Research, strategy and policy

Our regulatory research

Research projects that we concluded this year were:

• qualitative research to understand and improve the experience of notifiers and health practitioners
• a cross-professional study of health practitioners with multiple notifications to accurately describe drivers for notifications that may be amenable to a regulatory response
• a study predicting the likelihood of notification outcomes to support regulatory decision-making
• a review of notifications about pharmacists involving the dispensing of oral methotrexate
• an analysis of notifications about occupational therapists
• conducting literature reviews, including on complaint issue taxonomies.

The guiding framework

We reviewed and revised the current research framework to better align research and evaluation projects to the overall National Scheme objectives and strategy.

Research ethics

The National Scheme published a Research ethics position statement. We are finalising a formal arrangement with a human research ethics committee registered with the National Health and Medical Research Council (NHMRC) that will provide ethical oversight for relevant research projects.

International research collaboration

In 2018/19, 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 United Kingdom, the United States and Canada.

As part of our research and evaluation activities to support the National Scheme, the National Boards and other scheme entities, we are collaborating with international partners from the UK and the US to investigate the potential of artificial intelligence to support regulatory decision-making in complaints about nurses.

Publications and presentations

As research and evaluation continues to evolve in the National Scheme, the 2020 National Scheme’s Combined Meeting incorporated research and evaluation throughout its program. The key speakers – Dr Gerald Hickson, Professor Valerie Braithwaite and Professor Kieran Walshe – included research and evaluation-related content in their presentations and workshops. In addition, Ahpra researchers Dr Eva Saar and Mr Michael Rasmussen co-presented with Dr Finn Lattimore of the Gradient Institute, on how to harness digital technologies such as artificial intelligence and machine learning to identify risk and facilitate regulatory solutions.

To ensure our research and evaluation is communicated widely for better knowledge sharing, we aim to produce publications for peer-reviewed health journals, where appropriate. Publications include:

• Biggar, S, Lobigs, LM and Fletcher, M (2020) ‘How can we make health regulation more humane? A quality improvement approach to understanding complainant and practitioner experiences’ Journal of Medical Regulation, 106(1) pp. 7–15.

Research partnerships

Ahpra maintains and facilitates research partnerships. Previously, this included a NHMRC partnership grant with the University of Melbourne. While this partnership has concluded, the University of Melbourne research team has produced publications during 2019/20 related to investigating hotspots of risk using regulatory data collected by the National Scheme. Publications include:

• Veness, BG, Tibble, T, Grenyer, BFS, Morris, JM, Spittal, MJ, Nash, L, Studdert, DM and Bismark, MM (2019) ‘Complaint risk among mental health practitioners compared with physical health practitioners: a retrospective cohort study of complaints to health regulators in Australia’ BMJ Open.

We continue to collaborate with the Digital Health Cooperative Research Centre 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 potential opportunities to contribute to specific projects, including projects related to improving quality and safety through enhanced performance feedback for practitioners.

Access to data for research

When our data and information are used for research, they are often published as research outcomes in academic journals. When information has been used by researchers and resulted in publication, we list them on our website. When publications can be accessed freely, we provide links to external websites.

Our vision in the National Registration and Accreditation Scheme strategy 2015–20 is to be recognised as a leading risk-based regulator enabling a competent and flexible health workforce to meet the current and future health needs of the Australian community. 

Four themes

Our four strategic themes – risk-based regulation, strategic partnerships and service excellence, and capability and culture – have an aligned set of objectives, measures and targets that are used to monitor and communicate our progress. With the current strategy drawing to a close in June, we gained final insights into our performance: 

• In risk-based regulation we have increased the percentage of common regulatory standards across the regulated health professions to reduce regulatory complexity and National Boards have increased their focus on initiatives that reduce risk within their regulatory plans. 
• In strategic partnerships, we have engaged with our partners in the National Scheme to produce better outcomes for patient safety and quality healthcare. For example, 100% of National Boards executed their agreements with their respective accreditation authority by 1 July 2019 and we continue to meet our commitments to provide updates through the Jurisdictional Advisory Committee before progressing them to the Ministerial Council. 
• In service excellence, work continues to redesign our processes with customer-focused approaches in mind to improve experiences for notifiers, practitioners, applicants and registrants. The majority of new registrants who applied online found their experience satisfactory, easy or very easy. 
• Our performance in capability and culture continues to develop and align with activities within our Ahpra people plan, such as improving capability through learning and development, defining and promoting good leadership and simplifying fit-for-purpose policies, processes and procedures. 

A major review of our strategy began in February 2019 to inform the development of a new National Scheme strategy 2020–25. Following consultation with a wide range of stakeholders across the scheme, we received support for a mission-led focus and for the inclusion of four new values for the first time. The four strategic themes of the new strategy − regulatory effectiveness, trust and confidence, evidence and innovation, and capability and culture − are a reflection of the wide feedback received on the importance of enhancing the trust and confidence of our stakeholders, doing our essential regulatory and registration work well, making a greater contribution to the broader healthcare environment and investing in our people. 

The new strategy was approved in June 2020 and implementation has started. The strategy has been published on our website, and includes a supporting guide, implementation map and behavioural attributes aligned to our values. Implementation activities will continue into 2020/21.

Policy support and coordination

This year the projects we contributed to included:

• the National Rural Health Commissioner’s policy options to improve access, distribution and quality of rural allied health services
• proposed regulations and registration standards for the Victorian Disability Worker Regulation Scheme
• the Department of Employment, Skills, Small and Family Business’ consultation on the Short-term Skilled Occupation List, the Medium and Long-term Strategic Skills List and the Regional Occupation List
• proposed regulations to improve the safe use of products commonly used in cosmetic procedures in NSW
• the review of the Victorian teaching profession code of conduct.

Joint policy initiatives

Regulatory responses to COVID-19

Registered health practitioners are playing a vital role in treating and containing COVID-19. We developed, reviewed and refined policy advice to National Boards to support timely, proactive regulatory responses to the pandemic. For example, we developed telehealth guidance to support health practitioners to continue providing safe care to their communities.

Review of processes

We made substantial progress on reviewing our policy and consultation processes to provide a clearer and more transparent message about how the National Boards hold consultations.

This work included reviews of the Consultation process National Boards 2020, the Procedures for development of accreditation standards and the Procedures for the development of registration standards, codes and guidelines, all to be published in 2020/21.

In response to the two COAG Health Council policy directions issued in January, in addition to accounting for the policy directions in our broader review of policy and consultation processes, we developed two templates: Patient health and safety impact statement and Patient health and safety impact assessment to strengthen the involvement of patient safety and consumer perspectives in our work.

Mandatory notifications

We reviewed the mandatory notifications guidelines and published separate Guidelines: mandatory notifications about registered health practitioners and Guidelines: mandatory notifications about registered students. The guidelines help notifiers understand who must make mandatory notifications and when they must be made. The guidelines incorporate legislative amendments that established a new, higher risk threshold for treating practitioners to make a mandatory notification.

Registration standards

Following a joint review and Ministerial Council approval, revised continuing professional development (CPD), recency of practice (ROP) and professional indemnity insurance arrangements (PII) registration standards came into effect for several National Boards.

We coordinated implementation of revised guidelines for CPD, piloting a new approach to developing CPD guidance that involved testing guidance through surveys and focus groups with practitioners.

Cosmetic procedures

We launched ‘be safe first’, an education campaign to advise consumers of the risks associated with cosmetic procedures and to help consumers know what kinds of questions to ask before going ahead with a cosmetic procedure. This is part of a multifaceted approach across regulators to help address risks and poor outcomes associated with cosmetic procedures.

Advertising

We continued work on advertising policy issues, including evaluating the Advertising compliance and enforcement strategy for the National Scheme. We held public consultation on the revised Guidelines for advertising a regulated health service.

Supervised practice

We made substantial progress on a review of the supervised practice guidelines used by some National Boards to establish a Supervised practice framework (with some profession-specific exclusions). Public consultation was held during September to December.

Other initiatives

We worked on:

• the review of the Code of conduct shared by seven National Boards and used by an additional five with minor profession-specific variations, incorporating the National Scheme’s definition of cultural safety, developed by the Aboriginal and Torres Strait Islander Health Strategy Group
• a literature review to inform the review of National Boards’ English language skills registration standards.