1. Promoting Good Medical Care Brussels, 21st May 2005 Edwin Borman edwin@borman.demon.co.uk

2. What well be covering Professionalism & challenges to it PGMC as Quality Assurance The QA cycle re-defined The UEMS model Towards a new professionalism

3. Professionalism Knowledge Altruism Commitment Autonomy Ethos Trust earned Professionalism Jargon and secrecy Paternalism Questioned Unaccountable Exploitation Trust threatened Protectionism : re-interpreted

4. The Quality Agenda Quality improvement CPD Quality assurance A & A Quality control PR

5. Definitions Quality Assurance the regular review against defined standards of medical care Performance how a doctor applies, in practice, their knowledge, skills & attitudes

6. Performance accountability Every doctor, on a regular basis, should be able to demonstrate their continuing fitness to practise

7. The Quality Assurance cycle The QA cycle Introducing Improvements Reviewing Results Setting Standards Monitoring Performance The QA cycle

8. Setting standards Should be: medically-led evidence-based derived by consensus Must be context-sensitive

9. Monitoring performance Methods may vary but must… reflect valid outcomes be sufficiently accurate have confidence of all groups Confidentiality of data is essential

10. Influences on outcomes Individual:case-mix, specialisation Collective:team contribution Global:resources, environment These cant always be corrected for

11. The UEMS model Based on the QA cycle Monitoring all tiers of healthcare As inclusive as possible Itself subject to regular review Developmental interventions

12. The work environment External audit by peer review visitation programmes trained specialist assessors working to defined standards producing developmental reports

13. The healthcare team Internal clinical audit emphasis on collective outcomes and on good communication Must have external review external audit by peers

14. The individual doctor Must consider practice context Methods may vary, must be valid individual audit appraisal by peer surveys of patients/colleagues

15. Medically led accountability The QA cycle Learning from or assisting outliers Developmental interventions Monitoring all functional tiers Assessing valid outcomes The QA cycle

16. Risk management Confidential incident reporting No-blame culture Its better to know of problems, learn from them & stop them repeating

17. The need for resources TimePeopleMoney Information Technology A protected, accountable, budget Ultimately the patient pays…

18. COLLECT daily activity & CPD information Revalidation MAINTAIN MAINTAIN personal development plan DISCUSS APPRAISAL DISCUSS at annual APPRAISAL Identify development and other needs CONFIRMATION CONFIRMATION by Medical Director REFLECT REFLECT on information collected Practice & CPD information Appraisal summaries REVALIDATION evidence for REVALIDATION DECISION linked to doctors licence to practise DECISION by Revalidation group (every 5 years) linked to doctors licence to practise : with compulsion

19. Compulsory systems lack of evidence that demonstrates the additional effectiveness of mandatory systems inappropriate to focus on only one element of a multifactorial system

20. Promoting Good Medical Care Towards a new professionalism Edwin Borman edwin@borman.demon.co.uk