Improving health practice

Projects

Research projects focused on:

• gaining ethical approval for the evaluation of the COVID-19 pandemic sub-register
• publishing snapshots of trend data for all professions
• literature and rapid evidence reviews on:
  • reflective practice as a protective factor for health practitioner continuing professional development (CPD)
  • systematic review of the evidence and efficacy of CPD and recency of practice requirements for health practitioner regulation
• beginning agency-wide multiyear work examining trust and confidence in regulatory functions across a broad range of stakeholders.

Access to data for research 

The comprehensive national regulation data that Ahpra collects have registration, workforce planning, demographic, commercial and research value, but 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. 

Research ethics 

We used the ethics pathway established with the Prince Charles Hospital Human Ethics Committee in line with best practice research and the National Health and Medical Research Council's ethical requirements. Ethics approval was granted for 14 projects, including: 

• Workforce trends of Ahpra-regulated professions 
• Exploring positive experiences of the notification process 
• Notifier Support Service evaluation 
• Examination of notifications involving people of Aboriginal and/or Torres Strait Islander origin 
• Coronial inquest analysis 
• Identifying and minimising the risk of self-harm and suicide in practitioners with a current regulatory matter: a quality improvement project 
• Identifying and minimising the risk of distress in practitioners subject to regulatory action: a quality improvement project 
• Post-implementation review of the professional capabilities for medical radiation practice 
• Pandemic response 2020 and 2021 sub-registers: data analysis, surveys, interviews and notifications about practitioners on the sub-register 
• Operation Reset evaluation 
• Identifying and improving stakeholder access and use of the Medical Training Survey (MTS): an impact assessment plan. 

We developed a research and evaluation policy and supporting processes for Ahpra and the National Boards, including an internal Advisory Committee to provide advice about when an ethics review is required. 

Publications 

We produced two publications in peer-reviewed health journals, to share knowledge: 

• Biggar S, Fletcher M, Van Der Gaag A & Austin Z (2022). 'Finding space for kindness: public protection and health professional regulation', International Journal for Quality in Health Care, 34(3). https://doi.org/10.1093/intqhc/mzac057  
• Main P & Anderson S (2022). ‘Evidence for continuing professional development and recency of practice standards for regulated health professionals in Australia: protocol for a systematic review’, JMIR Research Protocols, 11(4). https://doi.org/10.2196/28625 

The National Boards and Ahpra regularly collaborate on shared policy issues that affect professions similarly. This collaboration facilitates effective and collaborative care, supports good interprofessional 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 

As the COVID-19 pandemic continued, registered health practitioners played a pivotal role in treating and containing COVID-19 and supporting the national vaccination program. We continued to work with the National Boards to support timely, proactive regulatory responses. As part of our efforts to support health practitioners, we: 

• extended the modification to the National Boards’ English language skills standard test pathway 
• temporarily approved additional English language tests. 

Supporting professional practice 

We published a new Resources section on the Ahpra website to create a helpful hub to support practitioners’ professional practice and help the public make safer health choices. 

We also issued several position statements to provide further advice and guidance on the National Boards’ expectations of registered health practitioners in response to emerging issues about the COVID-19 pandemic, including Facilitating access to care in a COVID-19 environment: Guidance for health practitioners. 

Policy support and coordination 

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

• Australian Government Department of Health review of Declaration of Relevant Professional Bodies under the Health Insurance Act 1973 
• Australian Government Department of Health consultation on proposed refinements to the framework for regulation (by the Therapeutic Goods Administration) of personalised medical devices 
• Victorian Department of Health consultation on authorising additional surge workforce to participate in Victoria's COVID-19 vaccination program 
• ACT Health Directorate consultation on temporary COVID-19 vaccine authorisations at public clinics 
• Australian Commission on Safety and Quality in Health Care (ACSQHC) consultation on Intellectual Disability Resources 
• Victorian Department of Health Public Health Emergency Orders 
• National Skills Commission (NSC) Skills Priority List Stakeholder Survey 
• Victorian Department of Health – Amendment of Secretary Approvals for Nurse Immunisers and Pharmacist Immunisers 
• National Prescribing Service (NPS) MedicineWise Prescribing Competencies Framework 
• Victorian Government – Consultation paper – Non-fatal strangulation 
• NSW Ministry of Health consultation – Draft Medicines, Poisons and Therapeutic Goods Bill. 

Work progressed 

So that the National Boards’ regulatory requirements remain contemporary and relevant, we: 

• established a Supervised practice framework, which allows for a responsive and risk-based approach to supervised practice across the National Scheme for 13 professions (with some profession-specific exclusions) 
• finalised and published a revised shared Code of conduct, which applies to practitioners in 12 professions – the revised code supports good patient care and the delivery of services within an ethical framework, helping to keep the public safe; it was published in English, one-page summaries were published in five other languages, and an Easy English version was developed, which will be published in late 2022 
• continued work on a joint review for 14 professions of the English language skills registration standards (ELS standards), to start public consultation on revised draft ELS standards in July 2022.

Our work gives us 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 to 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. 

In the past year, we identified risks to the public and for practitioners in five areas.

Professional indemnity insurance 

Most cases we see of lapsed professional indemnity insurance (PII) are accidental occurrences. 

The professional indemnity insurance registration standard is an important part of protecting the public by addressing the risk posed by uninsured practitioners. The requirement to have PII in place ensures financial protection for both practitioners and the public in the event of an adverse occurrence. 

Some employers provide PII but not all. It is the responsibility of all practitioners to ensure both they and their patients are protected. 

To manage this risk 

• Practitioners are encouraged to be aware of what, if any, insurance their employer has in place, and remember that general public liability insurance is not sufficient to meet the registration standard. 
• Technology can be a great assistance for reminders – practitioners can use diaries or calendars to monitor their PII renewals, or use any other method they currently employ to remember to pay a regular bill or take a regular action. 
• Practitioners should take care to keep their insurance provider up to date with their current contact details, and add their PII provider to any checklists of details to update if they are changing or leaving jobs or moving home. 
• It is essential that practitioners consider very carefully the declarations they make at each registration renewal. A declaration that you won’t practise without having PII in place is a serious statement and a practitioner may face disciplinary procedures if it turns out to be incorrect. 
• If a practitioner discovers at renewal or at any other time that they have practised without adequate PII, the smoothest way to resolve this is to promptly advise the regulator, address the omission and seek retrospective cover. 

Complaints handling 

Health consumer feedback is a valuable part of the quality improvement cycle. Complaints help to identify areas in need of improvement and uncover any real or potential failures from a consumer perspective. 

Every day Ahpra learns about complaints to practitioners that are not managed well and have been escalated to us. These range from a failure by a practitioner to respond to a patient’s needs, to an unsatisfactory open disclosure process, and everything in between. When a notifier tells us that they complained to a practitioner before notifying us, this means that the practitioner had an opportunity to avoid the notification by resolving it directly with the notifier. 

To manage this risk 

• There are multiple pathways and platforms for complaints, and a wide variety of supporting tools for practitioners on how to manage complaints. 
• First and foremost, consumers and carers deserve to be treated with respect and dignity, and to have their concerns treated as genuine and to be properly followed up on. Practitioners can demonstrate this respect through taking the time to provide a considered response and to share information on how they intend to prevent a future occurrence. For example, practitioners may wish to consider: 
  • if their complaints-management approach is one of learning and continuous improvement or one that is more defensive 
  • whether they could benefit from understanding more about complaints management as part of their continuous professional development 
  • applying an approach more consistent with the National Safety and Quality in Health Service’s Partnering with Consumers Standard to get better outcomes in relation to patient complaints. 
• When dealing with a person who has made a complaint, practitioners can use this as an opportunity to consider how they could have avoided the complaint by managing the interaction differently.

Informed consent 

Informed consent is a critical part of a patient’s relationship with their whole healthcare team, and consumer expectations of accountability and responsibility continue to grow. Informed consent procedures must include providing information to patients in a way they can understand before seeking their consent, and clearly explaining the risks and benefits of the proposed treatment. A shared understanding between the practitioner and patient helps to avoid future confusion. 

Any kind of physical examination that is poorly explained or conducted can result in patient distress and a notification. 

Managing informed consent well can prevent dissatisfaction and misunderstandings later. It is essential for practitioners to consider if the patient understands the information provided, keeping in mind that most patients do not have the same knowledge and experience of healthcare and procedures as the practitioner. This is especially important where a patient’s cultural experience or background may mean they have different expectations to the practitioner. 

To manage this risk 

• Practitioners can reflect on their practice and ensure they are up to date in contemporary approaches to informed consent discussions. The expectations of Boards are recorded in their codes of conduct and regularly supported by information distributed from professional associations and organisations. There are many educational and other resources available from reputable professional sources to support best practice. 
• Remember that informed consent is individual to each patient and that what is sufficient for one person may not be so for another. Take the time to ensure your patient understands and is comfortable with the treatment plan, including its limitations and risks. 
• Maintaining clear, accurate and contemporaneous clinical records will assist in demonstrating a commitment to best-practice informed consent should there be a need to resolve issues in the future. 

Social media 

Being a registered health practitioner carries a level of respect and expectation in our communities and a high level of trust. When practitioners post or share information on social media, the public might give that information more weight than that coming from other commenters, and view it in the context of the practitioner’s professional knowledge. 

To manage this risk 

• Practitioners should manage social media privacy settings carefully to ensure they are engaging with people they trust and want to communicate with. 
• Practitioners should take care to maintain careful boundaries between personal and professional personas. If a practitioner is providing a professional opinion or one that reflects on the professional opinion of others, the practitioner will need to consider compliance with the relevant code of conduct. 
• Social media is not a place to engage with patients and consumers as the boundaries can easily become blurred between personal and professional. This can happen regardless of the intent with which a practitioner takes part in an interaction. 
• If engaging with consumers on social media is part of a practice’s structured communication approach, it’s important to apply usual workplace practices and good record-keeping requirements. 

Providing care to family and friends 

The requirements of Boards around providing care to family and friends vary by profession, and practitioners should make sure they are aware of their professional obligations. 

It’s also important to be aware of local requirements – states and territories have specific rules preventing prescribing to friends and families, which practitioners also need to meet. 

The risks of providing care (including prescribing) to family and friends include potential lack of impartiality, lack of clarity on expectations and the potential for boundaries to be blurred. 

Providing ad hoc care to family and friends can prevent them from seeking appropriate support or more specialised care from the wider healthcare community and could, despite good intentions, compromise their care. 

To manage this risk 

• It is preferable not to provide care to family and friends and to keep personal and professional boundaries separate. 
• Directly engaging with a primary treating team is the best pathway to care. Supporting family and friends to access care from an appropriate colleague is the best way to help. 
• If a practitioner does provide care to family or a friend, including a prescription or medication, they should maintain good records, communicate with other professionals involved in care, and support safe transition of care to another practitioner at the earliest opportunity.

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

Regulatory effectiveness 

Efficient and effective core regulatory functions include being responsive to the rapidly evolving nature and scope of health practitioner practice and ensuring that our management approaches achieve long-term sustainability. 

Initiatives 

• Implementing a risk-assessment and control framework to manage investigations. We established new processes managing investigations, provided new resources and guidance to support our investigation teams and increased the number of completed investigations. 
• 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. A new cost allocation framework was approved by the National Boards and moved to the next stage of consultation. 
• Building a contemporary and user-friendly technological interface for our regulatory operations. The preparation stage was completed and the detailed design stage is underway. 
• Implementing an Enterprise Project Methodology, which has standardised our approach to project management and enabled greater oversight of the status of our projects. 

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. 
• Improving and promoting the search function of the public register and improving the quality of published information on registered health practitioners. Phase 2 of this initiative was on track for release in late 2022. 

Trust and confidence 

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

Initiatives 

Continuing to provide 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. Despite the challenges of conducting face-to-face learning, 1,443 participants have enrolled in the program, and 1,082 have completed it since it began in February 2021. 

Providing easier access to information for all Ahpra stakeholders. We began redesigning our website. 

Capability and culture 

We are working to create 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. 

Initiatives 

• Developing a ‘culture roadmap’ that defines our aspirational culture. In the ‘discovery’ phase we identified a strong connection between employees’ personal values and Ahpra’s values of integrity, respect, collaboration and achievement. 
• Continuing to implement a Leadership Development Framework and supporting programs to continuously improve management and leadership capabilities. Surveys about Ahpra’s COVID-19 response revealed that most staff are comfortable with how our leaders engaged with them during the pandemic. A ‘Foundations of leadership’ program was launched in September for new and emerging leaders. 
• Supporting our people through our flexible working policy, for better balance of work and personal commitments. 
• Expanding our wellbeing program to create psychologically safe workplaces and ensure easily accessible programs and support services are in place. Our ‘Leading with care’ and ‘Reflective practice’ programs were implemented to reduce risk of vicarious trauma. 
• Continuing to implement actions from the Ahpra Aboriginal and Torres Strait Islander Employment Strategy 2020–2025. Targeted recruitment activities saw application rates from Aboriginal and Torres Strait Islander–identified candidates more than double in the 12 months to 30 June 2022.