Promoting Good Medical Care

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Promoting GoodMedical Care
Brussels, 21st May 2005
Edwin Bormanedwin_at_borman.demon.co.uk
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What well be covering

• Professionalism challenges to it
• PGMC as Quality Assurance
• The QA cycle re-defined
• The UEMS model
• Towards a new professionalism

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Professionalism
re-interpreted

• Knowledge
• Altruism
• Commitment
• Autonomy
• Ethos
• Trust earned
• Professionalism

• Jargon and secrecy
• Paternalism
• Questioned
• Unaccountable
• Exploitation
• Trust threatened
• Protectionism

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The Quality Agenda
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Definitions

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

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Performance accountability

• Every doctor, on a regular basis,
• should be able to demonstrate
• their continuing fitness to practise

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The Quality Assurance cycle
Setting Standards
Monitoring Performance
Introducing Improvements
Reviewing Results
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Setting standards

• Should be
• medically-led
• evidence-based
• derived by consensus
• Must be context-sensitive

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Monitoring performance

• Methods may vary but must
• reflect valid outcomes
• be sufficiently accurate
• have confidence of all groups
• Confidentiality of data is essential

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Influences on outcomes

• Individual case-mix, specialisation
• Collective team contribution
• Global resources, environment
• These cant always be corrected for

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The UEMS model

• Based on the QA cycle
• Monitoring all tiers of healthcare
• As inclusive as possible
• Itself subject to regular review
• Developmental interventions

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The work environment

• External audit by peer review
• visitation programmes
• trained specialist assessors
• working to defined standards
• producing developmental reports

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The healthcare team

• Internal clinical audit
• emphasis on collective outcomes
• and on good communication
• Must have external review
• external audit by peers

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The individual doctor

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

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Medically led accountability
Monitoring all functional tiers
Assessing valid outcomes
Learning from or assisting outliers
Developmental interventions
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Risk management

• Confidential incident reporting
• No-blame culture
• Its better to know of problems, learn from them
  stop them repeating

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The need for resources

• Time People Money
• Information Technology
• A protected, accountable, budget
• Ultimately the patient pays

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Revalidation
with compulsion
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Compulsory systems

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

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Promoting GoodMedical Care
Towards a new professionalism
Edwin Bormanedwin_at_borman.demon.co.uk