between regulators and key stakeholders, such as legal defence organisations, indemnity providers, employers, and those with lived experience of complaints processes. Together they can improve the support for practitioners facing a complaint and address the stigma, shame, and fear associated with regulatory complaints processes. This project provides further evidence that a more compassionate approach to regulation has the potential to be better for all parties and, ultimately, the wider healthcare system.

Health practitioner regulation and national health goals.

The role of health practitioner regulation in ensuring patient safety is well recognized. Less recognized is the role of regulation in addressing broader health system priorities. These goals include managing the costs, capacities and distribution of health professional education institutions; ensuring the competence and equitable distribution of health workers; informing workforce planning and mobilization; enabling the use of digital technologies; and addressing challenges related to the international mobility of health workers. Even where health practitioner regulation is designed to advance these goals, important gaps exist between the potential of regulatory systems and their performance. The response to the coronavirus disease 2019 (COVID-19) pandemic led many countries to introduce regulatory changes to allow more flexibility and innovations in the mobilization of health practitioners. Building on this experience, we need to critically re-examine health practitioner regulatory systems to ensure that these systems support rather than impede progress towards national health goals. We discuss the role of health practitioner regulation in contemporary health systems, highlighting recent regulatory reforms in selected countries, including during the COVID-19 pandemic. We identify the importance of dynamic, effective and flexible health practitioner regulatory systems in progress towards universal health coverage and health security.

Le rôle qu'exerce la réglementation relative aux professionnels de la santé pour la sécurité du patient est bien connu. En revanche, celui qu'elle joue dans la définition des grandes priorités du système de santé l'est moins. Elle comporte ainsi plusieurs objectifs, notamment: assurer la gestion des coûts, des capacités et de la distribution des établissements de formation des professionnels de la santé; garantir une répartition équitable d'agents de santé compétents; guider la planification et la mobilisation de la main-d'œuvre; permettre l'intégration des technologies numériques; et enfin, relever les défis liés à la mobilité internationale des acteurs du secteur. Même dans les endroits où une telle réglementation est conçue pour atteindre ces objectifs, des écarts considérables subsistent entre le potentiel des systèmes de réglementation et leurs performances réelles. La lutte contre la pandémie de maladie à coronavirus 2019 (COVID-19) a encouragé de nombreux pays à modifier les règles en vigueur en vue d'offrir une plus grande flexibilité et davantage d'innovations en matière de mobilisation des agents de santé. En nous fondant sur cette expérience, nous devons impérativement réexaminer les systèmes de réglementation propres aux praticiens afin qu'ils constituent un moteur, et non un frein, à la poursuite des objectifs nationaux en matière de santé. Dans le présent document, nous évoquons le rôle de la réglementation relative aux professionnels de la santé dans les systèmes de santé actuels, en mentionnant les récentes réformes entreprises par une série de pays dans ce domaine, y compris durant la pandémie de COVID-19. Nous soulignons également l'importance d'instaurer des systèmes de réglementation dynamiques, efficaces et flexibles pour les praticiens sur la voie menant à la sécurité sanitaire et à une couverture sanitaire universelle.

La función de la reglamentación de los profesionales sanitarios para garantizar la seguridad de los pacientes es bien conocida. Sin embargo, se reconoce menos la función de la reglamentación para atender prioridades más amplias del sistema sanitario. Estos objetivos incluyen: gestionar los costes, las capacidades y la distribución de las instituciones de formación de profesionales sanitarios; asegurar la competencia y la distribución equitativa de los trabajadores sanitarios; informar la planificación y movilización del personal; permitir el uso de tecnologías digitales; y abordar los retos relacionados con la movilidad internacional de los trabajadores sanitarios. Incluso en los casos en que la reglamentación de los profesionales sanitarios está concebida para promover estos objetivos, existen diferencias considerables entre el potencial de los sistemas de reglamentación y sus resultados. La respuesta a la pandemia de enfermedad por coronavirus de 2019 (COVID-19) llevó a muchos países a introducir cambios en la reglamentación para permitir una mayor flexibilidad e innovaciones en la movilización de los profesionales sanitarios. A partir de esta experiencia, es necesario volver a examinar de forma crítica los sistemas de reglamentación de los profesionales sanitarios para garantizar que estos sistemas apoyen y no impidan el progreso hacia los objetivos sanitarios nacionales. En este artículo se analiza la función de la reglamentación de los profesionales de la salud en los sistemas sanitarios contemporáneos y se destacan las recientes reformas reglamentarias introducidas en algunos países, en particular durante la pandemia de COVID-19. Asimismo, se destaca la importancia de que los sistemas de reglamentación de los profesionales sanitarios sean dinámicos, eficaces y flexibles para avanzar hacia la cobertura sanitaria universal y la seguridad sanitaria.

Preventing critical failure. Can routinely collected data be repurposed to predict avoidable patient harm? A quantitative descriptive study.

OBJECTIVES: To determine whether sharing of routinely collected health service performance data could have predicted a critical safety failure at an Australian maternity service. DESIGN: Observational quantitative descriptive study. SETTING: A public hospital maternity service in Victoria, Australia. DATA SOURCES: A public health service; the Victorian state health quality and safety office-Safer Care Victoria; the Health Complaints Commission; Victorian Managed Insurance Authority; Consultative Council on Obstetric and Paediatric Mortality and Morbidity; Paediatric Infant Perinatal Emergency Retrieval; Australian Health Practitioner Regulation Agency. MAIN OUTCOME MEASURES: Numbers and rates for events (activity, deaths, complaints, litigation, practitioner notifications). Correlation coefficients. RESULTS: Between 2000 and 2014 annual birth numbers at the index hospital more than doubled with no change in bed capacity, to be significantly busier than similar services as determined using an independent samples t-test (p<0.001). There were 36 newborn deaths, 11 of which were considered avoidable. Pearson correlations revealed a weak but significant relationship between number of births per birth suite room birth and perinatal mortality (r2 =0.18, p=0.003). Independent samples t-tests demonstrated that the rates of emergency neonatal and perinatal transfer were both significantly lower than similar services (both p<0.001). Direct-to-service patient complaints increased ahead of recognised excess perinatal mortality. CONCLUSION: While clinical activity data and direct-to-service patient complaints appear to offer promise as potential predictors of health service stress, complaints to regulators and medicolegal activity are less promising as predictors of system failure. Significant changes to how all data are handled would be required to progress such an approach to predicting health service failure.

Eyes and Ears on Patient Safety: Sources of Notifications About the Health, Performance, and Conduct of Health Practitioners.

OBJECTIVE: The aim of the study was to describe the sources of notifications of concern ("notifications") regarding the health, performance, and conduct of health practitioners from 14 registered professions in Australia. METHODS: This retrospective cohort study analyzed 43,256 notifications lodged with the Australian Health Practitioner Regulation Agency and the Health Professional Councils Authority between 2011 and 2016. We used descriptive statistical analysis to describe the characteristics of these notifications, including their source, issue and domain, and subject. RESULTS: Patients and their relatives lodged more than three-quarters (78%) of notifications regarding clinical performance, including diagnosis, treatment, and communication. Fellow practitioners were a common source of notifications about advertising and titles. Self-reports commonly related to health impairments, such as mental illness or substance use. Other agencies played a role in reporting concerns about prescribing or supply of medicines. CONCLUSIONS: Various actors in the healthcare system play different roles in sketching the picture of healthcare quality and safety that notifications present to regulators. Improved understanding of which sources are most likely to raise which concerns may enhance regulators' ability to identify and respond to patient safety risks.

A step towards evidence-based regulation of health practitioners.

In 2010 Australia established a national registration and accreditation scheme, covering more than 620 000 health practitioners. The data held by the Australian Health Practitioner Regulation Agency is a remarkable platform for research aimed at improving health practitioner regulation, health care quality and workforce planning.

Establishing a global learning community for incident-reporting systems.

BACKGROUND: Incident-reporting systems (IRS) collect snapshots of hazards, mistakes and system failures occurring in healthcare. These data repositories are a cornerstone of patient safety improvement. Compared with systems in other high-risk industries, healthcare IRS are fragmented and isolated, and have not established best practices for implementation and utilisation. DISCUSSION: Patient safety experts from eight countries convened in 2008 to establish a global community to advance the science of learning from mistakes. This convenience sample of experts all had experience managing large incident-reporting systems. This article offers guidance through a presentation of expert discussions about methods to identify, analyse and prioritise incidents, mitigate hazards and evaluate risk reduction.

The harm susceptibility model: a method to prioritise risks identified in patient safety reporting systems.

BACKGROUND: Medical errors are endemic in healthcare. Patient safety reporting systems (PSRSs) have been developed and implemented to identify and reduce medical errors. Although they have succeeded in identifying errors (over 1 million reports in the NHS), there are limited methods by which to analyse this large number of events. METHODS: Adapting the safety theory of risk resiliency, the authors developed the Harm Susceptibility Model (HSM) as a method of quantifying the variation in risk of harm within an organisation and the Harm Susceptibility Ratio (HSR) as a statistic to compare and rank harm across trusts or work areas. The HSM was applied to data from 20 trusts reporting events to the National Reporting and Learning System (NRLS) between 2004 and 2006. FINDINGS: A total of 104,74 incident reports from 12 distinct work areas were analysed. Fifty-five per cent of the variation in harm was attributed to differences among trusts, suggesting that HSR would best be used within trusts. Within a specific trust, the HSR ranged from 0.25 to 4.30, with the pharmacy having the highest HSR (4.30, 1.89 to 9.68). The A&E, therapy department and radiology had the highest probability of a high HSR across the majority of trusts. INTERPRETATION: The HSM can be used to analyse a large number of incident reports from PSRSs. It provides a quantifiable way for organisations to identify areas where defences against errors are weak and prioritise limited resources directed at improving patient safety.

Towards an International Classification for Patient Safety: the conceptual framework.

Global advances in patient safety have been hampered by the lack of a uniform classification of patient safety concepts. This is a significant barrier to developing strategies to reduce risk, performing evidence-based research and evaluating existing healthcare policies relevant to patient safety. Since 2005, the World Health Organization's World Alliance for Patient Safety has undertaken the Project to Develop an International Classification for Patient Safety (ICPS) to devise a classification which transforms patient safety information collected from disparate systems into a common format to facilitate aggregation, analysis and learning across disciplines, borders and time. A drafting group, comprised of experts from the fields of patient safety, classification theory, health informatics, consumer/patient advocacy, law and medicine, identified and defined key patient safety concepts and developed an internationally agreed conceptual framework for the ICPS based upon existing patient safety classifications. The conceptual framework was iteratively improved through technical expert meetings and a two-stage web-based modified Delphi survey of over 250 international experts. This work culminated in a conceptual framework consisting of ten high level classes: incident type, patient outcomes, patient characteristics, incident characteristics, contributing factors/hazards, organizational outcomes, detection, mitigating factors, ameliorating actions and actions taken to reduce risk. While the framework for the ICPS is in place, several challenges remain. Concepts need to be defined, guidance for using the classification needs to be provided, and further real-world testing needs to occur to progressively refine the ICPS to ensure it is fit for purpose.

The WHO World Alliance for Patient Safety: towards the years of living less dangerously.

Improving the safety of patient care is now a global issue. In 2004, the World Health Assembly supported the creation of the World Alliance for Patient Safety to coordinate, spread and accelerate improvements in patient safety internationally. Australia has been at the forefront of international work on patient safety and is working closely with the World Alliance. The World Alliance is taking forward work in six main action areas: Patients for Patient Safety; Reporting and Learning; Taxonomy; Solutions; Research; and Global Patient Safety Challenge. Despite differences in context, there are many common challenges for countries seeking to establish patient safety programs and initiatives. Looking forward, long-term action on patient safety must be built and sustained with the commitment of policy makers and the active engagement of health care professionals.