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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 Conference September 15-17 Phoenix, Arizona. Presentation Overview. Philosophy behind Remediation - PowerPoint PPT Presentation
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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
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
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!
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
Different Receptors of Information
Regulatory Receptorsof Information
Registration – Entrance to Practice
Practice Review/Inspections
Complaint/breach Investigations
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
Shared Processes
• Assessment
• Evaluation
• Remediation
• Enforcement
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
The ‘Nuts and Bolts’: Creating the Processes
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
The ‘Nuts and Bolts’: Creating the Processes
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
The ‘Nuts and Bolts’: Creating the Processes
5. Undertaking – Recognition of need for improvement– Definition of enforceability
6. Decision and Reasons– Demonstrate value of remediation– Accountable/reasonable
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
The ‘Nuts and Bolts’: Creating the Processes
7. Compliance Monitoring– Consent to information release– Follow up mechanisms– Conclusion & confirmation of success– Further enforcement if non-compliant
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
The ‘Nuts and Bolts’: Competency Consultation
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!
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
The ‘Nuts and Bolts’: Competency Consultation
5. Submit to staff/Committee
6. Respond to staff/Committee questions and modify, as required
7. Address the Committee on remediation issues
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
Case Review – J.L.
• Investigation– Gathered documentation– Interviewed co-workers– Member’s response– Obtained a continuing competency assessment
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
Case Review – J.L.
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
Case Review – J.L.
• 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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
Benefit Analysis – J.L.
• Extensive Remediation– Lengthy and expensive – Not a specified committee power
• Cost and time effective • Avoided complicated discipline case• Appropriate & meaningful
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
Case Review – N.S.
• Negotiated attempts for compliance
• Failed again
• Is breach Discipline or Competence based?
• Consultation with Continuing Competence
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
Case Review – N.S.
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
Case Review – N.S.
• Obtained Education Plan
• Used discipline for breach as leverage
• Negotiated Enforceable Undertaking– Failure to result in enrolment in the QA stream
• Success!!!!
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
Benefits Analysis – N.S.
• Effective monitoring
• Meaningful process
• Averted need for Discipline
• Achieved improved quality outcome!
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
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
Presented at the 2005 CLEAR Annual ConferenceSeptember 15-17 Phoenix, Arizona
Speaker Contact Information
Claudia Skolnik, Manager, Investigations & Resolutions
Nora MacLeod-Glover, Manager, Continuing Competency
Ontario College of Pharmacists483 Huron Street, Toronto, Ontario M5R 2R4Tel:416-962-4861 Fax:416-847-8282www.ocpinfo.com