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Warmerdam BWCM, van der Vorst JR, van Schaik J, Hamming JF. Lessons learned from Dutch medical disciplinary law regarding aortic aneurysm and dissection care. Ann Vasc Surg 2024:S0890-5096(24)00393-5. [PMID: 39009120 DOI: 10.1016/j.avsg.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES The current study is an explanatory analysis of Dutch disciplinary law regarding aortic aneurysm and aortic dissection care. We aim to give insight in the way disciplinary judges rule on quality of care and to extract the lessons to be learned. METHODS The online open-access governmental database, which includes all disciplinary rulings since 2010, was searched using search terms related to aortic aneurysm and dissection care. First, abstracts were screened for relevance. Thereafter, the full text of all remaining cases was read. Cases related to the diagnosis, treatment, or the postoperative phase of an aortic aneurysm or aortic dissection were included. Characteristics were registered and analyzed for quantitative assessment. Each case was summarized and coded for qualitative analysis. RESULTS Forty-eight first-instance cases were included, of which 19 (40%) were founded. Reprimands (n=9) and warnings (n=7) were the prevailing measures. Seven out of 8 appeal cases filed by plaintiffs were unfounded. Six out of 9 appeals filed by defendants were adjudged and led to a less severe measure. Most cases concerned the subject of 'wrong treatment/wrong diagnosis' (75%). Whether not recognizing an aneurysm or dissection led to disciplinary culpability depended on case-specific circumstances, and much importance was attached to adequate documentation. In many complaints, an element of inadequate communication was recognized. CONCLUSIONS Patient-involvement, clear communication, and implementing changes after a mistake could increase patient satisfaction, avert complaints, and prevent time-consuming trials. Maintaining adequate documentation and having knowledge on the analytical framework of the court is beneficial when confronted with a complaint.
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Affiliation(s)
- Britt W C M Warmerdam
- Department of Vascular Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
| | - Joost R van der Vorst
- Department of Vascular Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
| | - Jan van Schaik
- Department of Vascular Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jaap F Hamming
- Department of Vascular Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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Leslie K, Bourgeault IL, Carlton AL, Balasubramanian M, Mirshahi R, Short SD, Carè J, Cometto G, Lin V. Design, delivery and effectiveness of health practitioner regulation systems: an integrative review. HUMAN RESOURCES FOR HEALTH 2023; 21:72. [PMID: 37667368 PMCID: PMC10478314 DOI: 10.1186/s12960-023-00848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/23/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions. METHODS We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework. FINDINGS This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners. CONCLUSION We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.
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Affiliation(s)
- Kathleen Leslie
- Athabasca University, Athabasca, Canada.
- Canadian Health Workforce Network, Ottawa, Canada.
| | - Ivy Lynn Bourgeault
- University of Ottawa, Ottawa, Canada
- Canadian Health Workforce Network, Ottawa, Canada
| | - Anne-Louise Carlton
- Royal Melbourne Institute of Technology (RMIT) University, Melbourne, Australia
| | - Madhan Balasubramanian
- College of Business, Government and Law, Flinders University, Adelaide, Australia
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
| | - Raha Mirshahi
- University of Ottawa, Ottawa, Canada
- Canadian Health Workforce Network, Ottawa, Canada
| | | | - Jenny Carè
- University of Technology Sydney, Sydney, Australia
| | | | - Vivian Lin
- University of Hong Kong, Hong Kong, China
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Walton M, Kelly PJ, Chiarella EM, Carney T. Management and outcomes of health practitioner complaints in Australia: a comparison of the national and New South Wales systems. AUST HEALTH REV 2020; 44:180-189. [PMID: 32070470 DOI: 10.1071/ah18262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/11/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to summarise the process and outcomes of complaints from five regulated health professions in Australia, and to compare these between the national and New South Wales (NSW) systems. METHODS This is a retrospective cohort study of all complaints lodged from 1 July 2012 to 31 December 2013 for medicine, nursing and midwifery, dentistry, psychology and pharmacy registered practitioners. Data were extracted from the Australian Health Practitioner Regulation Agency, the NSW Health Professional Councils' Authority and the NSW Health Care Complaints Commission databases. The main outcome measures were frequencies and percentages of process decisions and outcomes. RESULTS Systems differed in classification of complaints as conduct (national 47%; NSW 22%) and performance (national 45%; NSW 71%). Thirty-eight per cent of complaints were investigated or managed through a health or performance stream (national 40%; NSW 34%), but the national system investigated more matters (national 35%; NSW 6%). Over 50% of complaints resulted in 'no further action' (national 60%; NSW 70%). The most common action was caution or counsel (national 12%; NSW 15%), followed by conditions, (national 10%; NSW 5%). Practitioner registration surrender was more common with the NSW than national system (national 0.1%; NSW 1.3%), but registration suspensions or cancellations were similar (national 0.6%; NSW 1.0%). CONCLUSION The main difference between the two systems is the administrative decision as to how complaints are assessed. In NSW, a classification of a complaint as 'performance' usually means the complaint is not investigated; rather, the practitioner is assessed by peers and may be required to undergo further education and training. Reaching agreement and understanding of complaints that should be investigated and those appropriate for performance review would strengthen a national approach to health complaint regulation. What is known about the topic? The national system of managing healthcare complaints is relatively new (since 2010) compared with the NSW system (since 1993). Annual reports of the regulatory authorities provide summaries of types and outcomes of complaints separately for each profession, and separately for NSW and the national system, but we do not know how the two systems directly compare in terms of complaint management or their outcomes. What does this paper add? This study examined how different types of complaints are managed between the two systems and whether there are any differences in outcomes. The types of complaints are almost identical between the two systems, but classification of complaints as 'performance' or 'conduct' differed. Immediate action is more common in the national than NSW system, especially for health impairment and boundary crossing. Health impairment complaints are much less likely to be discontinued at the assessment stage in NSW compared with the national system. The NSW and national systems are similar in terms of complaints proceeding to either an investigation or performance or health assessment, but the national system investigates more than the NSW system. For many types of complaints the outcomes were similar between systems, but there were clear differences for some types of complaints, such as health impairment and boundary crossing. What are the implications for practitioners? An efficient and fair regulatory system is crucial for maintaining practitioner trust, as well as trust of the public. This study shows that there are many similarities between the national and NSW systems in terms of process and outcomes, but there are differences in the way some types of complaints are assessed between the two systems. This knowledge may assist regulatory authorities in their efforts to achieve a nationally consistent approach to complaints.
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Affiliation(s)
- Merrilyn Walton
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Edward Ford Building (A27), Camperdown, NSW 2006, Australia. ; and Corresponding author.
| | - Patrick J Kelly
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Edward Ford Building (A27), Camperdown, NSW 2006, Australia.
| | - E Mary Chiarella
- Sydney School of Nursing and Midwifery, University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia.
| | - Terry Carney
- Sydney Law School, University of Sydney, New Law School Building (F10), Camperdown, NSW 2006, Australia.
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Glonti K, Struckmann V, Alconada A, Pettigrew LM, Hernandez-Santiago V, Minue S, Risso-Gill I, McKee M, Legido-Quigley H. Exploring the training and scope of practice of GPs in England, Germany and Spain. GACETA SANITARIA 2018; 33:148-155. [PMID: 29576244 DOI: 10.1016/j.gaceta.2017.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore general practitioner (GP) training, continuing professional development, scope of practice, ethical issues and challenges in the working environment in three European countries. METHOD Qualitative study of 35 GPs from England, Germany and Spain working in urban primary care practices. Participants were recruited using convenience and snowball sampling techniques. Semi-structured interviews were recorded, transcribed and analysed by four independent researchers adopting a thematic approach. RESULTS Entrance to and length of GP training differ between the three countries, while continuing professional development is required in all three, although with different characteristics. Key variations in the scope of practice include whether there is a gatekeeping role, whether GPs work in multidisciplinary teams or singlehandedly, the existence of appraisal processes, and the balance between administrative and clinical tasks. However, similar challenges, including the need to adapt to an ageing population, end-of-life care, ethical dilemmas, the impact of austerity measures, limited time for patients and gaps in coordination between primary and secondary care are experienced by GPs in all three countries. CONCLUSION Primary health care variations have strong historical roots, derived from the different national experiences and the range of clinical services delivered by GPs. There is a need for an accessible source of information for GPs themselves and those responsible for safety and quality standards of the healthcare workforce. This paper maps out the current situation before Brexit is being implemented in the UK which could see many of the current EU arrangements and legislation to assure professional mobility between the UK and the rest of Europe dismantled.
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Affiliation(s)
- Ketevan Glonti
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Verena Struckmann
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | - Alvaro Alconada
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Luisa M Pettigrew
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Virginia Hernandez-Santiago
- Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Sergio Minue
- Andalusian School of Public Health, Granada, Spain
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore.
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Sattar K, Roff S. Comparison of recommended sanctions for lapses in professionalism of undergraduate medical students in a Saudi Arabian and a Scottish medical school. MEDICAL TEACHER 2016; 38:1262-1266. [PMID: 27631714 DOI: 10.1080/0142159x.2016.1230190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Medical Professionalism is recognized as a cultural construct. We explore perceptions of the severity of lapses in professionalism of undergraduate medical students at two medical schools with different cultural contexts. METHODS Respondents from two medical schools (Saudi Arabia & UK) recommended sanctions for the first time, unmitigated lapses in academic professionalism, using the Dundee Polyprofessionalism Inventory 1: Academic Integrity. RESULTS While more than two-thirds of the recommended sanctions for the 30 items of poor professionalism were fully or nearly congruent among the 1125 respondents, there were substantial differences in recommended response for one-third of the items, with a strong tendency for the Saudi students to recommend more lenient sanctions than the Scottish students. CONCLUSION The strategy of using recommended sanctions as a proxy for the perception of the severity of different lapses in professionalism may be a useful tool in learning and teaching academic professionalism among medical students in different cultural contexts.
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Affiliation(s)
- Kamran Sattar
- a Department of Medical Education, College of Medicine , King Saud University , Riyadh , Saudi Arabia
| | - Sue Roff
- b Center for Medical Education, University of Dundee , Dundee , UK
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Guraya SY, Norman RI, Roff S. Exploring the climates of undergraduate professionalism in a Saudi and a UK medical school. MEDICAL TEACHER 2016; 38:630-2. [PMID: 27007746 DOI: 10.3109/0142159x.2016.1150987] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
AIM To explore the usefulness of an online inventory for tracking medical students' understanding of the importance of lapses in academic integrity. METHOD Respondents were asked to recommend sanctions for lapses as a proxy of their understanding of the importance of the 34 types of poor professionalism. RESULTS The data suggest that while there is congruence, there are also substantial differences between ratings of the importance of poor professionalism, particularly in relation to data integrity, between a cohort in Saudi Arabia and one in the UK. CONCLUSION This resource may be useful both for teaching and learning in individual schools, and particularly for the induction of doctors into organisational environments different from the one they were trained in.
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Affiliation(s)
- Salman Y Guraya
- a College of Medicine , Taibah University , Almadinah Almunawwarah , Saudi Arabia
| | - Robert I Norman
- b Department of Biological Sciences and Psychology, College of Medicine , University of Leicester , UK
| | - Sue Roff
- c Centre for Medical Education , Dundee Medical School , Dundee, Scotland
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