Insights, research, policy and strategy

Through our work, we have data and insights into some of the challenges and opportunities for registered health practitioners and, more broadly, for the healthcare system in Australia. 

We want to use this knowledge and experience to support practitioners to practise professionally and so they can identify and manage risk in their practice. Our aim in sharing these insights is to promote a culture of reflection and continuous improvement for practitioners that protects the public and contributes to the safety and quality of healthcare. 

We are exploring opportunities to share more detailed insights directly with health practitioners, such as through profession-specific newsletters and case studies. We will also look for ways to share relevant insights with consumers and our health system partners.

Our data show there are risks to the public and for practitioners in the following areas.

Health and wellbeing

• Staying healthy and well maintains a practitioner’s ability to provide safe, professional healthcare. 
• There has been an increase in self-reported notifications from practitioners experiencing mental health issues over the last two years, and an increase in reports about practitioners misusing drugs and alcohol. 
• Consistent with international experience, these are potential indicators of increased stress from working as a health practitioner during the pandemic. For example, from frontline exposure or through impact on practitioner businesses affected by shutdowns.

To manage this risk

Practitioners are encouraged to look after their own health and support their health practitioner colleagues. Practitioners who have concerns about their own or a colleague’s health are encouraged to seek support. For many practitioners (dentists, doctors, pharmacists, nurses and midwives), free and confidential support services are available from their profession’s dedicated practitioner health service.

Respectful practice

• Practitioners must always treat patients, consumers, students, employees and colleagues with respect. This includes communicating professionally and respectfully with and about others.
• Being respectful and culturally safe towards patients and colleagues supports a positive patient experience and can reduce the likelihood of a notification.
• Discrimination in healthcare, such as sexual harassment, racism or bullying, is a barrier to better health outcomes. This includes care provided to Aboriginal and Torres Strait Islander Peoples, which must be culturally safe. 

To manage this risk

Practitioners can invite feedback from patients and colleagues. They can reflect on any feedback received and consider the expectations set out in their code of conduct or equivalent. Practitioners can learn or refresh themselves on what is involved in culturally safe healthcare and reflect on whether they are providing culturally safe healthcare and what changes they could make to overcome any unintentional shortcomings (remembering that only Aboriginal and Torres Strait Islander Peoples can define whether care is culturally safe). 

Managing health records

• Maintaining clear and accurate patient health records is essential for the continuing good care of patients. 
• When a notification is made, the relevant patient health records are often a key piece of further information National Boards will seek from a practitioner. 
• Many practitioners who have been through the notifications process report that they would recommend ‘good record keeping’ to other practitioners, as a way to help in responding to a complaint.

To manage this risk

Practitioners could reflect on their processes for maintaining health records, ensuring that they are sufficient to support the care being provided. There are resources that practitioners can access to help them, including guidance resources and electronic record-keeping programs. 

Communication

• Effective and respectful communication is critical to providing safe healthcare.
• Communication continues to be a strong theme in notifications.
• Patients who are dissatisfied with the communication of their healthcare provider are more likely to complain to both their provider and us.

To manage this risk

Practitioners can reflect on their communication with patients and colleagues, and identify and quickly address communication breakdowns in their practice. This can support better relationships and more engaged patients who have a deeper understanding of their care.

Informed consent

• Informed consent is a critical part of the practitioner–patient relationship.
• Managing informed consent well can prevent misunderstandings. What a practitioner might consider as adequate communication to gain informed consent can be different from the client’s or patient’s expectations, particularly where the examination or procedure to be done involves physical contact with a patient.
• There continues to be a gap between contemporary consumer expectations of informed consent and the approach to consent taken by many health practitioners.
• A physical examination that is poorly conducted or not supported by clear communication and consent can be distressing, alienating and harmful for patients. Such an exam may be considered assault and result in serious consequences, including police investigations and prosecutions.

To manage this risk

Practitioners can reflect on their approach to informed consent – and the expectations set out in their code of conduct or equivalent, and consider whether their communication or documentation of consent can be strengthened. Remember that informed consent is individual and different people may need more information and time to consider it than others. Practitioners should use simple language to explain what is involved in the physical examination, and check that the patient has understood. What has worked in the past with one person may not be effective or appropriate for another. In some circumstances, recording that a patient has consented to the specific, physical contact that will occur during the examination can be helpful evidence of informed consent. 

Projects

Our research and evaluation work improves our regulatory effectiveness and helps us become an evidence-informed regulator. 

Research projects focused on were:

• finishing a cross-profession study of health practitioners with repeat notifications
• evaluating the first phase of the pandemic response sub-register
• a study of whether notification rates vary by the pathways practitioners use to meet English language skills registration standards 
• developing snapshots of trend data for National Scheme professions, with snapshots to be published soon
• literature and rapid evidence reviews on:
  • continuing professional development and recency of practice requirements to inform registration standard reviews
  • professionalism, to support further work on protective factors of professional practice and reflection
  • global health workforce regulatory responses to COVID-19
• initial research on possible ways augmented intelligence could provide additional information to help human judgement in our regulatory processes: 
  • developing a proof of concept approach using augmented intelligence to help in identifying lower and higher risk notifications to help human judgement in the triage process 
  • a collaboration with Royal Holloway University of London, the Nursing and Midwifery Council (UK) and the Texas Board of Nursing on artificial intelligence research to support regulatory decision-making in complaints about nurses in the US, UK and Australia
• initial work analysing notifications related to racism and Aboriginal and Torres Strait Islander Peoples
• an initial exploration of the prevalence of notifications in recently graduated health practitioners
• supporting our regulatory functions in developing evaluations.

Research ethics

To implement the National Scheme research ethics position statement, we now have a formal arrangement with Queensland Health’s Prince Charles Hospital to use their National Health and Medical Research Council-registered human research ethics committee (HREC). 

Publications and presentations

The National Scheme’s Combined Meeting's program incorporated research and evaluation, discussing the potential use of augmented intelligence in regulation.

We participated in the Digital Health Cooperative Research Centre’s Telehealth Datathon. In this competition, participants use real data to answer real questions, solve health management challenges and produce data visualisations and models that can be applied to support business processes and decision-making. Ahpra was the only regulator participating and we won the retrospective analysis section. 

We produce publications for peer-reviewed health journals, to share knowledge. Publications were:

• Gee C, Tonkin A, Gaby S, Urh V, Anderson S, Hardy H & Fletcher M (2021). 'Responding to sexual boundary notifications: the evolving regulatory approach in Australia', Journal of Medical Regulation, 107(2), 25–31.
• Leslie K, Moore J, Robertson C, Bilton D, Hirschkorn K, Langelier MH, & Bourgeault IL (2021). 'Regulating health professional scopes of practice: comparing institutional arrangements and approaches in the US, Canada, Australia and the UK', Human Resources for Health, 19(1), 1–12.
• Fletcher M, Anderson S, Townley H & Simmonds B (2020) 'Reflections from Australia: how regulators have responded to the pandemic', Healthcare Professionals Crossing Borders, Winter edition issue 49, 15.

Access to data for research

While the comprehensive national regulation data that Ahpra collects have registration, workforce planning, demographic, commercial and research value, the National Law and the Privacy Act 1988 (Cth) impose strict limits on their use. Our data access and research policy focuses on helping researchers and other parties to better understand the process for considering requests for data and research. 

Ahpra’s website outlines the data already available and how to access them, the processes for accessing data not publicly available, and the policies and legislation that govern what can and cannot be released. 

National Boards and Ahpra regularly collaborate on shared policy issues, when the issue involved affects professions similarly. This collaboration facilitates effective, collaborative care, supports good inter-professional practice and helps to simplify the regulatory landscape. It makes it easier for the public, practitioners and employers to know what to expect of registered health practitioners. 

We have continued to explore and expand how our work as a health practitioner regulator can support registered health practitioners to provide safe and effective care in their professional practice. 

Responses to the pandemic

Registered health practitioners continued to play a vital role in treating and containing COVID-19 and supporting the national vaccination program. We continued to develop, review and refine policy advice to National Boards to support timely, proactive regulatory responses to the COVID-19 pandemic. 

As part of our efforts to support health practitioners, we developed temporary policy positions to support:

• a temporary modification to the National Boards’ English language skills standard test pathway
• flexible recency of practice requirements for professions whose renewal period ended 30 November 2020.

We also reviewed and updated our telehealth guidance for practitioners to support the provision of safe virtual care, and are working with National Boards to monitor the need for further guidance. 

Supporting professional practice

We issued several position statements to provide further advice and guidance on National Boards’ expectations of registered health practitioners in response to emerging issues, including:

• COVID-19 and appropriate use of social media 
• COVID-19 vaccination, including guidance about being vaccinated, administering vaccines and giving advice and information about vaccination
• a joint statement with the Therapeutic Goods Administration on promoting COVID-19 vaccination and complying with the advertising requirements of the National Law 
• sexism, sexual harassment and gendered violence in healthcare. 

Policy support and coordination

Ahpra develops policy resources and tools to support regulatory policy development and provides policy advice to National Boards. Together with the National Boards, we provided input to external policy consultations and reviews for:

• National Prescribing Service MedicineWise’s review of the Prescribing Competencies Framework
• National Skills Commission’s Skills Priority List Stakeholder Survey
• Victorian Department of Health and Human Services’ consultation on options to respond to the independent review of Chiropractic Spinal Manipulation of Children Under 12 Years
• Australian Commission on Safety and Quality in Health Care’s proposed National Safety and Quality Primary Healthcare Standards
• Australian Commission on Safety and Quality in Health Care’s draft resource, Credentialing and Defining Scope of Clinical Practice
• House of Representatives’ terms of reference for a Select Committee on Mental Health and Suicide Prevention
• Safer Care Victoria’s consultation on a proposed statutory duty of candour and protections for clinical incident reviews.

Work progressed

So that National Boards’ regulatory requirements remain contemporary and relevant, we continued our work:

• finalising a review of the supervised practice guidelines used by some National Boards to establish a Supervised Practice Framework to allow for a responsive and risk-based approach to supervised practice across the National Scheme (with some profession-specific exclusions)
• on the joint review of the Code of conduct shared by 12 National Boards, most in an identical form with some minor variations for several National Boards; an eight-week public consultation on the shared code started in May
• coordinating reviews for some National Boards’ English language skills, continuing professional development and recency of practice registration standards.

Arranging our strategy into themes helps us to communicate how we will achieve our vision

Regulatory effectiveness

To protect the public, we must maintain a strong focus on having efficient and effective core regulatory functions. This includes being responsive to the rapidly evolving nature and scope of health practitioner practice and ensuring that our financial planning and management approaches achieve long-term financial sustainability.

Initiatives

• Implementing a risk-assessment and control framework to manage investigations at the team, delegate and practitioner level. The operation reset initiative in notifications, was implemented from October to May, and has strengthened our risk-based regulatory practices.
• Providing greater transparency and visibility to stakeholders on costs, informing National Boards on financial decision-making and financial strategies, and helping in the determination of costs in our co-regulatory environments in our cost-allocation project.
• Building a contemporary and user-friendly technological interface for our regulatory operations in the transformation project.

Evidence and innovation

We use our data to understand critical issues in health practitioner regulation and the healthcare environment and make sure our standards, codes and guidelines continue to be supported by strong evidence. We are developing and improving our systems and processes to identify risk and make sure we have a strong, reliable and consistent framework for data, analysis, evaluation and reporting. 

Initiatives

• Building a modern data platform from which other initiatives and programs can leverage data and services in the data and integration program.
• Improving and promoting the search function of the online public register and improving the quality of the published information on registered health practitioners in the public register enhancement project. This will also provide us with better data and analytics to inform our future direction.

Trust and confidence

We are focused on building the trust and confidence that the public, health practitioners, organisational partners and other stakeholders have in the National Scheme. 

Initiatives

• Providing Moong-moong-gak cultural safety training as part of our commitment to improve Aboriginal and Torres Strait Islander Peoples’ health equity and increase the trust and confidence of the community in our ability to provide culturally safe regulatory practices. All Ahpra staff, Board and committee members in Tasmania, ACT, Queensland, Northern Territory and South Australia have now completed the training. Our people in the remaining states will finish the training by the end of 2021.

Capability and culture

We are focused on creating a workplace that is: psychologically and physically safe for all; enhances the capability, learning and development of our people; and embeds a culture that motivates our people to actively participate and achieve positive outcomes in all that we do.

Initiatives

• Scoping a ‘culture roadmap’ that defines our aspirational culture and key drivers to enable delivery of the National Scheme Strategy.
• Implementing a Leadership Development Framework and supporting programs to continuously improve our management and leadership capabilities.
• Implementing a new flexible working policy and other initiatives across our workspaces to better enable our flexible ways of working, and continue supporting our staff to better balance their work and personal commitments. 
• Exploring options to expand our current wellbeing, offering to create psychologically safe workplaces and ensure easily accessible programs and support services are in place.
• Continuing to implement actions from the Ahpra Aboriginal and Torres Strait Islander employment strategy 2020–2025 to create a culturally safe work environment that encourages increased Aboriginal and Torres Strait Islander workforce participation rates and long-term retention, and that reflects the communities in which we operate and serve.