Remediation: When is it Gold? An Alternative Response to Complaints Claudia Skolnik Nora MacLeod-Glover Ontario College of Pharmacists Presented at the

Remediation: When is it Gold?An Alternative Response to Complaints

Claudia Skolnik

Nora MacLeod-Glover

Ontario College of Pharmacists

Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona


Presentation Overview

• Philosophy behind Remediation

• ‘Nuts and Bolts’: Creating the Processes

• Putting it into Context– Case reviews


Who are we?

Investigations & Resolutions• Investigation• Creative processes • Solution based• Responsive & accountable• Viewed as punitive

Continuing Competency• Assessment• Identifying practice

weaknesses• Solution based• Proactive & accountable• Educationally based


Shared Objectives

• Improve quality of care

• Reduce the risk of harm

• Infuse meaning into our processes & outcomes

• But – different “receptors”

Collaboration was a natural evolution!


Different Receptors of Information

Regulatory Receptorsof Information

Registration – Entrance to Practice

Practice Review/Inspections

Complaint/breach Investigations


Shared Processes

• Assessment

• Evaluation

• Remediation

• Enforcement


The ‘Nuts and Bolts’: Creating the Processes

1. Find your legislative authority− Complaints Committee Authority

• Take appropriate action not inconsistent with the laws

− Discipline Committee Authority• Terms, Conditions and Limitations

Professional misconduct to breach a term, condition or limitation

− Discipline referral• Illusion of choice

− Access your Quality Assurance Enforcement legislation



2. Gather your facts− Adapt your investigation

• Gather all relevant information

• Not just “what?” but “why?”

• Anticipate Committee interest in remediation

• Consult with Continuing competency re: remediation opportunities



3. Create your remediative solution– Obtain Remediation Assessment & Education

Plan

4. Guide the Committee review – Confirm practice deficits – Consider suitability of remediation– Justify the reasonableness of the remediation



5. Undertaking – Recognition of need for improvement– Definition of enforceability

6. Decision and Reasons– Demonstrate value of remediation– Accountable/reasonable



7. Compliance Monitoring– Consent to information release– Follow up mechanisms– Conclusion & confirmation of success– Further enforcement if non-compliant


The ‘Nuts and Bolts’: Competency Consultation

1. Maintain your remediation tool box– Know your remediation opportunities

• Develop & maintain a network of educators

– Review programs and assess suitability• Rely on education frameworks

• Examine learning objectives

2. Examination of Practice Deficit– Complete a review of the investigation– Probe & obtain further information



3. Analyze case to find root cause − Examine each issue addressed in investigation– Define the practice gap– Identify the remediative potential– Match the remediation recommendation to the

practice gap

4. Create the Remediation Assessment & Education Plan

– Includes an assessment component– Be open and creative!



5. Submit to staff/Committee

6. Respond to staff/Committee questions and modify, as required

7. Address the Committee on remediation issues


Putting it into Context

Case Review (J.L.)• 29 incidents, over 2 years , hospital

setting– Dispensing errors– Poor recordkeeping– Abdication of responsibility

• Terminated from employment


Case Review – J.L.

• Investigation– Gathered documentation– Interviewed co-workers– Member’s response– Obtained a continuing competency assessment



Root Causes

• Ineffective communication skills*

• Poor therapeutic knowledge management and application

• Rote prescription processing skills

• Inadequate error management skills

• Lacks awareness of professional accountability

Remediation

• IPG program participation– Applied therapeutics

– Communication skills

– Basic Professional practice lab

– Professional Practice Theory including drug information sessions and jurisprudence

• Effective communication strategies program

• Confronting Medication Errors program



• Committee endorsed remediation option

• Negotiation (two communication programs)

• Undertaking – contracting terms

• Final Committee decision– Ordered remediation– Oral caution– Rationalize the decision and suitability of

remediation


Benefit Analysis – J.L.

• Extensive Remediation– Lengthy and expensive – Not a specified committee power

• Cost and time effective • Avoided complicated discipline case• Appropriate & meaningful


Putting it into Context

Case Review (N.S.) • Member disciplined

– Failed to identify excessive narcotic prescriptions

• Discipline order– Suspension– Term, condition and limitation re: remediation

• Failed remediation – breached condition


Case Review – N.S.

• Negotiated attempts for compliance

• Failed again

• Is breach Discipline or Competence based?

• Consultation with Continuing Competence



Root Causes• Lacked basic

interviewing skills• Deficiencies in

communication skills• Weak therapeutic

knowledge base

Remediation• IPG program

– Language of Patient counselling

– Communication skills

• Therapeutic study, three of:– Print coursework– Live lectures: IPG



• Obtained Education Plan

• Used discipline for breach as leverage

• Negotiated Enforceable Undertaking– Failure to result in enrolment in the QA stream

• Success!!!!


Benefits Analysis – N.S.

• Effective monitoring

• Meaningful process

• Averted need for Discipline

• Achieved improved quality outcome!


Why Remediate?

• Professionals come to work with intention to do good

• Distinguish between conduct and practice– Theft/fraud vs patient care shortcomings

• Principles of CQI– Quicker solutions

• Penalties options may not be effective


Mining for success

• Institutional philosophy of CQI

• Openness to modify processes

• Creative interpretation of legislation

• Meaningful and valid remediation options

• Draw upon unique skills of individuals

• Culture of interdepartmental collaboration

• Educate committees and get their buy-in


Speaker Contact Information

Claudia Skolnik, Manager, Investigations & Resolutions

[email protected]

Nora MacLeod-Glover, Manager, Continuing Competency

[email protected]

Ontario College of Pharmacists483 Huron Street, Toronto, Ontario M5R 2R4Tel:416-962-4861 Fax:416-847-8282www.ocpinfo.com

mailto:[email protected]

Documents

Remediation: When is it Gold? An Alternative Response to Complaints Claudia Skolnik Nora MacLeod-Glover Ontario College of Pharmacists Presented at the