14 and 15 august 2012 council strategic and policy ... · 12. nz bpac have now implemented the...

14 and 15 August 2012

Council

Strategic and Policy Directions

3.0 Strategic and Policy Directions

Progress on strategic directions

Purpose

1. To report on progress with strategic directions and initiatives for the year 1 July 2011 to

30 June 2012.

Strategic Directions

2. During the 2011/2012 year we have continued to implement the initiatives within our

four strategic directions. The following report is a summary of the progress with key

initiatives over the 12 months from 1 July 2011 to 30 June 2012.

3. Benefits maps (Appendix 1) demonstrate the link between each of the strategic directions

and Council’s strategic goals. The benefits maps also demonstrate the outcomes and the

benefits and value delivered.

Fitness to practise

Recertification for doctors registered in a general scope of practice

4. At its October 2011 meeting Council resolved to approve bpacnz as the provider for

Council’s recertification programme for doctors registered in a general scope of practice.

5. A communication plan was put in place for the 6 months before the programme was

implemented. In December 2011 details about Council’s new requirements and the

Inpractice recertification programme were communicated to stakeholders and the

profession. Each doctor holding a current practising certificate received an individual

letter notifying them of the changes. Stakeholders were also notified by mail. Prior to the

release Philip and I met with New Zealand Resident Doctors Association(NZRDA) and New

Zealand Medical Association (NZMA) to discuss the programme.

6. Since February 2012 we have met with a number of other stakeholders and discussed the

recertification programme. Some of these include the New Zealand Society of

Anaesthetists (NZSA), Royal Australasian College of Physicians (RACP), CPD Committee,

NZ Locums, Royal Australasian College of Medical Administrators (RACMA) Council of

Medical Colleges (CMC), National DHB General Mangers HR, National Joint Consultative

Committee, Australian and New Zealand College of Anaesthetists (ANZCA), National DHB

joint COO/CMO meeting, Health Workforce New Zealand regional training hubs, the DHB

RMO regional operations meeting, RDA / DHB National Resident Doctors Engagement

Group (NREG) meeting, National CMO meeting, National DHB COO meeting, Clinical

Directors of Capital and Coast DHB, PGY1s and PGY2s of Hutt Valley DHB, and Royal

Australasian College of Surgeons (RACS).

7. Following Council’s decision at its meeting 14 March 2012, every doctor with a current

practising certificate was informed of the change in requirement for Medical Officers

permanently employed at a DHB and participating in an approved college recertification

programme.

8. The Inpractice programme is being implemented over a 12 month period, over four

practising certificate cycles. The first cycle has been completed with approximately 400

doctors having enrolled in the programme by 20 July 2012. The second cycle is now

underway.

9. We have implemented a process of follow up and action for those who are required to

join the programme but have not yet done so. This is proving effective, with only four

doctors from the May cycle not yet enrolled. Doctors who do not join by 31 July, will

receive further communication outlining further action that may be taken due to non

compliance.

10. We have live access to the Inpractice membership list and this has allowed us to

undertake a data match with bpacnz and our own records. An audit has also been carried

out for those doctors who have indicated a change in their monitoring. For example, we

have obtained verification from colleges of doctors in the May cycle who have changed

from a ‘collegial relationship’ to participation in a vocational training programme.

11. We have refined our administration process during the first cycle and now have a

structured plan in place for dealing with the doctors required to join the programme for

the August practising certificate cycle.

12. Bpacnz have now implemented the multisource feedback component of the recertification

programme. Bpacnz are using the General Medical Council (GMC) multisource feedback

tools to gather feedback from colleagues and patients.

13. Work in progress related to this initiative includes:

• Developing an evaluation programme to determine whether the recertification

programme is delivering the benefits we expect (this will be provided to Council for

consideration).

• Working with bpacnz to develop the regular practice review component (RPR) of the

recertification programme. Bpacnz will begin liaising with colleges in September 2012

to progress this work, with an expected implementation date for Regular Practice

Review (RPR) being June 2013.

Multisource (colleague and patient) feedback

14.

A working group was established to identify multisource feedback tools that have proven

reliability and validity, for implementation across Council’s Performance Assessment

Committee (PAC) and Vocational Practice Assessment (VPA) processes.

Clinical Audit

15. Council’s Education Committee considered the issue of clinical audit at its 2011 May

meeting. The Education Committee requested that the proposed definition and criteria

be discussed with Branch Advisory Bodies (BABs) with the feedback to inform this work.

Credentialling

16. A credentialling working group was established last year in liaison with the national DHB

CMO group which includes three CMOS, a DHB credentialling coordinator, Royal New

Zealand College of General Practitioners (RNZCGP), New Zealand Medical Association

Doctors in Training Council (NZMA DiTC) and Council staff. This work is being completed

in partnership with the Ministry of Health (MoH) and the Health, Quality and Safety

Commission (HQSC).

17.

The working group aims to raise the overall standard of credentialling processes

undertaken by service providers and DHBs, to ensure patient safety. At its meeting in

October 2011 the group agreed this will be achieved best by ensuring that credentialling

of doctors by service providers is a mandatory process. The setting of national standards

to be assessed by an external accreditation system, is necessary in order to achieve

improvement of standards.

18.

The group reviewed the principles set out in the MoH publication The Credentialling

Framework for New Zealand Health Professionals 2010 with the view of drafting more

detailed criteria to sit beneath the principles which then may be used as part of the

assessment for accreditation.

19. In December 2011, Ian Brown and I held an initial meeting with Don Mackie, Chief

Medical Officer-Clinical Leadership, Protection and Regulation, MoH, to discuss the

potential for MoH to be involved in the accreditation of service provider credentialing

processes for the medical profession as part of the assessment for health CERT

accreditation. Don was supportive of this approach and planned to explore different

options within the MoH.

20. Following this Ian and I later met with Don Mackie, Brenda Wraight (HWNZ), Janice

Wilson (HQSC) to discuss the potential role of HQSC in credentialling for the medical

profession. It was agreed that the Chief Executives of DHBs need to understand the

importance of robust credentialling processes. Don agreed to discuss credentialling with

the Chair of the national DHB Chief Executive group, and to explore within the MoH

options for setting standards.

21. There has been no further progress with this work during 2012. Don and I are meeting to

discuss how to best further this later in the year.

Preliminary Competence Inquiry Pilot (PCI)

22. At its May 2012 meeting Council considered the outcome of the 12 month PCI pilot and

whether to retain it as an optional step in the performance process. Seven PCIs took

place over the 12 month pilot period.

23. At the meeting Council decided to incorporate the PCI into Council’s performance

processes and review cumulative data gathered from the PCI process on an annual basis.

The reasons for Council’s decision were that the PCI reports proved useful in providing

Council with further information about whether further action is required, and the PCI

proved to be a preferred process for the doctor concerned. A third reason for Council’s

decision was that the PCI process reduces costs.

Regular Practice Review (RPR)

24. Regular Practice Review (RPR) is a supportive and collegial review of a doctor’s practice

by peers, in a doctor’s usual practice setting. The primary purpose of RPR is to help

maintain and improve the standards of the profession. RPR is a quality improvement

process. It may also assist in the identification of poor performance which may adversely

affect patient care.

25. At the end of last year John Nacey, Philip Pigou and Council staff met with Kim Miles

incumbent CEO and Dr Flora Gilkinson the new CEO of New Zealand Orthopaedic

Association (NZOA) to discuss the outcome of the pilot of the NZOA practice visit

programme.

26. The NZOA provided Council with a copy of their tools and agreed that the tools could be

shared amongst other BABs who are interested in developing RPR processes. The Royal

Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) have

also agreed to share their tools.

27. Philip, Michael and I recently met with the Royal Australasian College of Physicians

(RACP) and they discussed their service review programme with us. As part of this, the

RACP plans to have each SMO undertake a comprehensive professional development

review. The review includes mandatory multisource feedback for each doctor. It also

includes an annual requirement for peer review, with the following activities completed

annually in rotation:

• clinical note review

• consultation review (clinic or ward round)

• personal learning project

• disease review

• procedure review.

28. It is pleasing to see components of RPR incorporated into the RACP Senior Medical Officer

SMO professional development review.

29. The RNZCGP have recently implemented RPR, and this is now available as a voluntary CPD

activity.

30. An engagement plan with BABs has been developed. We plan to facilitate meetings

between those who have already successfully implemented RPR, such as RANZCOG and

the NZOA, and those yet to develop RPR processes. This will commence in early 2013.

31. In 2011 a small working group explored how we could evaluate the effectiveness of RPR.

At that time Council indicated support for the proposed programme, and agreed that this

work should be put aside and recommence once the bpacnz recertification programme

was implemented. This will allow an evaluation of the RPR component of the

recertification process to be put in place from the commencement of RPR in June 2013.

The recommendations from the working group about the content of an evaluation

programme were accepted by Council and these will form part of a Request for Proposal

(RFP), to determine who should undertake the research on Council’s behalf.

Medical Workforce

Approved Practice Settings (APS)

32. Since July 2011, the following services have been accredited as an Approved Practice

Setting (APS):

• Medicross Accident and Medical Clinic, New Plymouth

• East Tamaki Healthcare, Auckland (nine sites)

• South Island Neurosurgical Service, Christchurch and Dunedin.

33. Radius Medical- The Palms, Palmerston North (General Practice and Accident and Medical

Centre) have submitted an application for accreditation as an APS. This application has

been reviewed, and feedback has been provided to the practice. An assessment team will

visit the practice on 2 August 2012. At the assessment visit, emphasis will be placed on

credentialling of IMGs, orientation and induction processes, and the supervision

framework for IMGs. We are working towards providing the application to Council for

consideration at its October meeting.

34. The General Medicine Department of Canterbury DHB are still in the process of

completing an application for accreditation as an APS. A preliminary review of the

application has been made and feedback has been provided to the service. Once a

complete application has been submitted the assessment team will review it before

providing it to Council for consideration.

35. Information about the APS model has been provided to a number of services, and it is

hoped that applications will be received in the near future. These include services at

Lakes DHB, MidCentral DHB, Hutt and Wairarapa DHB, Whangaroa Health Services, and

the Mental Health Unit at Capital & Coast DHB.

Training workshops for supervisors of IMGs

36. Over the last 12 months six training workshops for supervisors of International Medical

Graduates IMGs have been held, with 144 attendees. Feedback continues to be positive.

Most attendees have found it useful in helping them learn different methods of dealing

with cultural competence, communication issues and addressing concerns that may arise

with the performance of IMGs. The workshops also provide supervisors with a forum to

meet with other supervisors so they can share ideas and experiences and form

networking groups.

37. Since we introduced the workshops in 2009, 13 workshops have been held, and 302

supervisors have attended the training. Sue Hawken and Richard Fox from Connect

Communications continue to facilitate the workshops, along with one of Council’s

medical advisers and a manager from Council office.

38. The responsibility for ongoing workshops for supervisors of IMGs has now been passed to

the Registration Team, who plan to schedule a further four workshops over the next

financial year. The following two workshops have been confirmed so far:

• 6 September 2012- Hamilton.

• 20 September 2012- Auckland.

39. Health Workforce New Zealand (HWNZ) have indicated an initial willingness to contribute

funding for the workshops, although they would like to see this in a partnership

arrangement with both Council and service providers.

Survey of doctors leaving New Zealand

40. Council carried out a survey of all doctors requesting a certificate of good standing (CGS),

who had indicated that they were leaving New Zealand. The purpose of the survey was

to gain an understanding of why doctors were leaving New Zealand. The survey ran from

March 2010 to June 2011.

41. Council considered the findings of the survey at its meeting in August 2011. The main

reasons the respondents reported for leaving New Zealand were to gain further training

or overseas experience, and to seek higher incomes overseas. Analysis of the feedback

also indicated that most doctors intended to return to New Zealand, many within 3 years

of departure.

42. The report Doctors leaving New Zealand: analysis of online survey results was distributed

to stakeholders and the media in early December 2011. It was picked up by the Herald in

February 2012, but other than this, it did not gain much media interest.

43. Des Gorman of HWNZ has indicated an interest in having further survey work completed,

and has indicated that funding may be available for this. Enhancements would be

required to IT systems to implement any potential future surveys efficiently.

Sharing of information with other medical regulators

44. A separate paper is included in this agenda about the International Association of Medical

Regulatory Authorities (IAMRA) Physician Information Exchange working group.

MedSys online capability to facilitate applications for practising certificates and

registration

45. This project was placed “on-hold” in 2011/12 for two reasons: first; the cost of

implementing on-line capability was higher than originally budgeted, and secondly; the

RA strategy focusing on a single secretariat was being pursued. The CEO considered that

if a single secretariat was implemented, all participating RAs should contribute to the

costs of IT infrastructure.

Medical Education

Review of prevocational training

46. A working group has been established and is tasked with drafting a curriculum

framework, with specific learning outcomes to be attained by the end of PGY1 and those

to be attained by the end of PGY2. The group is also drafting a model for how assessment

takes place, and how this should be tracked and monitored. The group has vast

experience and expertise in medical education, medical regulation, intern training, and

service provision.

47. The working group initially reviewed the contents of the Australian Curriculum

Framework for Junior Doctors (ACF) and the work of the Medical Training Board (MTB),

the New Zealand Education Framework for Prevocational Training, to determine a list of

learning outcomes under the following headings:

• clinical management

• professionalism

• communication

• clinical problems and conditions

• procedures and interventions.

48. Three sub groups of the working group have been working on a number of key pieces of

work. One group was given the responsibility of working on the list of procedures and

interventions, a second group worked on the list of clinical problems and conditions, and

a third on the clinical management, professionalism and communication sections. Each

group have split the lists into the following:

1) An essential list of core skills needed by “any doctor, anytime” – these should be

gained by the end of PGY1.

2) Skills useful in a hospital or general practice – these should be gained by the end

PGY2.

3) Skills, to be acquired over time – aspirational – may be partly gained during PGY1

and PGY2 and further developed during vocational training.

One of the sub groups has drafted an assessment framework, and a system of recording

and monitoring this.

49. The work completed by the sub-groups will be considered at the next meeting of the full

working group on 6 August 2012. By the end of this meeting the working group hopes to

have:

• a completed draft of the curriculum framework, with specific learning outcomes to

be attained by the end of each PGY1 and PGY2

• agreed to a draft assessment framework, including a method for tracking, assessing

and recording skills and knowledge acquired during PGY1 and PGY2

• drafted guidelines on how learning objectives can be met in various settings,

including relief runs and locum positions

• drafted guidelines on time to be spent in different clinical settings (inpatient,

outpatient, and community based settings) to gain the required competencies.

50. A proposed timeline for the completion of the review of prevocational training is included

as Appendix 2. We are planning to commence a consultation process in February 2013.

This allows both the Education Committee and Council to consider the recommendations

from the working group and provide input.

51. We have continued to provide an update of our work on prevocational training to

stakeholders in individual and collective meetings. An update was also included in the

recent edition of MCNews.

Governance Structure for Prevocational Training

52. In April John Adams, Philip and I met with Des Gorman and Brenda Wraight from HWNZ

to discuss concerns about a lack of a governance structure for prevocational training.

Following this John Adams received a letter from Des suggesting a governance system

should be put in place to oversee prevocational training. John Adams has invited Des to

meet to discuss the possibility of collaboration through a combined Steering Committee

of the Council and HWNZ.

53. On 30 May 2012 John Adams, John Nacey, Philip and I met to discuss the options around

a governance structure, and agreed:

• A ‘Governance Group’- needs to include representation from the regulatory

authority (Medical Council) and a funding authority (HWNZ / MoH).

• It is best to avoid the use of the term ‘Governance Group’, and instead use the term

Steering Committee.

• Agreement should be captured in a MoU between Council and the HWNZ / MoH,

which clearly outlines roles and responsibilities (issues of standards by Council, and

issues of funding by HWNZ).

• An advisory group should be established to provide advice at a strategic level to the

Steering Committee, and this group should include a range of stakeholders.

Trainee Intern Registration (Medical Student Registration)

54. The working group met on 16 April 2012 to discuss the possibility and options for trainee

intern registration (formerly medical student registration). The group consists of

representatives from the Education Committee, Universities, New Zealand Medical

Students' Association, NZMSA, NZMA DiTC, national CMO group and Council staff.

55. At the meeting the group explored the issues pertaining to registering medical students

at their 6th year of medical school under the current legislation, the HPCAA 2003.

Concerns were raised over Council’s role in regulating medical students, and whether it

fits within Council’s primary purpose of protecting the public. Following a discussion

about the role of trainee interns in DHBs, the group agreed that there is a need for

medical student registration for the trainee intern year, primarily because it provides a

mechanism for protecting the public.

56. The working group agreed to the following actions from the meeting:

• Council’s internal legal team will review the current legislation, and determine what

impact that may have on how trainee intern registration can be implemented. If

required, a letter may need to be written to the Minister of Health to get him to

consider making changes to the current Act to remove any impediments or

otherwise provide separately for trainee intern registration.

• Council staff will draft a scope of practice for New Zealand and Australian trainee

interns and circulate it to the group for consideration.

• John Adams will write to Kevin Woods, Director-General of Health to outline the

Council’s progress on trainee intern registration, and the reasons for this initiative,

and seek feedback from Kevin about the potential for registering trainee interns.

57. The next trainee intern registration working group meeting date is yet to be confirmed,

and its direction may depend on the outcome from the above actions.

Regional Training Hubs

58. We have continued to liaise with regional training hubs. Philip and I attended a HWNZ

regional training hub meeting, and I have also met with the Midland regional training hub

to discuss Council’s work on prevocational training.

Review of the General Practice Education Programme (GPEP) and Rural Hospital

training programme in accordance with Council’s Memorandum of Understanding

59. The review of General Practice Education Programme (GPEP) is complete and Council is

now undertaking an accreditation process of the changes.

Accountability to the public and stakeholders

Stakeholder engagement plan

60. A stakeholder engagement plan has been implemented. A short report summarising all

meetings held with stakeholders and staff from across Council office is provided as

Appendix 3.

61. In the year July 2011 to June 2012 Council staff have attended approximately 230

stakeholder meetings.

62. The following is an statistical breakdown of meetings with stakeholders for the 2011 /

2012 year:

• 66 with medical colleges and associations

• 20 with DHBs and employers

• 11 with advocacy groups and unions

• 32 with government and government departments

• 45 with other regulatory authorities and international bodies

• 7 policy meetings with various colleges and associations

• 17 Council led workshops and meetings

• 2 Consumer Advisory Group meetings

• 6 stakeholder visitors to Council meetings

• 26 further meetings with a range of stakeholders including the HDC, CHRE, and MPS.

A report for stakeholder meetings for June and July 2012 is attached as Appendix 4.

Consumer Advisory Group (CAG)

63. The Consumer Advisory Group (CAG), provide advice and feedback to the Commissioner

on strategic issues including the handling of consumer complaints about health and

disability services, public interest issues and policy.

64. On 12 August 2011 Philip Pigou and George Symmes met with Tania Thomas, Deputy

Health and Disability Commissioner (HDC) to discuss Council’s participation in the HDC’s

Consumer Advisory Group (CAG). It was agreed that Council would use the services of the

CAG three times a year. The cost is $22,000 per annum.

65. Council’s first meeting with the CAG group was held on 17 November 2011 and attended

by Philip Pigou, Council member Laura Mueller and Michael Thorn. At this meeting Philip

provided an overview of Council’s role and function.

66. A second meeting was held on 19 April 2012. At its meeting the CAG discussed:

• the review of Good Medical Practice

• the review of Council’s statement Doctors and health related commercial

organisations

• the protocol for decision-making principles

• proposed text for Council’s website on information for consumers about conditions

on practice.

Annual branch advisory body meeting

67. The annual Branch Advisory Body (BAB), meeting was held on 26 September 2011 at Te

Papa. It was attended by 59 representatives from all of the BABs.

68. The topics covered at the meeting included:

• Review on prevocational training requirements

• Conflicts of interest – funding of CPD by pharmaceutical companies (presented by Dr

D Mangin)

• The MoU with the Australian Medical Council (AMC)

• Assessment of IMGs for a vocational scope of practice (presented by representatives

from RACP, RACS and RANZCOG)

• A general update on strategic initiatives.

69. The next annual BAB meeting will be held on 7 September 2012 at Te Papa. Please see

Appendix 5 for the draft agenda.

Protocol for decision making principles

70. The decision-making principles reflect both Council’s quasi-judicial function and

governance role. Although there are common principles for both roles, each role has

distinctly separate principles. The decision-making protocol identifies common and

separate principles, relevant to Council’s roles.

71. The protocol was reviewed by the Consumer Advisory Group (CAG) and several

amendments went back to Council at the reserve day meeting on 16 May 2012 for

Council’s consideration. At this meeting Council approved the revised protocol.

Reviewing and refreshing Council’s website

72. Council’s new website went live at 11.00am on 17 April 2012. It is continually being

reviewed and updated to reflect accurate and current information.

Media Day

73. The annual media day was held on 6 October 2011 with 8 journalists attending. At the

meeting attendees learnt about Council’s conduct and competence processes, with

presentations from staff as well as Dr Brendon Gray, Head of Medicolegal Services (New

Zealand), Medical Protection Society and Dr Paul Ockelford, Chair of the New Zealand

Medical Association.

Memorandum of Understanding with DHBs

74. The DHB Memorandum of Understanding (MoU) oversight group meet regularly to

monitor, evaluate and report on the performance of the MoU. Members of the oversight

group include representatives of the CMO group, primary care, the COO group, the HR

Manager group and Council staff.

75. At its meetings the group have discussed a number of strategic and operational issues

including the supervision of IMGs, recertification for doctors registered in a general scope

of practice, review of prevocational training, and issues raised by the DHBs in their input

register.

76. The DHB MoU oversight group meeting has agreed to meet three times in the 2012 /

2013 year.

MoU with primary care

77. Last year representatives from the RNZCGP and Council staff met to discuss the possibility

of establishing a working group to explore an MoU between Council and primary care.

The RNZCGP was positive about participating and could see merit in forming a working

group drawing on a number of stakeholders from primary care.

78. Council staff have contacted various PHOs and organisations seeking nominations for

members to join a working party to explore whether a similar agreement to that made

with DHBs can be put in place for primary care. A meeting will be scheduled for late this

calendar year to progress this work.

MoU with BABS

79. The MoU was completed and sent to all BABs for signing in October 2011. Most BABs

have signed the MOU. However RACS and RACP, in particular, have objected to certain

clauses and we are working together to agree on wording changes.

MoU with Southern Cross and other private hospitals

80. Meetings were held with Southern Cross in December 2011 and April 2012 with a view to

establishing a MoU clarifying roles and responsibilities in regard to the employment of

doctors and medical regulation. A third iteration of the draft MoU was provided to

Southern Cross on 1 August for consideration by the Southern Cross on 9 August.

Southern Cross are expecting to include comment on the MoU in a specialists newsletter

currently being prepared.

MoU with AMC and accreditation of colleges

81. The vocational colleges welcomed the move to have joint accreditation processes and we

developed a plan with each college to align the accreditation timeframes. This meant

some colleges had their New Zealand accreditation period reduced by 1 or 2 years and in

other cases extended by up to 2 years so that the next comprehensive report or full

accreditation process for each college could be a joint one. The situation with each

college was considered individually and appropriate arrangements made to ensure

maintenance of Council’s accreditation standards.

82. In the past year the following joint processes have been conducted under the MoU:

• College for Intensive Care Medicine of Australia and New Zealand (CICMANZ )–

integrated comprehensive report submitted (2011)

• RACP – integrated comprehensive report submitted (2011)

• RANZCP – (existing programme) integrated comprehensive report submitted (2011)

• RANZCP – assessment of new competency based programme (2012).

83. Implementation of the spirit of the MoU remains a work in progress and there are

concerns that assessment of Council’s additional criteria in the areas of cultural

competence, provision of advice on IMGs, recertification programmes and remediation of

poor performers is not yet fully integrated into the AMC’s processes. Written requests

have been made to the respective chairs of Medical Education Accreditation Committee

(MeDSAC) and Specialist Education Accreditation Committee (SEAC) that these concerns

will be addressed at MeDSAC and SEAC meetings later in 2012.

Attachments

84. Appendix 1 – Strategic directions benefits maps

Joan Crawford

Strategic Programme Manager

30 July 2012

MEDICAL WORKFORCE - benefits map for business plan 1 July 2011 – 30 June 2012

Capability Build Outcomes Business Change Outcomes Stakeholder Value Outcomes

Med

ica

l W

ork

forc

eS

trate

gic

Dir

ecti

on

Cri

tical

Bu

sin

ess

Assu

mp

tio

ns No

Requirement

for a Data

Warehouse

Large # of

Stakeholders can

be engaged /

aligned (incld

industrial groups)

High Risk

Medium Risk

Low Risk

Improved DHB

process & systems

for assessing

individual doctor

competence

Improved protection of

the health & safety of

members of the public

Created /

improved

standards for DHB

IMG orientation,

supervision &

credentialing

Final Business Benefits

Reduced / mitigated

risks to public

Improved

support provided

by supervisors to

IMGs

Improved Support

for IMG’s

Maintained /

improved

standards for

supervision

Improved

understanding of

IMG experiences in

moving to NZ to

work

Created

a central repository

of IMG orientation

and supervision

best practice

Induction of

IMGs is

Inconsistent

Smooth

Implementation

of changes

Across a Large #

of Stakeholders

Maintained /

increased

existing levels of

stakeholder

engagement &

input

KPI’s Key / Measures

Consistent Credentialing processes used by service

providers

Council’s requirements for Orientation and Induction of

Supervisors are published

Survey results are published

Services are accredited as Approved Practice Settings

Supervisors receive appropriate support

MCNZ

positioned to help

influence the

return of

graduates to

NZ

100% complete

Undertake a

supervisors needs

analysis

Created an

understanding of

supervisors needs

Improved baseline

data & information

on IMGs

Streamlined

processes for the

registration of IMGs

Detailed Analysis

Areas requiring

improvement

identified

Improve the

integration of IMGs

into the New

Zealand medical

workforce

Improved

mechanisms to

ensure that doctors

are competent & fit

to practise

Areas requiring

improvement

identified

Created a bank

of knowledge on

performance of

each BAB

Improved

performance and

quality of IMGs and

overall medical

professionImproved doctors

confidence that they

are working safely

within competency

levels

Quality &

Performance

Decreased %

of IMGs receiving

- poor reports

- standards issues

MCNZ

recognised as

providing improved

value to public and

its stakeholders

Reputation

Improved publics

level of trust

in IMGs

Maintained

International

networks &

relationships

Contributed to improved

international standards &

level of competence of

doctors

Current workforce

resource

capability &

willingness

Increased MCNZ

influence in

government

decision making

1

10

2

8

11

16 17

12

13

11

22

Created a

central repository of

credentialing best

practice

Areas requiring

improvement

identified

100% complete

Analysis of research

findings

Increased sharing

of best practice

amongst DHB and

employers

Best Practice

Improved

MCNZ’s ability to

provide recognition

of organisations

demonstrating best

practice

5100% complete

Develop

communication

& engagement

plan for all

stakeholders

100% complete

Review current DHB

& other employers’

orientation and

supervision

processes

100% complete

Review current DHB

& other employers’

credentialling

processes

100% complete

Implement the APS

model of

supervision.

100% complete

Confirm / develop

and agree the

definition of an IMG

(Local)

Ongoing

Lobby Gov &

employers to create

greater awareness &

influence change

20

Ongoing

Provision of

expertise &

resources to

Pacific countries

Ongoing

Assist / contribute

to development of

International

standards, e.g.

IAMRA

International Assistance – ongoing

21

100% complete

Research IMGs

experience with

orientation, supervision

and registration

100% complete

Make changes to

improve orientation

and supervision

standards & processes

100% complete

Develop and

facilitate supervisors

training and support

systems

3

6

9

14

15

18

19

100% complete

Implement new web

design

100% complete

Imbed ongoing

programme of

supervisor training

100% complete

Conduct survey of

doctors exiting NZ

90% complete

Work collaboratively

with BABs to

streamline processes

for assessing IMGs

applying for a

vocational scope

90% complete

Review current

vocational

registration

processes

100% complete

Disseminate best

practice standards &

recommendations to

stakeholder

organisations

Ongoing

Continue to

promote the

implementation of

APS

50% complete

Research qualifications

for special purpose

locum tenens

registration

4

7

Glossary

FTP – Fitness to practise

PDP – Personal development plan

PCI – Preliminary competence inquiry

EDA – Extended performance assessment

CPD – Continuing professional development

RPR – Regular practice review

VPA – Vocational practice assessments

BAB – Branch advisory body

DHB – District Health Board

RA – Regulatory authority

OngoingEngage with IAMRA and

other International medical regulators to explore proactive information

sharing

40% complete

Implement online

capacity for applications

for registration and

practising certificates

DMS: 711818

MEDICAL EDUCATION - benefits map for business plan 1 July 2011 – 30 June 2012

Capability Build Outcomes Business Change Outcomes Stakeholder Benefits / Outcomes

Med

ical

Ed

uc

ati

on

Str

ate

gic

Dir

ecti

on

Cri

tical

Bu

sin

ess

As

su

mp

tio

ns High Risk

Medium Risk

Low Risk


Supervisors will

meet MCNZ

expectations

KPI’s / Key Measures of Success

Prevocational framework implemented

Assessment tools are developed

Training plan for SMOs is implemented

List of core competencies for vocational scopes agreed

Improved transition from trainee intern to intern

Early intervention and rehabilitation for students with health concerns

Improved

Protection of the

Health & Safety of

Members of the

Public

Improved

competency levels

of Interns

Achieved setting

of required standard

of education &

training for interns &

PGY2

Assessment tools

are adequate

to measure

whether standards

are met

Regular &

ongoing

consultation will

occur

0% complete

Develop assessment

tools for assessment of

interns

Improved ability to

effectively integrate

the framework in to

operation

Ensured quality of

training by service

provider

Created

pre-vocational

training framework

Assessment Tool

Ongoing

Continue to

collaborate with

HWNZ

Resources will be

made available to

develop &

implement (Inclds

financial & people)

Key

stakeholders

have bought

into framework

Key stakeholders

will change current

behavior re training

of interns (allocation

& use of funding &

resources)

Stakeholders

will have a

sense of

ownership of the

framework

MCNZ

maintains links

with Health

Workforce

New Zealand

0% complete

Develop a training

plan for SMOs on

assessment method

Ongoing

dialogue

maintained

with

stakeholders

Trainee intern is

ready for work &

teachable

Training model

& structure is

determined

0% complete

Develop community

based and/or

emergency department

experience

50% complete

Develop a draft

curriculum framework 0% complete

Develop robust

processes for

accreditation of

services

100% complete

Review the length of

the internship

Created a common

understanding of

core competencies

across specialties

Created ability for

doctors to retrain in

different specialties

Pre

-vo

cati

on

al

0% complete

Develop review

processes for

assessment tools

Developed flexible

and agile workforce

training

Created greater

recognition of prior

learning

Key

stakeholders

consulted

13

1 9

4

3

6

15

7

11

30% complete

Develop standards,

supervision support, and

consistent assessment

procedures for

prevocational training that

includes boxes 4, 5, 6.

0% complete

Consult with

stakeholders on draft

curriculum framework

0% complete

Consider feedback to

determine requirements

for registration in a

general scope Created

assessment tool

which will be used to

assess individual

doctors against

framework

14

8

10

12

Glossary











100% complete

Develop and implement

communications plan

for consultation

(pre-vocational training)

2 100% complete

Consider feedback to

inform requirements for

registration in a general

scope

5

Eliminate duplication

of training for core

competencies

50% complete

Develop agreed list of

core competencies to

enter vocational training

for all scopes To include

in curriculum framework

0% complete

Develop a discussion

paper

0% complete

Consider feedback &

determine registration

requirements for

medical students

18 0% complete

Develop

and implement

communications plan

for consultation

1916

17Medical students

fit and competent to

be registered in a

general scope

Improved

continuum of

training from

university to interns

to vocation

Created ability to

intervene earlier and

target interventions

Improved ability to

identify and manage

FTP for medical

students

Increased

awareness of MCNZ

standards &

processes

Improved ability

to define clinical

responsibilities for

medical students

particularly in TI1

Interns are

competent and fit

to practise in a

general scope

Quality of training

for interns

Improved

prevocational

training

Improved

standards of junior

doctors

40% complete

Explore potential of

registration for medical

students under the

HPCAA

Vo

cati

on

al

20 90% complete

Review GPEP and Rural Hospital

training programme in accordance

with our Memorandum of

Understanding. The RNZCGP will

be a partner with HWNZ and the

Council in this project

Created ability to

meet emergent

health workforce

requirements

Improved

vocational training

Ongoing

Promote the

recognition of prior

learning across

specialties

DMS: 712507

FITNESS TO PRACTISE – benefits map for business plan 1 July 2011 – 30 June 2012


Critical

Busine

ss

Assum

ptions

All stakeholders

will support

changes and

make necessary

changes in their

business

MCNZ and

Stakeholders

have resources

to implement

changes

successfully

High Risk

Medium Risk

Low Risk


BABs will fulfill

role with

respect to poor

performers

Current IT systems

will capture

necessary data ie,

no major systems

investment required


Recertification programmes for general scope doctors are

accredited by MCNZ

BABs working within Council approved framework for both

CPD and monitoring

Evaluation report is completed and communicated

PCI is evaluated and reported

MCNZ provide guidance on standardised tools

Created a central

resource which can be

used to develop

improved risk mitigating

/ at risk identification

processes and tools

100% complete

Undertake research

into risk factors and

associated

weightings

Improved

mechanisms to

ensure doctors

practising

competently within

scope

Improved the

standards of the

profession and

assisted the

identification of poor

performance

Improved ability to

remediate or

manage poor

performers

Created the ability

to intervene earlier

Improved ability to

remediate or manage

poor performers

Improved medical

professionalism and

regulation including standards

of clinical competence, cultural

competence & ethical conduct

reflecting expectations of the

public, the profession and

stakeholders

No major critical

changes to

regulatory

framework

HPCAA enables

MCNZ to

develop policy to

proactively

manage

performance

Doctors will

address their

learning needs

through CPD

activities

Ongoing

Liaise with

regulatory

authorities re

research on fitness

to practise

Improved

stakeholder

collaboration

(includes BABs,

DHBs and RAs)

Create consistent

RPR processes

across scopes

Improved

professional self

regulation in

partnership with the

public

Created central

repository of RPR best

practice which can be

used to reduce

difference in practices

across scopes

Contrib

utio

n to

Sta

kehold

er

FTP means: -

- Competence

- Health

- Conduct

(for practice)

Optimized

mechanisms to

ensure doctors are

competent & fit to

practise

Improved

understanding of

why doctors perform

poorly

Created a

common

understanding of

competence &

fitness to practice

(FTP)

Improved

Knowledge

Continuous

quality

improvement

principles will

be used

Proactive

rather than

reactive

1

9

10

14

11

8

90% complete

Review and develop multi-

source feedback tools (for

validity and reliability) to

assess cultural competence

and professionalism, for use

in:

Performance

assessments

Vocational practice

assessments

Regular practice review

100% complete

Provide guidance for

doctors on what to do

when they have concerns

about colleagues

13

7

12

5

4

20% complete

Implement

evaluation

programme for RPR

for general scope

doctors

Ongoing

Co-ordinate / facilitate

the gathering &

sharing of best

practice about RPR

across stakeholders

Ongoing

Promote the best

practice application of

credentialing across

all service providers

public/private

Reduced risk of

doctors practising

outside levels of safe

competence

Improved protection

of the health and

safety of members of

the public

3

6

Glossary











100% complete

Implement Council’s policy for

strengthened recertification

requirements that includes RPR

& a PDP for doctors registered

in a general scope of practice

and approve programme(s)

Improved the

mechanisms for

doctors to identify

their own learning

needs

Improved the

opportunity for

doctors to target

their CPD activities

to their identified

learning needs

Improved &

targeted CPD activities

80% complete

Review clinical audit

requirements as part of

CPD and provide

guidance on Council’s

expectations

2

100% COMPLETE

Undertake pilot of

preliminary

competence inquiry

and evaluate

Fit

ne

ss t

o P

racti

ce –

Str

ate

gic

Dir

ecti

on

Ongoing

Promote best

practice for

credentialling

Ongoing

Monitor and review

international

developments in research

on extended performance

assessments

Ongoing

Promote the best

practice application of

credentialing across

all service providers

public/private

Ongoing

Implement new /

improved

standardised process,

models, tools across

all stakeholders

Ongoing

Assist and support

medical colleges and

BABs to develop their

RPR processes for

vocational scope

DMS: 711795

ACCOUNTABILITY TO THE PUBLIC AND STAKEHOLDERS - benefits map for business plan 1 July 2011 – 30 June 2012


Ac

co

un

tab

ilit

y t

o t

he

Pu

blic

an

d S

takeh

old

ers

-S

trate

gic

Dir

ecti

on

10%

100 % complete

Review stakeholder

engagement and

explore new methods

of public engagement

Cri

tical

Bu

sin

ess

As

su

mp

tio

ns Public has a

need or desire to

know more about

the MCNZ role &

services

IT & other

systems will

support tracking

of comms &

correspondence

High Risk

Medium Risk

Low Risk


Increased

involvement by

stakeholders in

policy development

will lead to better

policies


Created processes which promote and support self-regulation in

partnership with the public

Achieved optimal standards of medical practice as agreed by all

stakeholders

Improved Protection

of the Health &

Safety of Members

of the Public

MCNZ has

sufficient

resources and

capacity to

implement

changes

Other Agencies

want / need

increase in

collaboration

Improved MCNZ’s

relationship and

partnership with the

public, profession and

stakeholders

100% complete

Review existing

communication

plans, systems and

governance

Identified areas

for improvement

& development

Improved

resources

available to interact

with stakeholders

Improved

stakeholder access

to MCNZ

information

(e.g. web site)

Created better

informed

stakeholders

Created improved

methods, process &

tools for managing

consultation & feedback

from stakeholders

during policy

development

Improved

Council’s ability &

resources to address

& respond to the key

issues / concerns in a

timely fashion

Improved

understanding of roles

& responsibilities

between stakeholders

& council

Created an environment

& tools that allow for

productive stakeholder

submissions

Goal 2.

MCNZ

fully fulfils its role /

obligations under the

Health Practitioners

Competence

Assurance Act

2003

100 % Complete a

stakeholder

analysis / survey /

review (Completed

2007)

Improved

MCNZ’s

understanding of

public, professions &

stakeholders needs,

key issues &

concerns

Created improved

processes, methods &

tools for communication

for staff & Council

members

Existing best

practices

identified &

maintained

Decreased

stakeholder

frustration with the

current consultation

process

Improved

responsiveness to

stakeholders needs /

requests

Improved

transparency of

MCNZ processes &

activities

Improved

stakeholders

perception of

Council / satisfaction

level

Improved

stakeholder

satisfaction levels

with the work /

services MCNZ

providesCreated a

forum for the

promotion of MCNZ

interests, e.g. medical

migration, F2P.

Improved

collaboration within

the sector (inclds

agencies, e.g. HDC,

ACC, MOH, quality

committees,

regulatory bodies)

Improved the

exchange of

information

Improved delivery of

planned communication

(i.e. it actually occurs)

Improved

stakeholder

understanding

of policy intent

Media

Decreased media

misinformation

Eliminated the

perception that

MCNZ protects

doctors

Improved

communications

to stakeholder

(i.e. right

information at the

right time)

Eliminated the

delivery of

inconsistent

messages

Communication

Improved MCNZ

feedback to doctors,

stakeholders &

public

Improved MCNZ’s

participation,

engagement,

transparency and

accountability to all

stakeholders

MCNZ Engagement & Feedback

Appropriate actions

implemented to

manage change

(internal &

external), e.g. skill

& web development

Eliminated /

decreased bad

publicity about

MCNZ

Improved public

understanding &

knowledge of the

role / purpose of

MCNZ

17

2

3

4

18

19

6

8

1

10%

100% complete - Define

MCNZ decision making

principles.

100% complete

Develop policy &

standard processes &

tools for consultation

and receiving feedback.

100% complete

Develop an annual

annual stakeholder

engagement plan

for meetings with

Minister, BABs,

DHBs & MOH

60% complete

Improve process /

policy / guidelines

for the disclosure

and sharing of

information

100 % complete

Repeat the

stakeholder

analysis / survey /

review (2010)

Provide for greater

public engagement

100% complete

Establish MoUs

with DHBs Improved

partnership &

relationships with

key stakeholders

100% complete

Implement the stakeholder

engagement plan for meetings

with Minister, BABs, DHBs &

MOH

10

11

14

7

30% complete

Develop MoUs with:

- HWNZ

- the Australian Health Practitioner Regulation

Agency and/or the Medical Board of Australia

- Primary care stakeholders

- Southern Cross

100% complete

Implement a new MCNZ web

design that will ensure

information and resources for

patients and the public are easily

accessible

100% complete

Develop a communication

plan for

Practice visit project

Supervision project

Consistent with Council’s

communication strategy

100 % complete

Establish a combined public

advisory group with the HDC to

achieve greater public

engagement in medical

regulation

90% completeAlign processes with the AMC’s for accreditation

of Australasian Colleges/all AUS & NZ medical

schools, & ensure NZ standards are reviewed &

reported in accreditation reports

12 13

15

90% complete

Review MoUs

with BABs

100% complete

Establish MoU

with the AMC

5

9

Glossary











Improved

engagement &

participation with

stakeholders & the

public

Decreased legal risk

associated with

consultation process

Improved the quality

of policies

100% complete

Monitor implementation &

effectiveness of MoUs with

DHBs

16

Ongoing

Maintain annual

engagement plan

DMS: 712561

14 and 15 august 2012 council strategic and policy ... · 12. nz bpac have now implemented the...

Documents