Continuing Professional Development of Health Professionals & Patient Safety 28 October 2016 Caroline Hager Team Leader Cross Border Cooperation Healthcare European Commission Health and Food Safety Directorate-General

Patient safety high on EU agenda: 2009 EU health ministers adopt Council conclusion on patient safety and quality of care, June 2014 European Parliament report on safer healthcare, April 2015 Council Recommendation on patient safety, 2009 2014 2015

Recognition of Professional Qualifications Directive & CPD Under the PQD Directive, Member States are required to: Ensure that professionals update knowledge, skills and competences to maintain safe and effective practice and to keep abreast of professional developments. (Article 22) Report measures to the European Commission by January 2016 Exchange information and best practice to ‘optimise’ CPD development – role of the Group of Coordinators

Mapping national approaches to CPD of health professions – January 2015 Comprehensive & comparative overview of CPD for health professionals in 31 European countries Share good practice & facilitate a discussion: policy-makers, regulatory and professional bodies

- Financing and transparency - Barriers and incentives EU Mapping Study on CPD - CPD systems - Accreditation - Financing and transparency - Barriers and incentives - Patient safety and quality of care - Trends in CPD structures - European cooperation

4 CPD systems in the EU CPD is mandatory for all professionals practising in a country. This is the most common situation for most health professions in most countries surveyed. a voluntary CPD framework is in place a voluntary CPD framework may in addition co-exist with a mandatory CPD requirement No formal CPD structures exist . This is the least common situation NOTE: Marked differences across the professions

CPD – Linked to licence review

CPD Systems - Conclusions There is no evidence that one CPD structure is preferable to another Mandatory and voluntary CPD encompass many different arrangements Formal and informal CPD activities co-exist

CPD and Patient Safety Very few studies, so lack of evidence on the impact of CPD on patient safety, care outcomes, clinical and professional practice. Out of 150 respondents to study survey, only 6 were able to share such studies. CPD activities on patient safety are available to professionals, but mandatory content only in a minority of cases. 15 countries had a formal requirement to include patient safety modules in one or more types of education. However, offer of CPD activities on patient safety seems to be increasing.

Recommendations CPD & Patient Safety Exchange of best practice should be further supported – European cooperation should facilitate this. Further research at European level on the impact of CPD activities on patient outcomes and patient safety should be undertaken. Prioritise areas in CPD training where a clear patient safety issue has been identified such as the use of new technologies or recorded incidents of patient harm. Patient safety should be embedded within the basic education of health professionals and be part of the working culture and environment. Employers have an important role to play

Ticking the Boxes or Improving Healthcare? – Workshop 11 February 2016 What can we learn from research evidence, education and clinical practice? What can we learn from national CPD models – England, Ireland, Sweden, France

What can we learn from research evidence, education and clinical practice? measuring the effectiveness of CPD difficult to capture CPD credits – no evidence of effectiveness contextual variables need to be taken into account evaluation of learning outcomes must focus on professional performance in real clinical practice Audit and feedback → performance improvement CPD activities may need to be prescribed: structured peer-to-peer dialogue or coaching can improve performance Challenging for the regulators! How to measure CPD effectively? Evidence-based outcome research – lack of scientific evidence (Cochrane), but still! We need Parameters to measure → quantifiable components

What can we learn from research evidence, education and clinical practice? Inter-professional education, multidisciplinary cooperation, coordinated care plan, improve communication, reduced risk, better care quality Self-assessment tool: Interprofessional Practice and Education Quality Scales Belgian intervention study in ICU System change to overcome professional resistance IPE requires a system change to breakdown the barriers to IPE learning, overcome strong professional resistance and fears over loss of professional identity. A short-term intervention study in a Flemish intensive care unit showed that high staff satisfaction and better communication through interprofessional collaborative practice led to a higher quality outcome, reducing the risk of errors and improving patient safety

What can we learn from research evidence, education and clinical practice? Jeroen Bosch Hospital, Netherlands new nursing leadership programme for continuous education for nurses → shared organizational vision + multiprofessional working context Spanish “Zero project” reduce hospital infections in intensive care units training module for doctors & nurses → decreased incidents NL outcome: They changed their behavior! Spanish training module explaining the clinical recommendations and patient safety guidelines, targeted three areas “bactermia zero”, “neumonia zero” and “resistencia zero”.

What can we learn from national CPD models? England New system of revalidation of the nurses’ licences Key success factor: Regulators work in partnership with the health professionals Ireland New system of revalidation for pharmacists Key success factor: partnership between the regulated and regulator The system aims to promote the integrity of nurses: nurses and midwives need to demonstrate that they are abiding by the Professional Code of Practice and Behaviour and that they undertake at least 35 hours of CPD every three years in order to re-register. The key to an effective revalidation process is the regulator working with the nurses and midwives in their mutual interest.

What can we learn from national CPD models? Sweden Creation of a learning environment to link professional development to better system performance & better patient outcomes Key success factor: collaboration of different actors participating the „development dialogue” France Reform CPD system: High Council of CPD to update knowledge, evaluation of professional practice & risk management Key success factor: Government working with national professional councils Support to improve patient safety and quality of care

Workshop Conclusions: Lessons Learned (1) Learning comes from the practice itself & no best method of learning to ensure better patient safety and quality of care. Measuring the impact of CPD should focus on real clinical performance, not on attitude and skills. The quality of the CPD programme is not the only factor for success. Difficult to find long-term indicators on improved patient outcomes by CPD due to the many dependent variables. Real success when professionals start using the learnt skills

Workshop Conclusions: Lessons Learned (2) Improving the patient safety culture depends on a range of factors – working environment, behavioural change Collaboration & shared organisational vision – success factors Revalidation links CPD hours with peer support, practice-related feedback & reflective process Real success when professionals start using the learnt skills

European Cooperation sharing expertise and knowledge to support national systems – "food for thought", inspiration and action European health professional organisations Social Dialogue in the hospital sector: European employer and trade unions Real success when professionals start using the learnt skills

For further information http://ec. europa