scholarly journals Serious misconduct of health professionals in disciplinary tribunals under the National Law 2010–17

2020 ◽  
Vol 44 (2) ◽  
pp. 190 ◽  
Author(s):  
Jenni Millbank
Keyword(s):  
New York ◽  
Health Professionals ◽  
Clinical Care ◽  
Sexual Misconduct ◽  
Health Professions ◽  
Health Practitioner ◽  
Legal Representation ◽  
Chi Squared ◽  
Uniform Manner ◽  
Board Level

Objective There is a gap in knowledge regarding serious disciplinary matters concerning health professionals under the Health Practitioner Regulation National Law Act 2009 (hereafter ‘National Law’). The present study applies a typology of misconduct to the first 7 years of available tribunal cases under the National Law brought against the five most populous regulated health professions with the overarching goal of mapping the relationship between type of misconduct and outcome. As subquestions, the study examined whether the ostensibly uniform law is producing consistency of outcomes, both between the professions and between jurisdictions. Methods All publicly available Australian tribunal-level decisions concerning complaints of serious misconduct and/or impairment brought against the five most populous regulated health professions (nurses and midwives, doctors, psychologists, pharmacists, and dentists) were gathered from 1 July 2010 to 30 June 2017. Decisions were coded for case and respondent attributes, the type/s of misconduct alleged, whether proved, and the relevant disciplinary outcome. Respondent attributes were: profession, sex, legal representation, and certain identified ‘risk’ factors from previous studies. The type of allegation was coded based on five main categories or heads of misconduct, with subtypes within each. Outcomes for proved conduct were coded and categorised for severity. Analyses of cases was conducted using SPSS, version 21 (IBM, New York, NY, USA). Data was subject to statistical analysis using Pearson’s Chi-squared test with an α value of 0.05. Results Major variations were identified in outcomes across the professions, with doctors being subject to less severe outcomes than other professions, in particular compared with nurses, even when the same main head of misconduct was in issue. Differences in legal representation did not completely account for such variation. Marked disparities were also identified between outcomes in different states and territories, suggesting that the National Law is not being applied in a uniform manner. Conclusion Tribunal cases reflected complaint data in that: (1) male practitioners were greatly over-represented as respondents; (2) outcomes were most severe for sexual misconduct and least severe for clinical care; and (3) doctors faced less severe outcomes than other professions. There were also significant variations in severity of outcome by jurisdiction. Variations were more pronounced when deregistration was the focus of analysis. What is known about this topic? Existing research on complaints data under the National Law in place since 2010 has suggested that doctors may be receiving less severe outcomes than other professions at board level. There is a gap in knowledge concerning serious disciplinary matters heard by tribunals. Unlike data on complaints against regulated health professionals collated by AHPRA, legal tribunals, which hear only the most serious matters, do not record data on cases in a consistent or centralised form. What does this paper add? This study is the first to compare tribunal outcomes for the five most populous professions by reference to the type of misconduct proved. The finding that different professions are receiving different outcomes for the same malfeasance is novel. Other novel findings include significant variations in severity of outcome by jurisdiction, more pronounced variations in outcomes by both profession and jurisdiction when deregistration was the focus of analysis and variations in outcome according to legal representation. What are the implications for practitioners? There are major implications for policy makers and decision makers in terms of whether the National Law is operating consistently, with important outcomes for practitioners in terms of equitable and fair treatment when facing disciplinary charges.

scholarly journals Health Practitioner Regulation: Has the National Law Produced National Outcomes in Serious Disciplinary Matters?

2019 ◽  
Vol 47 (4) ◽  
pp. 631-654
Author(s):  
Jenni Millbank
Keyword(s):  
Health Professionals ◽  
Health Professions ◽  
Health Practitioner ◽  
Contributing Factors ◽  
Professional Misconduct ◽  
National Regulation ◽  
Uniform Manner ◽  
Nurses And Midwives

Since 2010, a national scheme regulates the registration, accreditation and discipline of health professionals in Australia (the ‘National Law’). This research examines disciplinary cases from tribunals nationwide to address the question: Has the national regulation of health professionals produced consistency in outcomes in serious cases of professional misconduct? All publicly available Australian tribunal-level decisions concerning complaints of serious misconduct and/or impairment brought against the five most populous regulated health professions (nurses and midwives, doctors, psychologists, pharmacists and dentists) were analysed for the period from 1 July 2010 to 30 June 2017. Each case was coded by reference to a typology of misconduct, practitioner characteristics and outcome, allowing for comparisons to be drawn both as between the professions and as between jurisdictions. Major disparities were identified in outcomes across the professions, with doctors being subject to less severe outcomes than other professions, in particular in comparison with nurses, even when the same main head of misconduct was in issue. Marked disparities were also identified between outcomes in different states and territories, suggesting that the National Law is not being applied in a uniform manner. This article examines these disparities and explores possible contributing factors.

scholarly journals Profile of the most common complaints for five health professions in Australia

2020 ◽  
Vol 44 (1) ◽  
pp. 15
Author(s):  
Merrilyn Walton ◽  
Patrick J. Kelly ◽  
E. Mary Chiarella ◽  
Terry Carney ◽  
Belinda Bennett ◽  
...  
Keyword(s):  
Clinical Care ◽  
Health Professions ◽  
Work Environments ◽  
Health Practitioner ◽  
Medical Practitioners ◽  
Australian Health ◽  
Health Impairment ◽  
South Wales ◽  
Work Tasks ◽  
National Cohort

Objective The aims of this study were to profile the most common complaints and to examine whether any demographic factors are associated with receiving a complaint for five health professions in Australia. Methods A national cohort study was conducted for all complaints received for medicine, nursing/midwifery, dentistry, pharmacy and psychology from 1 July 2012 to 31 December 2013 (18 months). Data were collected from the Australian Health Practitioner Regulation Agency (AHPRA), the New South Wales (NSW) Health Professional Councils’ Authority and the NSW Health Care Complaints Commission. The frequency and risk of complaints were summarised for the five professions and by demographic information. Results There were 545283 practitioners registered with AHPRA between 1 July 2012 and 31 December 2013, consisting of 20935 dentists, 101066 medical practitioners, 363040 nurses/midwives, 28370 pharmacists and 31872 psychologists. During the study period there were 12616 complaints, corresponding to an annual rate of 1.5 per 100 practitioners. Complaints were most common for doctors and dentists (5% per annum per practitioner) and least common for nurses/midwives (0.5% per annum per practitioner). Sex (P<0.01), age (P<0.01) and country of birth (P<0.01) were all associated with risk of complaint. The most common complaints were clinical care (44% of all complaints), medication (10%) and health impairment of the practitioner (8%). Types of complaints varied by profession, sex and age. Conclusions The risk of a complaint is low, but varies by profession and demographics. The types of complaints also vary by profession and demographics. Differences between professions is most likely driven by their different work tasks and work environments. What is already known on this subject? Although complaints are summarised annually from state and national health regulators, no overall national summary of complaints across professions exists. Thus, it is difficult to examine which complaints are most common, how professions differ from each other or what factors may be associated with risk and type of complaint. Previous studies have primarily focused on a single profession, such as medicine, where, for example, the number of prior complaints, sex, doctor speciality and age have been found to be associated with recurrent complaints. What does this paper add? This paper is the first of this kind to provide a national summary of all complaints from five of the most common health professions in Australia. We found that regardless of profession, men were at least twice as likely to have a complaint made against them than women. We also found that the types of complaint differed between men and women. There were similarities across professions for the most common types of complaints, but clear differences between professions were also noted. Not surprising, clinical care was typically the most common type of complaint for the five professions, but somewhat surprising was the inclusion of health impairment as one of the most common types of complaints. What are the implications for practitioners? Identifying the most common complaints, and the factors associated with these, may assist practitioners to understand their risk(s) of complaint and could potentially assist educators and regulators develop education programs that help reduce complaints.

scholarly journals Characteristics and predictors of regulatory immediate action imposed on registered health practitioners in Australia: a retrospective cohort study

2020 ◽  
Vol 44 (5) ◽  
pp. 784
Author(s):  
Owen M. Bradfield ◽  
Marie M. Bismark ◽  
David M. Studdert ◽  
Matthew J. Spittal
Keyword(s):  
Substance Abuse ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Care ◽  
Sexual Misconduct ◽  
Health Practitioner ◽  
The Public ◽  
Australian Health ◽  
Health Practitioners

ObjectiveImmediate action is an emergency power available to Australian health practitioner regulatory boards to protect the public. The aim of this study was to better understand the frequency, determinants and characteristics of immediate action use in Australia. MethodsThis was a retrospective cohort study of 11200 health practitioners named in notifications to the Australian Health Practitioner Regulation Agency (AHPRA) between January 2011 and December 2013. All cases were followed until December 2016 to determine their final outcome. ResultsOf 13939 finalised notifications, 3.7% involved immediate action and 9.7% resulted in restrictive final action. Among notifications where restrictive final action was taken, 79% did not involve prior immediate action. Among notifications where immediate action was taken, 48% did not result in restrictive final action. Compared with notifications from the public, the odds of immediate action were higher for notifications lodged by employers (mandatory notifications OR=21.3, 95% CI 13.7–33.2; non-mandatory notifications OR=10.9, 95% CI 6.7–17.8) and by other health practitioners (mandatory notifications OR=11.6, 95% CI 7.6–17.8). Odds of immediate action were also higher if the notification was regulator-initiated (OR=11.6, 95% CI 7.6–17.8), lodged by an external agency such as the police (OR=11.8, 95% CI 7.7–18.1) or was a self-notification by the health practitioner themselves (OR=9.4, 95% CI 5.5–16.0). The odds of immediate action were higher for notifications about substance abuse (OR=9.9, 95% CI 6.9–14.2) and sexual misconduct (OR=5.3, 95% CI 3.5–8.3) than for notifications about communication and clinical care. ConclusionsHealth practitioner regulatory boards in Australia rarely used immediate action as a regulatory tool, but were more likely to do so in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct. What is known about this topicHealth practitioner regulatory boards protect the public from harm and maintain quality and standards of health care. Where the perceived risk to public safety is high, boards may suspend or restrict the practice of health practitioners before an investigation has concluded. What does this paper add?This paper is the first study in Australia, and the largest internationally, to examine the frequency, characteristics and predictors of the use of immediate action by health regulatory boards. Although immediate action is rarely used, it is most commonly employed in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct. What are the implications for practitioners?Immediate action is a vital regulatory tool. Failing to immediately sanction a health practitioner may expose the public to preventable harm, whereas imposing immediate action where allegations are unfounded can irreparably damage a health practitioner’s career. We hope that this study will assist boards to balance the interests of the public with those of health practitioners.

scholarly journals How hospitalized patients evaluate and report their pain together with nurses: A scoping review

2021 ◽  
pp. 205715852110134
Author(s):  
Bente Dale Malones ◽  
Sindre Sylte Kallmyr ◽  
Vera Hage ◽  
Trude Fløystad Eines
Keyword(s):  
Scoping Review ◽  
Pain Assessment ◽  
Health Professionals ◽  
Clinical Care ◽  
Hospitalized Patients ◽  
Assessment Tools ◽  
Post Surgery ◽  
Reliable Assessment ◽  
Scoping Reviews ◽  
The Relationship

Pain assessment tools are often used by patients to report their pain and by health professionals to assess patients’ reported pain. Although valid and reliable assessment of pain is essential for high-quality clinical care, there are still many patients who experience inappropriate pain management. The aim of this scoping review is to examine an overview of how hospitalized patients evaluate and report their pain in collaboration with nurses. Systematic searches were conducted, and ten research articles were included using the PRISMA guidelines for scoping reviews. Content analysis revealed four main themes: 1) the relationship between the patient and nurse is an important factor of how hospitalized patients evaluate and report their post-surgery pain, 2) the patient’s feelings of inconsistency in how pain assessments are administered by nurses, 3) the challenge of hospitalized patients reporting post-surgery pain numerically, and 4) previous experiences and attitudes affect how hospitalized patients report their pain. Pain assessment tools are suitable for nurses to observe and assess pain in patients. Nevertheless, just using pain assessment tools is not sufficient for nurses to obtain a comprehensive clinical picture of each individual patient with pain.

scholarly journals Changing relationships: how does patient involvement transform professional identity? An ethnographic study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045520
Author(s):  
Marie-Pierre Codsi ◽  
Philippe Karazivan ◽  
Ghislaine Rouly ◽  
Marie Leclaire ◽  
Antoine Boivin
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Health Professionals ◽  
Clinical Care ◽  
Ethnographic Study ◽  
Structured Interviews ◽  
Administrative Team ◽  
Nurse Clinician ◽  
New Perspective ◽  
Relational Framework

ObjectivesTo understand identity tensions experienced by health professionals when patient partners join a quality improvement committee.DesignQualitative ethnographic study based on participatory observation.SettingAn interdisciplinary quality improvement committee of a Canadian urban academic family medicine clinic with little previous experience in patient partnership.ParticipantsTwo patient partners, seven health professionals (two family physicians, two residents, one pharmacist, one nurse clinician and one nurse practitioner) and three members of the administrative team.Data collectionData collection included compiled participatory observations, logbook notes and semi-structured interviews, collected between the summer of 2017 to the summer of 2019.Data analysisGhadiri’s identity threats theoretical framework was used to analyse qualitative material and to develop conceptualising categories, using QDA Miner software (V.5.0).ResultsAll professionals with a clinical care role and patient partners (n=9) accepted to participate in the ethnographic study and semi-structured interviews (RR=100%). Transforming the ‘caregiver–patient’ relationship into a ‘colleague–colleague’ relationship generated identity upheavals among professionals. Identity tensions included competing ideals of the ‘good professional’, challenges to the impermeability of the patient and professional categories, the interweaving of symbols associated with one or the other of these identities, and the inner balance between the roles of caregiver and colleague.ConclusionThis research provides a new perspective on understanding how working in partnership with patients transform health professionals’ identity. When they are called to work with patients outside of a simple therapeutic relationship, health professionals may feel tensions between their identity as caregivers and their identity as colleague. This allows us to better understand some underlying tensions elicited by the arrival of different patient engagement initiatives (eg, professionals’ resistance to working with patients, patients’ status and remuneration, professionals’ concerns toward patient ‘representativeness’). Partnership with patients imply the construction of a new relational framework, flexible and dynamic, that takes into account this coexistence of identities.

scholarly journals Gastrointestinal endoscopy during the coronavirus pandemic in the New York area: results from a multi-institutional survey

2020 ◽  
Vol 08 (12) ◽  
pp. E1865-E1871
Author(s):  
Srihari Mahadev ◽  
Olga C. Aroniadis ◽  
Luis H. Barraza ◽  
Emil Agarunov ◽  
Michael S. Smith ◽  
...  
Keyword(s):  
New York ◽  
Clinical Care ◽  
Patient Characteristics ◽  
Feeding Tube ◽  
Tube Placement ◽  
Peak Time ◽  
City Region ◽  
Peak Period ◽  
Hospital System ◽  
The Impact

Abstract Background and study aims The coronavirus disease 2019 (COVID-19), and measures taken to mitigate its impact, have profoundly affected the clinical care of gastroenterology patients and the work of endoscopy units. We aimed to describe the clinical care delivered by gastroenterologists and the type of procedures performed during the early to peak period of the pandemic. Methods Endoscopy leaders in the New York region were invited to participate in an electronic survey describing operations and clinical service. Surveys were distributed on April 7, 2020 and responses were collected over the following week. A follow-up survey was distributed on April 20, 2020. Participants were asked to report procedure volumes and patient characteristics, as well protocols for staffing and testing for COVID-19. Results Eleven large academic endoscopy units in the New York City region responded to the survey, representing every major hospital system. COVID patients occupied an average of 54.5 % (18 – 84 %) of hospital beds at the time of survey completion, with 14.5 % (2 %-23 %) of COVID patients requiring intensive care. Endoscopy procedure volume and the number of physicians performing procedures declined by 90 % (66 %-98 %) and 84.5 % (50 %-97 %) respectively following introduction of restricted practice. During this period the most common procedures were EGDs (7.9/unit/week; 88 % for bleeding; the remainder for foreign body and feeding tube placement); ERCPs (5/unit/week; for cholangitis in 67 % and obstructive jaundice in 20 %); Colonoscopies (4/unit/week for bleeding in 77 % or colitis in 23 %) and least common were EUS (3/unit/week for tumor biopsies). Of the sites, 44 % performed pre-procedure COVID testing and the proportion of COVID-positive patients undergoing procedures was 4.6 % in the first 2 weeks and up to 19.6 % in the subsequent 2 weeks. The majority of COVID-positive patients undergoing procedures underwent EGD (30.6 % COVID +) and ERCP (10.2 % COVID +). Conclusions COVID-19 has profoundly impacted the operation of endoscopy units in the New York region. Our data show the impact of a restricted emergency practice on endoscopy volumes and the proportion of expected COVID positive cases during the peak time of the pandemic.

The Mount Sinai (New York) Visiting Doctors Program: Meeting the Needs of the Urban Homebound Population

2011 ◽  
Vol 12 (4) ◽  
pp. 139-143 ◽  
Author(s):  
Katherine Ornstein ◽  
Cameron R. Hernandez ◽  
Linda V. DeCherrie ◽  
Theresa A. Soriano
Keyword(s):  
New York ◽  
Social Work ◽  
Clinical Care ◽  
Older Individuals ◽  
Social Service Agencies ◽  
Complex Needs ◽  
Home Based ◽  
Major Teaching ◽  
Mount Sinai ◽  
Physician Availability

The Mount Sinai Visiting Doctors program, a joint program of Mount Sinai Medical Center’s Departments of Medicine and Geriatrics, is a large multidisciplinary teaching, research, and clinical care initiative serving homebound adults in Manhattan since 1995. Caring for more than 1,000 patients annually, the physicians of Visiting Doctors make more than 6,000 urgent and routine visits each year, making it the largest program of its kind in the country. Services include 24–hour physician availability, palliative care, social work case management, collaboration with nursing agencies, and in-home specialty consultation. The program serves many individuals who have previously received inadequate and inconsistent medical care. Patients are referred by social service agencies, local physicians, and hospitals and are primarily frail older individuals with complex needs. Funded by Mount Sinai and private support, the program serves as a major teaching site for medical, nursing, and social work trainees interested in home-based primary care.

scholarly journals New York Transplant Teams Versus COVID-19

2020 ◽  
Vol 30 (3) ◽  
pp. 194-198 ◽  
Author(s):  
Daryle Blackstock ◽  
Laura Butler ◽  
Samantha Delair ◽  
Katherine Dokus ◽  
Farrington Eileen ◽  
...  
Keyword(s):  
New York ◽  
Organ Procurement ◽  
Clinical Care ◽  
New York State ◽  
Severity Of Illness ◽  
Surgical Patient ◽  
Work Processes ◽  
Hospital Units ◽  
Lifetime Experience ◽  
Organ Procurement Organizations

New York State, and especially New York City, were hit hard by the coronavirus disease 2019 (COVID-19) virus. While we followed its course in other parts of the world, and began preparations, there was no way we could have been prepared for the volume and severity of illness that began to overflow in our emergency departments and hospital units. We expanded intensive care units into our medical surgical units while turning conference rooms into medical surgical patient care areas. Clinicians at the bedside described war-like situations with numerous patients arresting and requiring ventilator support. Our New York consortia and organ procurement organizations met online 3 times a week and shared creative strategies to address clinical care and work processes. We would like to share strategies from what we hope was a once in a lifetime experience.

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