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The Quarterly


Partnering for performance: The Victorian Approach To Performance Development and Support Print E-mail
The Quarterly 2011



An online discussion on "Models of managing senior medical staff performance" gave participants an opportunity to ask questions and exchange experiences with the authors Drs Grant Phelps and Andrew Johnson. Listen to the audio recording here.

The active engagement of senior doctors with their organisation as part of their routine work is increasingly recognised as a critical pre-requisite of high quality care, and consequently, organisational performance. Recent high profile clinical service failures, both in Australia and internationally, have highlighted the importance of the proper monitoring and where required, management of the performance of senior doctors. Victorian hospitals individually employ or contract their senior medical staff, within a policy context provided by the Department of Health (the department). The meaningful engagement of senior medical staff with and by their organisations is a high priority for the department, which is aware of significant disengagement by senior medical staff in some hospital settings. Since 2007 the department's Clinical Engagement Program has sought to develop a policy framework to support senior doctors in their clinical and other roles.

In 2007 the department developed a formal policy approach to assist organisations as they credential senior medical staff and define their scope of practice. The policy recognises that high quality health care requires an effective relationship between senior medical staff and their hospitals. The policy also embeds a peer based approach to this process, recognising that the quality of clinical practice can only be judged by peers.

In 2010 the department released Partnering for performance - a performance development and support process, specifically designed for senior medical staff within the context of the credentialling process. The framework development included a literature review and extensive stakeholder consultation. The policy describes a five year credentialling cycle as the performance framework for all senior medical staff in Victoria's public hospitals, linking clinical performance to the individual doctor's scope of practice.

Partnering for performance is based on a number of core principles:

  • The core business of hospitals is the delivery of high quality patient care.
  • High quality care requires a mutual commitment by both senior doctors and their organisations.
  • The assessment of clinical practice requires a peer based approach.
  • The vast majority of senior doctors are performing well and must be supported to do so.
  • Whilst underperformance is uncommon, it needs to be detected early and managed appropriately to ensure patient safety.
  • The relationship between senior doctors and their organisations should operate on a 'no surprises' basis.
  • The process must operate according to the principles of natural justice.
  • The process should support doctors in their commitment to their Continuing Professional Development (CPD) and medical college requirements.

The Partnering for performance process for senior doctors consists of two core elements:

  1. A framework to guide performance development conversations - this emphasises the mutuality of the relationship, and includes both formal and informal elements.
  2. A peer based approach to understanding clinical practice.

Thus, over a five year credentialling cycle (Figure 1), a senior doctor in a Victorian hospital should expect to:

  1. Have at least annual formal performance conversations with their medical manager. These conversations reflect the principle of mutuality through the opportunity to provide feedback both to the doctor and to the organisation.
  2. Have occasional or ad hoc informal performance conversations that are documented.
  3. Base both forms of conversation around a number of agreed and shared goals aligned to the described performance domains (Figure 2).
  4. Develop an understanding of their clinical practice using a number of standardised, clinical level, peer based processes.
  5. Work closely with their medical manager to contribute to organisational strategic development and service delivery.
  6. Be able to largely meet their medical college and Australian Health Practitioners Registration Agency (AHPRA) CPD requirements.
  7. Undergo an open and transparent re-credentialling process.

The credentialling cycle emphasises the importance of the relationship between senior doctors and their organisation by establishing ongoing informal and regular formal conversations, based around a shared commitment to high quality patient care. In doing so, the credentialling cycle meets both organisational needs, and individual performance and continuing professional development needs, through assisting with the identification of improvement opportunities. Partnering for performance adapts the CanMEDS framework1 (Figure 2) to define the roles of senior doctors across four domains:

  • work achievement (includes clinical expertise)
  • professional behaviours
  • learning and development
  • career progression

The policy recognises that health care organisations have different levels of sophistication in supporting Partnering for performance, thus it provides a principles based approach to this activity. Organisations need only ensure that any existing processes align with the principles of Partnering for performance. The policy provides proformas and a series of tools to support its implementation, including specific tips on performance conversations and the development of shared goals. The policy recommends caution in the use of multisource feedback as a tool for assessing individual performance, except in situations where high levels of organisational trust and expertise exist, and where resources are available to properly support this activity.

The policy provides specific guidance to Victorian doctors in the use of commonly used clinical tools such as clinical audit, case note review and morbidity and mortality meetings. The use of administrative data for the purpose of understanding an individual doctor's clinical practice is discouraged. Where sufficient scale exists, groups of peers are encouraged to develop local approaches to understanding clinical practice, using existing tools.

Partnering for performance is an important policy which recognises the outstanding contribution that Victoria's senior doctors make to the health care system. The department expects hospitals to have implemented the policy in line with the Credentialling and defining scope or practice policy by October 2012, but understands that the culture change and engagement that will flow from this work may take some time.

All sections of the policy are available in modular form at: www.health.vic.gov.au/clinicalengagement/pasp/.

For further information contact Sarah Harper, Senior Project Officer, Department of Health by email This e-mail address is being protected from spambots. You need JavaScript enabled to view it or (03) 9096 9030 or Grant Phelps, Clinical Lead, Department of Health on 0418 504 252.

Grant Phelps, FRACP, FRACMA, Clinical Lead, Clinical Engagement Program, Department of Health
Sarah Harper, Senior Project Officer, Clinical Engagement Program, Department of Health

1 http://rcpsc.medical.org/canmeds/index.php

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