Connecting clinicians to improve care. Clinician education and training performance measures

Transcription

1 Clinician education and training performance measures

2 Executive summary Healthcare is now delivered in an environment of performance measurement. Clinician education and training (CET) are critical elements in a contemporary health service. Effective education strategies improve patient safety and health service performance, and support development of the future healthcare workforce. The Queensland Clinical Senate (QCS) recommends that effective measures of CET for Hospital and Health Services (HHSs) will enable recognition of the important contribution CET makes to the overall quality of the health system. The QCS has developed five measures of CET: Performance measure Data capture method/source 1. Governance HHS Boards designate a specific CET oversight role within the Board, to report annually on CET measures to the Department of Health and local clinician engagement structures. 2. Percentage of total budget spent on CET 3. Quality/quantity of interprofessional learning 4. Multidisciplinary and team-based simulation training HHSs demonstrate investment in CET through the HHS service agreement line item on CET. HHSs report the number/type of multidisciplinary CET activities, including specific information on seniority and disciplines of participants. HHSs demonstrate existence of policy statements or strategic plans regarding the use of simulation in multidisciplinary clinical learning at the organisational level. The Health Workforce Australia CET evaluation tool (or equivalent) be implemented once available. 5. Learner/teacher experience and attrition rates Two questions have been introduced into the Public Service Commission Working for Queensland Survey to identify clinician perspectives on CET. The QCS recommends that: The Department of Health incorporate CET performance measures into HHS service agreements, and The Department of Health introduce a governance structure to monitor CET performance by HHSs and refine these performance measures based on objective outcomes over time. Page 2 of 7

3 Background In October 2013 the QCS considered how performance measures for CET might stimulate investment and improvements in these areas. QCS members supported the development of CET performance measures in consultation with all relevant stakeholders. It was agreed that this performance framework would focus on input, governance and output measures. In order for the measures of CET to be effective, the QCS agreed performance measures must be: patient and quality outcome focused valid, reliable, reproducible measureable collectable (through existing data sources in the first instance) locally relevant applicable across professional streams. The QCS committed to take a leadership role by establishing a working group (Appendix A), in collaboration with relevant stakeholders from the education and training sectors, to provide a framework for the Department of Health to incorporate into HHS service agreements. The CET working group was tasked to: articulate the reason for developing performance measures as part of HHS service agreements identify specific performance measures in collaboration with key stakeholders outline the reporting process for the framework describe mechanisms to communicate outcomes explore opportunities for integration with existing national benchmarking frameworks. Whilst the QCS meeting focused specifically on CET, the working group also considered the applicability of the CET principles to research in HHSs. This report outlines the conclusions of the CET working group. Page 3 of 7

4 1. Governance Education and training is central to providing quality health services and a skilled workforce to support this. The QCS believes in the importance of a framework through which healthcare organisations are accountable for routinely monitoring and reporting the quality and outcomes of CET. Implementation of such a framework should create an environment which supports patient safety and quality care. It is hoped that reporting on CET activities at the Hospital and Health Board (HHB) level will promote both recognition of the importance of CET and accountability for its delivery. Through the HHS business model this should flow down through all levels of the organisation. The QCS recommends the allocation of a CET portfolio within the HHB membership. This portfolio is to be responsible for annual reporting of the CET activities within the HHS to the: HHB Department of Health HHS Clinical Council (or equivalent). This reporting should include but not be limited to the performance measures outlined below. 2. Percentage of total operational budget spent on CET Clinical workforce capacity and CET are significant issues for delivering quality health care. Ensuring CET programs are adequately resourced is essential. Currently, the Queensland Department of Health funds CET in HHSs with Activity Based Funding (ABF) facilities through block funding grants. Whilst the Independent Hospital Pricing Authority is currently exploring mechanisms to quantify CET within an ABF framework, completion of this project remains some years away. The QCS recognises the importance of keeping collection of performance metric data as simple as possible. It is unlikely (and unrealistic) that we will be able to capture every dollar spent on every aspect of CET. With this in mind and recognising it is crude methodology, the QCS proposes the CET line item in HHS Budgets as an indicative measure of investment by HHSs towards CET. The QCS acknowledges this does not measure actual expenditure (HHS effort) and does not capture CET effort occurring in smaller, rural public hospitals in Queensland (i.e. non Page 4 of 7

5 ABF facilities). A more appropriate measure should be considered over time as the health system develops more sophisticated mechanisms to quantify investment in CET. The QCS recommends a transparent budget line item reporting on CET investment (as a proportion of total HHS expenditure) is a necessary first step in demonstrating the importance of CET. Development of a more sensitive measure of investment in CET should be considered over time. 3. Quality/quantity of interprofessional learning Interprofessional learning aims to build understanding between different members within the healthcare team, including different craft groups and service levels to improve collaboration and quality of care. Interprofessional learning has been demonstrated to lead to improvement in 1 : workplace productivity staff morale patient outcomes patient safety and access. The QCS acknowledges that, while observable high quality interprofessional and institutional training and development is currently happening, measuring the quality of CET activities is difficult. Quantitative measurements such as the frequency and type of formal CET activity undertaken in organisations may serve as a de-facto preliminary measure of effort while a metric to measure quality is developed over time. It is important to acknowledge that this education may occur both within formal training sessions and be a component of service meetings as part of clinicians routine practice. The QCS recommends HHSs report the number and type of multidisciplinary CET activities (not limited to pure training) taking account of seniority (e.g. novice to expert) and disciplines of participants. 4. Multidisciplinary and team-based simulation training Simulated learning environments are considered a useful tool to provide CET. Despite significant investment in simulation training within the health system, there is little reporting on its utilisation. 1 MedEd09 Medical Education Conference: Investing in our Medical Workforce October 2009 Sydney. Page 5 of 7

6 While strategies to support simulation-based education are currently being considered by the Expert Simulation Advisory Group of the Queensland Clinical Education and Training Council, outcome measures for simulation based training have not been implemented to date. The QCS has consulted with the Expert Simulation Advisory Group. Subsequently the QCS believes that the priority and profile of CET within HHSs can be measured through demonstration of the existence of clinical learning simulation policy statements or strategic plans at the HHS level. Tools to measure simulation training, such as those being developed in association with Health Workforce Australia (HWA) may provide a better way of measuring the use of simulation in CET. With the recent announcement of the discontinuation of HWA it may be necessary to find an alternative tool. The QCS recommends HHSs demonstrate existence of policy statements or strategic plans regarding the use of simulation in clinical learning at the organisational level and that the Health Workforce Australia CET Evaluation tool (or similar) be implemented once available. 5. Learner/teacher experience and attrition rates The significant relationship between learners perceptions of the learning experience and their overall professional satisfaction and success is well documented. Thus, the QCS considered employment satisfaction as a preliminary indirect measure of how clinicians feel about CET opportunities within their organisation. The Working for Queensland Employee Opinion Survey is a well-established tool that captures the attitudes and experiences of Queensland public service employees. Additional data on the clinical workforce has been introduced into the Working for Queensland Employee Opinion Survey 2014 following agreement by the Public Service Commission, Commission Chief Executive. The QCS recommends HHSs be provided organisation specific results from the Public Service Commission Working for Queensland Employee Opinion Survey to identify clinician perspectives on CET within their workplace. These results should be reported to the HHB and to the HHS Clinical Council (or equivalent). Page 6 of 7

7 APPENDIX A: QCS working party members Dr Trish Baker, Board Member, Metro North Medicare Local Dr Anthony Brown, Director of Clinical Training, Cairns and Hinterland HHS Professor Darrell Crawford, Head, School of Medicine, University of Queensland Ms Mish Hill, Director, Nursing and Midwifery Services, Adults, Women's & Children's Health Services, Mater Health Services Dr Anita Green, General Practitioner, University of Queensland Professor Amanda Henderson, Nursing Director, Education, Princess Alexandra Hospital Ms Liza-Jane McBride, Team Leader, Allied Health Professions Office, Queensland Department of Health Dr Ewen McPhee, General Practitioner, Central Queensland Medicare Local Dr Will Milford, Australian Medical Association Council of Doctors in Training Professor Robin Mortimer, President of the Australian Medical Council Dr Susan O Dwyer, Executive Director of Medical Services, Princess Alexandra Hospital Dr Colin Owen, General Practitioner, Inglewood Ms Paula Schulz, Deputy Head of School, School of Nursing, Midwifery & Paramedicine Faculty of Health Sciences, Australian Catholic University Mr Paul Stafford, Director, Leadership Unit, Department of Health Ms Christine Went (QCS CET Co-Chair), Chief Executive Officer, St Andrew s-ipswich Private Hospital Dr Glen Wood, (QCS CET Co-Chair), Urologist, Greenslopes Private Hospital Page 7 of 7