Trevor’s Take On: Building a Better Practice Improvement Program

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Physician Practice Improvement

While the concept of ongoing quality improvement is not new to physicians, the HOW varies considerably across Canada and around the world. This column explores how the CPSA is reviewing our role in that process, how physicians can be involved in developing a new approach, and how our work fits into the global picture.

In Alberta, the CPSA is mandated to ensure physicians remain competent throughout their careers, and to date, that has meant physicians participated in the Physician Achievement Review (PAR) Program, completed mandatory CPD requirements, took part in Infection Prevention and Control Inspections, received prescribing feedback and/or were involved in a practice review/assessment.

Recently, we’ve started to ask Alberta physicians to help us. We’re reaching out through surveys, scheduling focus groups, making presentations, and having face to face conversations with physicians throughout the province. We want to understand the type of information and feedback that would be most useful to you as individuals, as groups of physicians and as part of a team of health care professionals.

Understand and Assess Your Practice

Understanding your practice begins by asking physicians to describe all aspects of their practice including professional roles and responsibilities (clinician; educator; researcher; administrator; etc.), the populations they serve as clinicians (e.g. breast cancer patients) and their practice setting (e.g. academia, solo or group practice, or community practice). This framework is generic enough to capture all practising physicians, including those like me who primarily do administrative work; I think most physicians will identify themselves as a combination of clinician, educator, and administrator (of their own practice, at a minimum).

Assessing one’s practice asks physicians how they get feedback about how well they function in each of those areas of practice (as clinician, educator and administrator, for example). In the clinical arena it is important, therefore, to know what patient population you serve. What conditions do they present with? And then to ask how well you manage those patients and those conditions?

What do you think you’re best at? Where do you feel you need help? What information would support those beliefs? Where can you get feedback about how well you function in practice? What data can you glean from your own patient records? What databases have information that might provide insights into your practice? Feedback should also be sought about how well one functions as an educator (student survey reports, for example) and administrator (ask your office staff how well things are working – and not working – and what they suggest needs to change).

We Are Not Recreating the Wheel

For many of you, this approach is not novel. I know of Primary Care Networks in Alberta currently getting information from the AHS data warehouse or the Health Quality Council about their practices, all for quality assurance and improvement purposes. Transplant physicians have registries and benchmark their results against national and international standards. Many cancer surgeons also participate in registries and use that data in order to compare their results and look for opportunities for improvement.

I note, for example, as a member of the Royal College, that participating in MainPro requires me to gain some of my CPD credits by undergoing assessment; I suspect this will also become a requirement of the MOC program of the CFPC. The point is that assessment and feedback are critical elements of practice, essential to identifying learning needs and, therefore, fundamental to quality improvement in practice and one’s continuing professional development. As the regulator, we need to ensure that our members stay competent throughout their careers, and as physicians, we want to know we’re doing the best we can for the patients and populations we serve.

How Is The CPSA Aligning With Others?

Over the past couple of years I’ve participated in a group focused on ensuring physicians remain competent throughout their careers. In the UK, this goal is known as revalidation; in Canada we’ve titled it Physician Practice Improvement (PPI).

The Federation of Medical Regulatory Authorities of Canada in partnership with the Medical Council of Canada, have brought together representatives from the following organizations to develop a framework around revalidation.

  • Canadian Medical Association,
  • Canadian Medical Protective Association,
  • HealthCare CAN (the amalgamation of the Canadian Healthcare Association and the Association of Canadian Academic Healthcare Organizations – ACAHO),
  • College of Family Physicians of Canada,
  • Royal College of Physicians and Surgeons of Canada and
  • Association of Faculties of Medicine of Canada
  • Representatives from MCC and FMRAC (and chaired by Dr. Andre Jacques of the College des Medecins du Quebec)

Our goal was to develop a pan-Canadian strategy to assist:

  • All practising physicians in identifying opportunities for improvement
  • All medical regulatory authorities in identifying physicians who may benefit from focused assessment and enhancement, and
  • All stakeholder organizations in identifying their roles and responsibilities in physician practice improvement

The Quality Improvement Cycle

The framework we created is, in essence, a quality improvement cycle applied to medical practice. The unique parts are #1 and #2 – understand your practice and assess your practice.qualityimprovementcycle

The College’s goal is to refine our existing Continuing Competence Program in alignment with this framework, to ensure it does what we hope it does, help physicians find learning opportunities with the ultimate goal of providing exemplary care to patients.

As mentioned, we are asking our members for feedback on this new structure in a variety of ways. I hope you will take the time to share your thoughts with us. For more information about how you can get involved, please contact Dr. Ernie Schuster at ernie.schuster@cpsa.ab.ca.

As always, I welcome your comments below or by email at trevor.theman@cpsa.ab.ca.

Trevor Theman

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