Strategy, policy and research

Shared policy issues

National Boards regularly collaborate on shared policy issues, when the issue involves the same or similar impact across professions. Maximising consistency in the regulatory framework across professions facilitates effective collaborative care and supports good practice. It has benefits for consumers and employers by simplifying the regulatory landscape and helping clarify expectations of all registered health practitioners.
Shared policy issues include:

• developing or reviewing common or shared registration standards, codes and guidelines across National Boards
• coordinating reviews of registration standards and guidelines which involve a mix of multi-profession and profession-specific issues
• developing coordinated policy responses to key issues such as advertising
• developing policy resources and tools, and
• coordinating joint submissions to relevant external consultations.

Common registration standards and guidelines have the same content for all National Boards and include the Criminal history registration standard, Guidelines for advertising regulated health services and Guidelines for mandatory notifications.
Shared standards and guidelines have very similar content across National Boards and include the English language skills registration standards for 12 National Boards and the Code of conduct shared by seven National Boards and used by an additional five with minor profession-specific variations.

Policy support and coordination

AHPRA develops policy resources and tools to provide policy advice to National Boards. It also develops and coordinates responses for external policy consultations. Examples include:

• Review of assisted reproductive treatment in Victoria
• Consultation about regulations to implement the new classification in the NSW Poisons and Therapeutic Goods Act 1966 for medicines used in cosmetic procedures
• Therapeutic Goods Advertising Code guidance, and
• Australasian Integrative Medicine Association Guiding Principles for Interprofessional Communication.

We also contributed to the UK’s Professional Standards Authority’s publication: Right-touch regulation in practice: international perspectives.

Joint policy initiatives

We continued our work on advertising policy issues, including further implementing the Advertising compliance and enforcement strategy for the National Boards and AHPRA. We developed and published new tools, including a titles tool, to support the strategy and help practitioners understand their obligations and facilitate compliance. We did initial testing of revised Guidelines for advertising regulated health services through preliminary consultation with major stakeholders, and we continued evaluating the strategy.

Following a joint review, we received Ministerial Council approval for revised continuing professional development (CPD), recency of practice (ROP) and professional indemnity insurance (PII) registration standards for three National Boards (Aboriginal and Torres Strait Islander Health Practice, Chinese Medicine and Occupational Therapy), and for Chiropractic and Optometry (CPD only) and Psychology (PII only).

We also:

• continued our work on the joint review of the Code of conduct shared by seven National Boards and used by an additional five with minor profession-specific variations (Aboriginal and Torres Strait Islander Health Practice, Chinese medicine, chiropractic, dental, medical radiation practice, occupational therapy, optometry, osteopathy, paramedicine, pharmacy, physiotherapy and podiatry). We prepared a revised draft code for initial testing with selected stakeholders, for when the definition of cultural safety being developed by the Aboriginal and Torres Strait Islander Health Strategy Group is available
• continued work to review the supervised practice guidelines used by some National Boards and to establish a clearer, simpler regulatory framework for supervised practice (other than supervision in the context of internships). We did further work on the proposed framework with stakeholders in preparation for public consultation
• substantially progressed a review of the joint National Boards' social media policy and work to coordinate a review of limited registration standards for some National Boards
• started work to explore how National Boards can best support professional practice by the practitioners they regulate, including through a more integrated and prevention-focused approach to their registration standards, codes and guidelines
• commissioned research to inform the next review of National Boards’ English language skills registration standards, and
• carried out the first pilot of a behavioural insights project to explore whether behavioural approaches could improve advertising compliance.

Following amendments to the National Law, we also embarked on a scheduled review of the Guidelines for mandatory reporting, with public consultation planned for the second half of 2019.

Developing strategy and doing research

Strategy

Enhancing capability

AHPRA and the National Boards identify and measure how well we are contributing towards achieving the National Registration and Accreditation Scheme Strategy 2015–20 objectives. We use the balanced scorecard methodology to help us communicate about our work and our strategic outcomes.

Our objectives are grouped into four themes: capability and culture, risk-based regulation, strategic partnerships and service excellence. Within these themes, our objectives are expressed as action statements describing how we will achieve our strategy. Each of these objectives has a set of measures and targets that are used to monitor our progress, and communicate our performance.

This helps AHPRA and the National Boards consistently align all major initiatives to these objectives, making our achievements easier to measure and the value and benefit they bring easier to identify. In 2018/19, AHPRA strengthened this approach through a project portfolio review of all initiatives to help us focus on the most important and highest value initiatives to deliver on our objectives.

Our maturing approach to regulatory planning for National Boards is also increasingly focusing on scheme-wide opportunities, including collaborating across Boards to achieve common goals. Recently, we began a cross-professional notifications analysis for eight National Boards, as well as their aligned NSW Health Professional Council and the Queensland Office of the Health Ombudsman. We will expand this kind of work in the future, focusing on consolidating initiatives into multi-professional projects when appropriate.

Strategic performance

The past 18 months provide insights into our performance against our strategic themes and objectives, including:

• In risk-based regulation, we showed consistent and improved performance in reducing the risk of harm to the public through reducing the time it takes to make decisions in notifications and monitoring and compliance matters.
• We continue enhancing our strategic partnerships with key stakeholders, particularly accreditation entities, the Jurisdictional Advisory Committee and the Ministerial Council.
• Our performance in capability and culture will continue to develop and improve with recent initiatives being aligned to our People Plan.
• The progressive redesign of our processes to better consider the notifier and practitioner experience is leading to improved service excellence.

Research

Our regulatory research

All our research is intended to answer specific questions and help support evidence-based decision-making in the National Scheme. Projects supporting National Boards and other National Scheme entities through research and evaluation activities, including investigating relevant regulatory data about registered practitioners, were completed. This included:

• assessing and comparing notifications and outcomes about International Medical Graduates versus Australian and New Zealand Medical Graduates (commissioned by the Medical Board of Australia)
• analysing notifications data for recently graduated practitioners to support the work of the Accreditation policy team
• analysing Optometry Board of Australia notifications data to identify drivers of notifications that may require a regulatory response
• completing a quality improvement study on AHPRA’s work towards better understanding and improving our engagement with notifiers and health practitioners
• developing an evidence framework as part of updated resources to help advertisers assess the claims in their advertising
• conducting literature reviews, including on nurse practitioner standards and sexual boundary violations, and
• examining best practices in regulating aged care and personal care attendants.

The guiding framework

Last year we published a research framework, which sets out the research priorities and principles that guide National Boards, AHPRA and external stakeholders in focusing their research efforts that use National Scheme data and information. See Data not publicly available.

This year we continued aligning research projects to the framework and promoting this work to our stakeholders. The framework is designed as a living document and is due to be updated in 2019/20.

A new international group

We established an international regulatory expert group to strengthen our research governance systems and provide advice on research, quality improvement and evaluation projects. The group brings together regulatory experts from Australia, New Zealand, the UK, the US and Canada. A highlight of the inaugural meeting was to hear Professor Anna van der Gaag, Visiting Professor, Ethics and Regulation at the University of Surrey, share her reflections on developing regulatory culture and associated opportunities for research.

Research Summit 2019

In February 2019, AHPRA hosted a Research Summit in Melbourne with over 340 participants. The theme of the summit was ‘Optimising research for regulatory effectiveness’ and it brought together AHPRA staff, Board members from the 16 regulated health professions, regulatory colleagues from New Zealand and other partners including representatives from accreditation authorities and academia. Professor Zubin Austin from the University of Toronto, Canada, presented the keynote session followed by presentations by AHPRA researchers and research collaboration partners, including Professor Tim Shaw, University of Sydney, and Professor Euan Wallace, Safer Care Victoria.

Research partnerships

AHPRA maintains and facilitates research partnerships, including a National Health and Medical Research Council (NHMRC) partnership grant with the University of Melbourne that has recently concluded. The University of Melbourne research has been investigating hotspots of risk using regulatory data collected by the National Scheme.

• Bismark, M, Tibble, H, Moore, J and others (2018) ‘Eyes and ears on patient safety: Sources of notifications about the health, performance, and conduct of health practitioners’ Journal of Patient Safety, 21 November 2018, doi: 10.1097/PTS.0000000000000544. [Epub ahead of print], and
• Spittal, MJ, Bismark, MM and Studdert, DM (2019) ‘Identification of practitioners at high risk of complaints to health profession regulators’ BMC Health Services Research [online first].

We also joined the new Digital Health Cooperative Research Centre (CRC) as a partner providing in-kind support. This program will invest over $200 million aimed at developing and testing digital health solutions for patients, while equipping Australians to better manage their own health and wellbeing. We have primarily focused on facilitating access to de-identified regulatory data. However, we are also exploring the potential opportunities for contributing to specific projects, including projects related to improving quality and safety through enhanced performance feedback for practitioners.

Access to data for research

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