Knowledge is Power Enhancing Patient Care through Competence Assessment & Education Bill O’Neill Director, Communications and Outreach CPEP The Center for Personalized Education for Physicians

Learning Objectives Identify red flags or practice patterns that can be early indicators of poor or declining performance Determine the best approaches to finding a solution Implement processes or identify resources to support effective remediation while protecting patient safety Disclosure Speaker works for a non-profit in the competence assessment field CE Information

Invisible when they do their job well Front page news when a physician makes an error Often THE continuity source in management of physician performance Medical Staff Services Professionals are…

What does the literature say? U.S. study estimated that 6 – 12% of physicians were dyscompetent 1 Canadian study of randomly selected physicians found 15% of FPs and 3% of specialists were practicing with considerable deficiencies 2,3 Underperforming Physicians 1) J Contin Educ Health Prof Summer;26(3): ) CMAJ. 1990;143:1193–1199 2) Healthc Policy. 2009;42:141–160

Focus on patient safety and quality Expectation that physicians be held accountable for quality of care Risk of negligent credentialing Employed physicians Increasing liability risk for hospitals Quality concerns with newly acquired practices Healthcare provider shortage Need to retain doctors on staff FPPE/OPPE processes Use of performance data to evaluate performance and identify outliers Increasing Attention on Physician Quality

Significant patient harm Multiple patient/staff complaints Questions about procedural skills/decisions Fitness for duty (following health issue) Returning to practice after absence Outside chart review identifies concerns Alarm Bells

Peer review relied on primarily patient or staff complaints Processes were variable Objectivity was difficult “He’s ok, I play golf with him every Wednesday” Times are changing - Before…

“Peer monitoring and reporting are the primary mechanisms for identifying physicians who are impaired or otherwise incompetent to practice, but data suggest that the rate of such reporting is lower than it should be.” “… however, when faced with these situations, many do not report.” 17% (309) of physicians reported direct personal knowledge of a physician colleague who was incompetent to practice 33% of those failed to report their colleague Challenges to Self-Regulation Physicians’ perceptions, preparedness for reporting, and experiences relating to impaired and incompetent colleagues.. DesRoches, et al., JAMA. 2010;304(2):

Implementing improved systems Software systems compare physicians to peers or national data sets Skills training available for physician leaders Progressive levels of feedback and intervention becoming more common Peer review increasingly presented as an educational process rather than punitive one Times are Changing - Today…

Common Model of Reporting Reported Event, e.g., Patient complaint Post-op infection Readmission <30 days Patient mortality Medical QI Committee Looks for possible trends Conducts root-cause analysis Peer Review Committee Conducts deeper review of the case Care found appropriate No further action Medical Executive Committee Care found appropriate? Restriction of privileges? Referral to CPEP or other resource? Termination/Suspension

Importance of Early Intervention If addressed early and effectively Win-win situation for physician, medical staff and patients If overlooked too long Possibility of significant patient harm Damaged relationships on staff Legal consequences for hospital and physician

Resources for Intervention FPPE process Proctoring; chart reviews; consultations External peer review or consultant visit Health program evaluation Voluntary remedial agreement (formal or informal) Self-education plan Research/report Specific CME courses Formal competence assessment/remedial education program

Resource Helps get Physicians Back on Track RESTORE physicians to safe clinical practice RETAIN physicians on your staff Help physicians R EENTER practice after an absence Goals of Competence Assessment & Education

Self referral As part of credentialing process As part of a voluntary remedial agreement In anticipation of pending hospital review/investigation As a provision of a disciplinary agreement Prior to restoration of privileges When to Consider an Assessment

“Global” Nature of Assessments Neuro-cognitive Screen Simulated Patient Encounters Structured Clinical Interviews NBME Exams Procedure Simulations EKG or Fetal Monitor Exam

Objective, third-party assessment removes even the perception of bias Comprehensive assessment and report provide greater insight than chart reviews alone Report can lead to an educational plan that can bring the participant back to safe, confident practice Benefits of External Assessment

Assessments & Educational Interventions 1)Conduct comprehensive clinical competence assessment 2)Design and implement educational intervention 3)Determine effectiveness 1) Diagnosis2) Treatment3) Post-test

Educational Intervention Activities, intensity and length Determined by areas of educational need Impacted by participant motivation Focus on application of knowledge to actual practice Measurable performance objectives Goal: Achieve and sustain improvements in practice CPEP, The Center for Personalized Education Assessment and Educational Intervention Program

Common elements of an educational plan include Medical Knowledge Enhancement Evidence-based self study Structured CME courses/activities Point of Care Experience May begin with direct supervision by preceptor Progress through decreasing levels of supervision Ultimately caring for patients independently Pace of progress depends upon participant performance Educational Plan Components

Competence Assessment Programs Provide objective information to reach decisions about physician competence Identify solutions to effectively remediate competence concerns Focus on application of knowledge to practice and sustained improvement in care Impact

“[Program] provides experienced people to do a deep dive to figure out what is really going on with a physician… we are not going to find a colleague with the expertise or time to provide that kind of information.” “We use these programs with the hope of saving a career and keeping a physician in our community…” Lynn Stockton, Director, Medical Staff Services Medical Center of Aurora Value of Assessment Programs

FSMB Clinical Competence Assessment Resources FSMB Directory of Physician Assessment and Remedial Education Programs Coalition for Physician Enhancement Competence Assessment Resources

Who’s got questions? CPEP 222 North Person Street Raleigh, NC Thank You!!