Speech: International Physician Assessment Coalition (IPAC) conference

E aku rangatira, tēnā koutou katoa. Ka nui te honore ki te mihi ki a koutou.

Thank you for inviting me to join you this afternoon.  I am told that New Zealand hosted the first IPAC Conference in 2001 and played host again in 2006, with both held in Wellington.  Being a South Islander, I am pleased that this year’s Conference has moved south to Queenstown.

I would like to start by acknowledging the Medical Council of New Zealand, including the Chair, Dr John Adams, and IPAC, including the Chair, Professor Pauline McAvoy, for putting together this year’s Conference.

Welcome also to your keynote speaker, Dr Julian Archer, and guest speaker, Professor Ron Paterson.  It would be difficult to find two speakers more suited to the theme of this year’s Conference. 

And finally I would like to welcome everyone here today, particularly the international representatives of responsible authorities and assessment agencies.  I trust you will find the Conference stimulating and thought provoking.

Today I would like to begin by talking about doctors as individual practitioners and as a profession.  Then I will talk about some of the initiatives New Zealand is implementing that are improving patient safety.  My Ministerial responsibilities include quality and safety, which rely on both practitioners and systems.  The two are intertwined and should support each other.

When we go to a doctor, whether within or outside a hospital, we all want to be sure that we will get high quality and safe care. 

With the movement of doctors around the world, we all need to take an interest in the quality of doctors internationally.  Around 42 percent of New Zealand’s medical workforce trained overseas.  We therefore need to know how other countries train and assess the ongoing competency of their doctors. 

With a common interest in the ongoing competency of doctors, we also need to take advantage of opportunities such as this Conference to share information about what works best in evaluating the performance of individual practitioners.

A widely held view is that 1-2 percent of current doctors are not practising at an acceptable level.  Some believe it may be as high as 5 percent.  In New Zealand, this means up to 600 doctors may be performing below an acceptable standard.  I hope you will agree that this is too many, particularly if you are the patient or the family of a patient who is harmed as a result of incompetence or poor performance. 

The difficulty, of course, is how should a doctor’s performance be assessed?  There are a myriad of questions to be debated.

• How often should we assess doctors?
• What aspects of performance can we measure?
• What about the aspects of performance that are not easily measured?
• Who should get to comment on a doctor’s performance – other doctors?  Managers?  Patients and their families?
• Whose opinion should carry the most weight?
• Should we be working more closely with patients and their families to understand doctors’ performance through their eyes?
• What should we do with the results, particularly when performance is shown to be less than ideal? 
• How do we evaluate our assessment model to make sure it continues to do what we want it to?

Dr Julian Archer and Professor Ron Paterson have pondered these types of questions for a number of years. 

Doctors also need to consider their responsibility to notify an employer or the responsible authority with concerns about a colleague’s competence or performance.  Australia’s Health Practitioner Regulation National Law 2009 includes a mandatory duty to report competence concerns. 

In New Zealand, the Medical Council encourages and gives guidance on how to report competence concerns about a colleague.  The Health Practitioners Competence Assurance Act states that a practitioner may inform the responsible authority of concerns about a colleague’s competence, but reporting is not mandatory. 

Is it time for another discussion amongst yourselves about this?

The health environment and its workforce are continually changing and the regulators of our health practitioners must adapt to ensure that quality and safety is maintained among health practitioners. 

An example of adapting to change is the Medical Council’s introduction of a recertification programme for doctors registered in a general scope of practice.  Recertification recognises that, these days, doctors may choose to spend more years registered in a general scope of practice before moving to a vocational training programme. 

Routine performance assessments are valuable, and the Medical Council has a process for routine assessment of doctors.  They can help identify any problems and deal with them early to reduce the likelihood of risk to public safety. 

Good routine performance assessments should reduce the need for performance assessments in response to specific complaints.  But there may be other performance review triggers that regulators should consider. 

I hope I am not encroaching on Professor Paterson’s talk by mentioning such things as assessing potentially ‘at risk’ practitioners through monitoring for prescription and referral rates that are outside the norm. 

The important point to remember in all this though, is that the goal of practitioner performance assessment is to protect the public. 

In our health and disability system, we have people with extensive knowledge, skills and commitment who are already working together to deliver excellent patient care.  But patients are still being harmed, sometimes with serious and long-term consequences. 

Protecting the public is about individual practitioners and about systems that support and facilitate quality and safety in our health service.  Individuals and systems, working together, are critical to providing quality and safety in health care. 

In May this year, I was delighted to launch New Zealand’s national patient safety campaign, Open for better care.  Led by the Health Quality & Safety Commission, the campaign focuses on four key areas where evidence shows it is possible to reduce patient harm – falls, health care associated infections, surgery and medication.

Evidence shows that up to 10 percent of people admitted to hospital acquire an infection, and many of these are likely to remain in hospital longer and have a longer recovery time. Medication errors made up five percent of serious harm reported by DHBs in 2011/12.  And between 2005 and 2010, a total of 205 claims for retained instruments or wrong site surgery were accepted in New Zealand. 

The Open for better care campaign challenges all health care workers to acknowledge mistakes, seeing them as an opportunity to learn, change and improve.

Improvements can be quite simple and include just about every health worker.  Take hand hygiene for example.  The most recent results from Hand Hygiene New Zealand show that DHBs nationwide are improving hand hygiene rates, and infection rates are falling.  From June 2012 to June 2013, compliance with the hand hygiene programme in New Zealand has risen from 62 percent to 70 percent.

Nowadays, people expect to make choices for themselves and they expect information to be easily available.  This includes information about their health system and health practitioners. 

That is why one of the ways the impact of the Open for better care campaign will be measured is against quality and safety markers.  The markers include:

• 90 percent of older patients are given a falls risk assessment
• 90 percent compliance with procedures for inserting central line catheters
• 70 percent compliance with good hand hygiene practice
• All three parts of the World Health Organization surgical safety checklist used in 90 percent of operations.

Options for the medication safety marker are being discussed at the moment.

The first report of DHB performance against the markers was published in June of this year, and from December progress will be reported publicly on a quarterly basis.  The success of the Government’s National Health Targets has demonstrated the effectiveness of regular public reporting in encouraging positive change in the health sector and improving the public’s confidence in our health system.

Many of you will have read The Good Doctor: What Patients Want, and know that Professor Paterson maintains that medical regulators need to become much more outward looking, providing clear information to the public about the steps being taken to promote patient safety and ensure doctors remain competent. 

I know that, in New Zealand, the Medical Council, and other responsible authorities, have been grappling with this issue.  It is certainly an aspect worth keeping in mind throughout the Conference.

I’ve talked today about quality and safety in our health service, and the roles individuals and systems play in achieving quality and safety.  I’ve also talked about the need to assess individuals and systems to ensure quality and safety is maintained across time. 

It doesn’t stop there – we also need to evaluate the effectiveness of the ways we assess individuals and systems.  Your conference is addressing a critical part of that evaluation loop. 

The other challenge we need to confront is that our attention to quality and safety should not just be focussed on DHB-run facilities, but should shine a light across the entire health care sector.

And on that final note, I wish you all a successful Conference and hope you enjoy your time in Queenstown. 

Nō reira, tēnā koutou, tēnā koutou, tēnā koutou katoa.