What are the concerns of prospective responsible officers about their role in medical revalidation?

Shepherd, Annabel; Cameron, Niall

doi:10.1111/j.1365-2753.2010.01433.x

Cited by 3 publications

(3 citation statements)

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“…This has the potential to radically change the landscape of malaria risk on the continent [22]. It is increasingly recognized that presumptive treatment of malaria in areas of Africa under declining transmission intensity is increasingly inappropriate [23], may increase patients risks of severe outcomes from un-diagnosed conditions [24] and increase unnecessary expense on limited public sector drug budgets or patients who have to pay for medicines.…”

Section: Introductionmentioning

confidence: 99%

The clinical burden of malaria in Nairobi: a historical review and contemporary audit

Mudhune

Okiro

Noor

et al. 2011

Malar J

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BackgroundWidespread urbanization over the next 20 years has the potential to drastically change the risk of malaria within Africa. The burden of the disease, its management, risk factors and appropriateness of targeted intervention across varied urban environments in Africa remain largely undefined. This paper presents a combined historical and contemporary review of the clinical burden of malaria within one of Africa's largest urban settlements, Nairobi, Kenya.MethodsA review of historical reported malaria case burdens since 1911 within Nairobi was undertaken using archived government and city council reports. Contemporary information on out-patient case burdens due to malaria were assembled from the National Health Management and Information System (HMIS). Finally, an audit of 22 randomly selected health facilities within Nairobi was undertaken covering 12 months 2009-2010. The audit included interviews with health workers, and a checklist of commodities and guidelines necessary to diagnose, treat and record malaria.ResultsFrom the 1930's through to the mid-1960's malaria incidence declined coincidental with rapid population growth. During this period malaria notification and prevention were a priority for the city council. From 2001-2008 reporting systems for malaria were inadequate to define the extent or distribution of malaria risk within Nairobi. A more detailed facility review suggests, however that malaria remains a common diagnosis (11% of all paediatric diagnoses made) and where laboratories (n = 15) exist slide positivity rates are on average 15%. Information on the quality of diagnosis, slide reading and whether those reported as positive were imported infections was not established. The facilities and health workers included in this study were not universally prepared to treat malaria according to national guidelines or identify foci of risks due to shortages of national first-line drugs, inadequate record keeping and a view among some health workers (17%) that slide negative patients could still have malaria.ConclusionCombined with historical evidence there is a strong suggestion that very low risks of locally acquired malaria exist today within Nairobi's city limits and this requires further investigation. To be prepared for effective prevention and case-management of malaria among a diverse, mobile population in Nairobi requires a major paradigm shift and investment in improved quality of malaria diagnosis and case management, health system strengthening and case reporting.

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Section: Introductionmentioning

confidence: 99%

The clinical burden of malaria in Nairobi: a historical review and contemporary audit

Mudhune

Okiro

Noor

et al. 2011

Malar J

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“…Existing research on ROs has typically focused on the practicalities of their work, particularly during early implementation ( Nath et al, 2014 ; Shepherd and Cameron, 2010 ; Webster and McLachlan, 2011 ), or on their own experiences of undergoing appraisal ( Furmedge et al, 2016 ; Griffin et al, 2015 ). In this paper, we analyse the RO role in the light of theoretical interpretations of comparable hybrid doctor-manager groups, to better understand their position at the interface of this fundamentally changed relationship between medical regulation and healthcare organisations.…”

Section: Introductionmentioning

confidence: 99%

Policing the profession? Regulatory reform, restratification and the emergence of Responsible Officers as a new locus of power in UK medicine

Bryce

Luscombe

Boyd

et al. 2018

Social Science & Medicine

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Doctors' work and the changing, contested meanings of medical professionalism have long been a focus for sociological research. Much recent attention has focused on those doctors working at the interface between healthcare management and medical practice, with such ‘hybrid’ doctor-managers providing valuable analytical material for exploring changes in how medical professionalism is understood. In the United Kingdom, significant structural changes to medical regulation, most notably the introduction of revalidation in 2012, have created a new hybrid group, Responsible Officers (ROs), responsible for making periodic recommendations about the on-going fitness to practise medicine of all other doctors in their organisation.Using qualitative data collected in a 2015 survey with 374 respondents, 63% of ROs in the UK, this paper analyses the RO role. Our findings show ROs to be a distinct emergent group of hybrid professionals and as such demonstrate restructuring within UK medicine. Occupying a position where multiple agendas converge, ROs' work expands professional regulation into the organisational sphere in new ways, as well as creating new lines of continuous accountability between the wider profession and the General Medical Council as medical regulator. Our exploration of ROs' approaches to their work offers new insights into the on-going development of medical professionalism, pointing to the emergence of a distinctly regulatory hybrid professionalism shaped by co-existing professional, managerial and regulatory logics, in an era of strengthened governance and complex policy change.

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“…Using a lens of ‘quality’ this study builds on existing research about RO perceptions of revalidation and focused on perceptions of effectiveness, robustness, and perceived impact as well as the acceptability of this activity as a way of both challenging and supporting ROs in their roles [20]. This study aimed to explore the perceptions of quality involved in RO appraisal from the perspective of the RO as well as their appraisers and to inform the revalidation community (doctors, their appraisers, ROs and medical directors) as policy and practice are shaped and embedded.…”

Section: Introductionmentioning

confidence: 99%

Quality and impact of appraisal for revalidation: the perceptions of London’s responsible officers and their appraisers

et al. 2015

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BackgroundTo evaluate NHS England London region’s approach to the revalidation appraisal of responsible officers in London, exploring perceptions of the quality and impact of the appraisal process. Revalidation is the process which aims to ensure doctors in the UK are up-to-date and fit to practice medicine thus improving the quality of patient care. Revalidation recommendations are largely premised on the documentation included in annual appraisals, which includes the professional development a doctor has undertaken and supporting information about their practice.MethodsA pan-London qualitative study exploring the views of responsible officers and their appraisers about the revalidation appraisal process. The study aimed to gain an in-depth understanding of the experiences and perceptions of the participants. Responsible officers were purposefully sampled to represent the broadest range of designated bodies. Data analysis generated themes pertaining to quality and impact of appraisal for revalidation with the potential to feed into and shape the evolving system under investigation.ResultsThe central importance of highly skilled appraisers was highlighted. Both groups reported educational opportunities embedded within the appraisal process. Independent appraisers, not matched by clinical speciality or place of work, were considered to take a more objective view of a responsible officer’s practice by providing an ‘outsider perspective’. However, covering the breadth of roles, in sufficient depth, was challenging. Participants reported a bias favouring the appraisal of the responsible officer role above others including clinical work. Appraisal and revalidation was perceived to have the potential to improve the healthcare standards and support both personal development and institutional quality improvement.ConclusionsResponsible officers play a central role in the revalidation process. Getting responsible officer appraisal right is central to supporting those individuals to in turn support doctors and healthcare organisations in continuous quality improvement. The complexity and importance of the role of responsible officer may make achieving an appraisal of all roles of such individuals problematic. This evaluation suggests responsible officer appraisal was perceived as educational and effective.

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What are the concerns of prospective responsible officers about their role in medical revalidation?

Abstract: We found important issues regarding the arrangements for revalidation which have not previously been described which may impact on the effectiveness of prospective responsible officers.

Cited by 3 publications

References 4 publications

The clinical burden of malaria in Nairobi: a historical review and contemporary audit

The clinical burden of malaria in Nairobi: a historical review and contemporary audit

Policing the profession? Regulatory reform, restratification and the emergence of Responsible Officers as a new locus of power in UK medicine

Quality and impact of appraisal for revalidation: the perceptions of London’s responsible officers and their appraisers

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