Understanding Risk: towards an evidence based approach to - PowerPoint PPT Presentation

www.gdc-uk.org www.gdc-uk.org Understanding Risk: towards an evidence based approach to regulatory policy development Claire Herbert & Guy Rubin General Dental Council IAMRA London 2014 11th INTERNATIONAL CONFERENCE ON MEDICAL REGULATION

www.gdc-uk.org Presentation content • Introduction • Policy Context • Understanding Risk • GDC Case Studies • Conclusion • Questions

www.gdc-uk.org Risk and regulation

www.gdc-uk.org i n dentistry….

www.gdc-uk.org Risk factors Human factors System Factors

www.gdc-uk.org Understanding risk • Risk – likelihood that a hazard will occur • Hazard – patient/public protection not maintained • Risk that Standards are not maintained e.g. impairment of practice • Risk Factors – variables that give rise to risk

Risk and regulation Regulatory Risk tools/ framework Evidence Risk base factors

www.gdc-uk.org Some questions for regulatory policy • What are the root causes, causal or contributing factors? • What are the precursors? E.g. pathway to risk • How can they be categorised? e.g. conduct, competence, context • Do the risks apply equally or differently across the register?

www.gdc-uk.org Patient safety and providing dental treatment directly to patients • Patients always seen by a dentist first • Treatment on dentist’s prescription • 2012 GDC review of “direct access” to dental patients • Consideration of patient risks

www.gdc-uk.org Literature Review The Literature Review considered: • Major impact factors, including risks and benefits of direct access • Evidence of increased risk to patients from introduction of direct access • Evidence that patients benefit from direct access

www.gdc-uk.org Findings • No evidence that widening direct access to dental care to Dental Care Professionals leads patients to be at greater risk of harm than is currently the case • Some evidence of benefits to patients – • access to dental services • limited evidence of at most modest cost savings to patients some • evidence of high patient satisfaction among dental hygienist and therapist patients • some evidence of higher relative satisfaction compared with dentists. • Some limited evidence of higher job satisfaction for dental professionals when working to their full remit and training

www.gdc-uk.org Implications for Regulation The GDC agreed direct access by dental care professionals in certain circumstances (set out in guidance) For those who do: • All registrants must be trained, competent and indemnified for any tasks they undertake. • All registrants must continue to work within their scope of practice regardless of these changes. • All registrants must continue to follow the GDC’s Standards for the Dental Team. Dental care professionals do not have to offer direct access and should not be made to

www.gdc-uk.org Transition to Independent dental practice What types of risk are there to patient safety in dentistry and other healthcare professions with new registrants, what are the reasons for them and how significant are they? How do the risks vary across the dental registrant categories and what are the reasons for this? What issues and risks are there with confidence, knowledge, competence and skills levels of new dental and other healthcare registrants over the four areas of clinical, communication, management and leadership, and professionalism. How may this vary and what are the reasons?

www.gdc-uk.org Findings (1) The literature specifically on risk posed by new registrants is limited and the studies that do exist are of moderate to low quality • No evidence of risk from analysis of dental or other regulators fitness to practice data • No comparative evidence found on how risk varies across groups and reasons for it • Few research studies on dental professionals trained overseas. Little evidence of risk

www.gdc-uk.org Findings (2) There are risk factors that could in some circumstances but potential risk factors Competence : extent of awareness of competence, tasks expected to undertake and the availability of support and guidance from more senior colleagues. Confidence: Some areas of low confidence and skill identified BUT: Supervision and support mechanisms: Education, training , supervision and support. Foundation/vocational Training for dentists – highly regarded and generally considered to be successful in moving the novice towards the status of a competent general practitioner

www.gdc-uk.org Implications for regulation The evidence has not identified clear risks to patient safety in relation to newly registered dentists or DCPs But unable to state categorically that such risks do not exist. Current evidence is simply not strong enough to support major regulatory change at this stage But • Further work to identify trends in different groups • Understanding the career paths of those joining the register. • Systematic monitoring of the different groups of registrants. • Further scrutiny of FtP data to establish if their are statistically significant trends. • Potential to benchmark against information from other regulators and professions • Longitudinal research to understand career paths of new registrants

www.gdc-uk.org Risk in Dentistry • Understanding risk in dental practice • Understanding common pathways to impairment • Feasibility of analysis of GDC Fitness to Practise data

www.gdc-uk.org Conceptual Framework of Risk COMPETENCE CONDUCT RISKS RISKS Factors Factors related to related to skills and behaviour knowledge CONTEXTUAL RISKS Environmental factors

www.gdc-uk.org Study 3 How is Performance Managed and Monitored Across Dentistry? Evaluation of Supporting Evidence Types for Revalidation Picker Institute Europe - October 2012

Phase 1: Website search and literature review Website searches Literature review Research questions RQ1. What are the types of evidence already used across dentistry to assess performance and quality of the practice of individual dentists? RQ2. What are the purposes of each evidence type?

Phase 2: Semi-structured interviews Purposive 18 key 8 practising samples to Lend DEPTH informants dentists maximise to study diversity Research questions RQ1. What are the types of evidence already used across dentistry to assess performance and quality of the practice of individual dentists? RQ2. What are the purposes of each evidence type? RQ3. What is the extent of consistency in application of evidence types and standardisation in format across the four countries of the UK and practice settings? RQ4. What contribution could they make to assessing practice in accordance with the GDC’s standards ? RQ5. What criteria could be used to evaluate compliance with GDC’s standards? RQ6. Could thresholds of (un)acceptable practice be identified and agreed?

Phase 3: Online surveys Survey 1: Survey 2: Lend dental dentists BREADTH organisations (n=499) to study (n=26) Research questions addressed (Potentially all) RQ3. What is the extent of consistency in application of evidence types and standardisation in format across the four countries of the UK and different practice settings ?

Conclusions • Large number of evidence sources in wide & variable use • Little consistency across countries • Little standardisation of implementation • Lack of evidence that participation in such activities is a valid or reliable indicator of good practice • Dentists working in many different settings so implementing a standardised approach challenging • Evidence used needs to be relevant to a dentist’s role

Application of evidence type by country Which of the following have you, or your practice, undertaken in the last year? (Registrant survey) .0% 20.0% 40.0% 60.0% 80.0% 100.0% CPD Clinical Audit Professional development planning Peer review Review of significant events Case-based discussion / assessment Complaints & compliments Multi-source (colleague) feedback Patient feedback England (n=171) Scotland (n=111) Wales (n=104) N.Ireland (n=93)

Recommendations The following evidence types have the potential to make a contribution to revalidation subject to certain conditions: • CPD • Clinical audit • Professional development planning • Review of significant events • Case-based discussion/assessment • Review of complaints and compliments • Multi-source feedback • Patient feedback • Evidence of activity

www.gdc-uk.org Risk and GDC policy development Outcomes - Proactive regulation: preventative as well as responsive Outputs – more concerns identified early and at source; fewer FTP cases; collaborative “regulation” Policy Actions – systems and processes for continuing assurance; targeted/dynamic standards and guidance; pre-registration education outcomes; information gathering

www.gdc-uk.org Questions for Discussion • What is the purpose of professional regulation in your context? • What part (if any) does risk play in your organisation’s approach to regulation? • What does risk mean in your context? • What approach do you take to identifying and understanding risk factors? • What are the benefits and challenges to undertaking this kind of analysis for regulatory policy? • What are the opportunities and challenges of sharing findings in this area, across professional and national boundaries?