Quality assurance of medical revalidation – the same principles apply as for appraisal itself
Many Trusts and other designated bodies and Responsible Officers are now thinking about how to facilitate quality assuring their revalidation system. Having been involved in this kind of work for some time, it seems that the same principles apply to this task as do appraisal and revalidation itself.
- It’s summative, yet should be delivered in a developmental way.
- It requires the assimilation and review of supporting information.
- Strengths and development needs should be agreed.
- If done well, it can be much more than a tick box exercise.
Quality assurance in revalidation
Quality assurance of medical revalidation is the process of assessing the policies and procedures an organisation has in place and the attitudes and competencies of the people involved in implementing those policies and procedures to ensure the management for medical revalidation within an organisation is robust, efficient and reliable. These processes should be streamlined and built into clinical governance with the board fully engaged with revalidation.
The details of quality assurance recommendations from the RST (Revalidation Support Team) are outlined in the documents “Information Management for Medical Revalidation in England” (March 2012) and “Quality Assurance of Medical Appraisers” (March 2012). Broadly speaking, the Responsible Officer (RO) is accountable for revalidation and the systems and processes in place. Therefore, they are also responsible for implementing quality assurance.
There are a number of levels available to assure quality:
- Quality assuring the Medical Appraiser including their methods, attitude, and competency
- Conducting an annual review of appraisal and revalidation systems and processes to check they are up to date; functioning efficiently and effectively; and managed correctly.
- A full appraisal and revalidation audit by an external person/organisation.
Why is it important?
The reason for revalidation is to check that doctors are fit and able to practice, and therefore the process that examines this must be robust and of a high standard.
Assessing the quality of the revalidation and appraisal process and appraisers is important for many reasons:
- To ensure the revalidation process is meeting its aims and objectives.
- To ensure consistency within the organisation.
- To get a consistent approach across organisations.
- To ensure the guidance is being adhered to.
- To check the process is of a high standard and is robust.
- To check the appraisers’ ability to carry out a quality appraisal and make appropriate recommendations.
- To check the quality of the training appraisers receive.
- To check the quality of appraisal outputs.
- To give RO’s confidence in appraisal information from previous employers when making revalidation recommendations.
- To ensure the act of checking a doctor’s ability to practice is credible.
In addition, in the future if incidents occur that bring into question a particular doctors ability to practice one of the first things that will be referred to is that doctors revalidation history and how they came to this point. If it is found that something was missed during the revalidation process that might have prevented the incident or identified the doctor as a risk, the processes will come into question and then more people will become accountable along with the Trust. The impact of an isolated incident on a Trust and it’s officers can be reduced if all processes have been recorded, followed and have undergone regular quality checking.
How do you quality check appraisers?
There are a number of ways this can be done and the starting point would be a regular performance review. Section 6 of the “Quality Assurance of Medical Appraisers” document from the RST recommends an annual review of performance for all medical appraisers. Other options can also be found there. For the most thorough approach you can use a combination of methods e.g.
- Performance review.
- Self-assessment.
- Knowledge based assessment.
- Feedback from appraisees.
- Observation at a mock appraisal with specific criteria included to fully test the appraisers ability.
- Review of appraisal outputs including PDP and appraisal summaries.
Annual review of appraisal systems and processes
This can be an internal or external review, with an external review holding more weight under scrutiny. Policies and procedures should be reviewed using the Own Risk and Solvency Assessment (ORSA) framework and the management of those processes should also be checked to ensure polices are adhered to and processes are followed in full and consistently.
How do you audit the revalidation process?
This is an in depth process which can be carried out every 3-5 years. The scope of the work covers: Leadership, policy, resources, culture and practice.
As revalidation is heavily dependent on the quality of the appraisal system and process, reviewing the appraisal plays a large part of this. This part is a more in depth version of quality checking appraisers and covers all appraisers and a large number of appraisees.
It also pays close attention to key processes including how recommendations are made and the robustness of the process for identifying, recording and updating the list of doctors within the Designated Body to be revalidated.
Outcomes of quality assurance
After a full audit a report should be presented to all the key managers of the revalidation process which will include findings and recommendations. Following this, an action plan should be put in place by those responsible for revalidation and appraisal. If the Trust completed an annual review or a quality check of appraisers then they should still implement a plan for going forward to deal with any issues and identify the parts of the processes that are successful.
This process may prompt a revision of policies/procedures or identify training needs which can be addressed. It might highlight for example a need for a better system for appraisers to keep records or a simpler administration system.
In rare circumstances some appraisers may be identified as not being suitable to appraise at that time either because they do not have the right attributes or they have failed to maintain and update the knowledge and skills required to perform this role. If this happens these individuals should not continue to carry out medical appraisals.
Whatever the outcomes of the quality assurance process it is important to remember the reasons for doing it and in particular knowing the Trust, the responsible officer and other staff members have been safeguarded against the consequences of isolated cases that can drastically effect reputations.