The health sector is ever-changing, with technological, social and economic influences shaking up traditional modes of care. To be effective as a regulator and achieve our paramount objective of public protection, Ahpra must stay abreast of emerging issues. By integrating research, advanced analytics, human insights and regulatory experience, we can identify and respond to regulatory issues early, enabling us to focus on prevention.
Research is the foundation – studying and analysing trends, policies and frameworks in regulation, practice and healthcare to gain a comprehensive understanding of the regulatory landscape. Ahpra can use its own and external data to identify potential risks and emerging issues. Having an evidence-based approach provides a solid basis for informed decision-making and proactive management of risks.
Advanced analytics allows us to use technology to augment and assist in data gathering, and helps to recognise trends and highlight key risks early. Advanced analytics tools can efficiently gather vast amounts of data from sources including regulatory publications, news articles and social media platforms. These tools will help us to analyse large datasets, identify patterns and detect early warning signs of regulatory changes or emerging risks. They can process and categorise information, providing valuable information that assists human decision-making and risk assessment.
Of course, advanced analytics tools cannot replace human insight and expertise. Human input and oversight are essential in interpreting the data generated by advanced analytics tools – to sense-check, provide contextual understanding and identify nuances that automated systems may miss. Regulatory experts with deep industry knowledge and experience can offer valuable insights, guide the interpretation of research findings and help prioritise regulatory risks.
Our regulatory experience brings a practical dimension to these insights. Regulation professionals who have hands-on experience with registration, notifications, compliance and accreditation can offer valuable perspectives on regulatory risk and potential regulatory interventions. By combining regulatory experience and regulatory intelligence, we can develop targeted and practical solutions to any such risks.
A multidisciplinary team of researchers, data analysts and regulatory experts work together to develop a comprehensive understanding of the regulatory landscape, regulatory risks and potential regulatory interventions. This collaborative effort allows cross-pollination of ideas, combines diverse perspectives, and is designed to develop targeted and effective regulatory responses.
Our research and evaluation work improves our regulatory effectiveness and helps us become an evidence-informed regulator. We developed a research and evaluation policy and supporting processes for Ahpra and the National Boards, including an internal advisory committee to provide advice about when an ethics review is required.
Research and evaluation projects were focused on:
We contributed four publications to peer-reviewed health journals, to share knowledge:
We used the ethics pathway established with the Metro North Health Human Research Ethics Committees in Brisbane, in line with best-practice research and evaluation, and the National Health and Medical Research Council’s ethical requirements. Ethics approval was granted for the following new and ongoing projects.
From 10 November to 31 January, Ahpra held public consultation on a draft data strategy and future directions for the data we hold. There were three areas of focus: the Register of practitioners, data sharing and advanced analytics. In January, we held webinars for members of the public and practitioners to learn more about the draft data strategy. We received 109 submissions from registered health practitioners, members of the public, employers and our health system partners. A consultation report was published in March, summarising what we heard, and the data strategy was published in July.
The comprehensive national regulation data that Ahpra collects have registration, workforce planning, demographic, commercial and research value, recognising that the National Law and the Privacy Act 1988 (Cth) impose strict limits on their use. Our data access and research policy focuses on helping researchers and other parties to better understand the process for considering requests for data and research.
Ahpra’s website outlines the data already available and how to access them, the processes for accessing data not publicly available, and the policies and legislation that govern what can and cannot be released.
Ahpra provides a data-matching service to Australian universities wishing to track graduate outcomes. We can match a graduate’s student number to their registration number so the university does not have to manually search the Register of practitioners. This enables universities to determine whether they are meeting their funding requirements and the intended outcomes of their rural training programs by determining how many of their health students are working in regional and rural locations. Some universities also use it to assess graduate outcomes more broadly in metropolitan and rural areas. We received and fulfilled eight requests for student data matching in 2022/23.
Each year Ahpra provides an extract of medical practitioner data from the Register of practitioners to Medical Deans, who combine it with their own data from surveys of final-year medical students. Including Ahpra’s data with their own allows Medical Deans to display information about medical practitioners that is broken down by a range of demographic factors, such as gender, rurality, specialty, and graduates’ preferred versus their actual work locations.
The National Boards and Ahpra regularly collaborate on shared policy issues that affect professions similarly. This collaboration facilitates effective and collaborative care, supports good interprofessional practice, and helps to simplify regulation.
It makes it easier for the public, practitioners and employers to know what to expect of registered health practitioners.
We have continued to explore and expand how our work as a health practitioner regulator can support registered health practitioners to provide safe and effective care in their professional practice.
We published new resources on the Ahpra website to support practitioners’ professional practice and help the public make safer health choices. These included:
We continued our work with the Australian Commission on Safety and Quality in Health Care (the commission) in exploring opportunities to improve the consumer experience of making a health complaint in Australia.
In 2021, Ahpra and the commission established a reference group to guide this joint work, which brings together voices from the consumer and health profession perspectives. It included representation from health consumer organisations, Ahpra’s Community Advisory Council and Aboriginal and Torres Strait Islander Health Strategy Group, professional associations and National Boards. Recognising that Ahpra is one of many bodies responding to consumer health complaints, there has also been engagement with other health complaints bodies.
The project has focused on ensuring that the consumer experience is better understood. To do this, there was wide-ranging consultation, including with consumers with a lived experience of making a health complaint and key professional groups.
There are many areas that Ahpra and the commission are exploring to improve the experience of consumers, including consistent messaging across both organisations’ websites and resources. We are also examining ways to provide education and guidance to strengthen the complaints culture and complaints-handling processes at the local level (directly with the health service or practitioner). Ahpra and the commission are working on resources to support both consumers and practitioners, to be published in late 2023.
Together the National Boards and Ahpra provided input to the following external policy consultations and reviews.
So that the National Boards’ regulatory requirements remain contemporary and relevant, we:
Through our data, we gain insights into challenges and opportunities for registered health practitioners. We want to use this knowledge to protect the public by supporting practitioners to practise professionally and avoid being the subject of a notification. We continue to see similar issues raised. These are:
Guidance to help practitioners practise professionally and protect their patients is available in codes of conduct, guidelines and registration standards published to the Ahpra and National Boards websites. The Boards and Ahpra periodically publish additional resources to support professional practice, including website resources and newsletter articles. Other helpful information on these topics can be found through many professional associations and organisational websites, such as that of the Australian Commission on Safety and Quality in Health Care.
We aim to build trust and confidence in our work through building awareness and understanding, developing relationships and partnerships, and improving people’s experiences with us.
Many people who are studying to be health professionals have limited knowledge of the regulatory system in Australia and what it means for them now and once they complete their training. One of the ways we have sought to build awareness and understanding is by developing and releasing four online modules for final year medical students on regulation and professionalism. The modules cover the purpose of regulation, replacing fear with facts about notifications, what matters to patients, and navigating professional challenges. They address specific issues such as the importance of doctors seeking help early for their own health issues, managing social media, mandatory notifications and important professional boundaries. The modules have been developed with input from students and MDANZ (Medical Deans Australia and New Zealand). They can be downloaded from the MBA website.
With patient safety our primary focus, we are consistently looking for ways to develop relationships and partnerships with the public and particularly those who represent diverse and underserved communities. One of the ways we are doing this is by including the voices of consumers with lived experience in our work to ensure that their unique knowledge and insights are considered. For example, we recruited consumers with recent experience of cosmetic surgery to be involved in our work to make cosmetic surgery safer. We have also been working on establishing a working group of community members to help us improve public safety in our management of practitioner sexual misconduct.
We are committed to improving people’s experiences with us across all of our work. A major focus is the experience of navigating our regulatory processes. This year we completed a significant project that was aimed at understanding and minimising the distress experienced by practitioners who are subject to a notification and those who have restrictions placed on their registration.
To do this, we commissioned an Expert Advisory Group (EAG) to advise us. We felt it was important to hear the firsthand experiences of these practitioners so we conducted a series of interviews. We also wanted to better understand the circumstances in which some practitioners involved in our processes had attempted or died by suicide to learn whether there are things we can do, either alone or in partnership with others, to prevent this devastating outcome. We looked at past cases over a four-year period of serious incidents involving practitioner suicide or attempted suicide.
Practitioners we interviewed told us about the stigma associated with receiving a notification and the fear of the worst-case-scenario outcome. Overseas-trained practitioners said that they felt particularly alone and isolated: ‘I have no family here … no one to guide me where to go’.
Most practitioners involved in the serious incidents had pre-existing mental health issues or a history of substance use disorders or both. Some had serious criminal or misconduct allegations.
The results highlighted specific areas of our processes that could be improved. Ultimately, the EAG made 15 recommendations covering 33 specific actions. They include improving how we manage health-related notifications, increasing our transparency and communication, increasing support for practitioners (and working to improve uptake of it) and making a commitment to learn from serious incidents and improve how we respond to them. Ahpra has accepted all recommendations and actions and is currently working to implement them.
As a regulator, our primary focus is protection of the public. We believe we can and should hold a concurrent concern for the wellbeing of practitioners. A more humane and compassionate approach to regulation will ultimately benefit patients and families as well as practitioners.
The health management team (HMT) was established on 4 July. It is made up of staff who have an interest in working with practitioners who have concerns raised about their health. This dedicated team’s case management model was developed around a mission to identify and carefully support practitioners who have an impairment.
Compassion, communication and respect are at the centre of the way this team operates.
The HMT recognises and values the services that practitioners provide to our community, and acknowledges, without judgement, that health concerns are universal. It is well known that being the subject of a notification is a stressful experience for a practitioner, and even more so if the issue is about one’s health.
Clear and regular communication through a continuity of case management approach helps the development of rapport and allows for the timely assessment of a practitioner’s capacity to manage their health effectively. We consider whether practitioners are engaged in treatment and what measures their workplace is taking in terms of support and oversight.
Trust is a crucial factor in the development of productive relationships with our wider stakeholders such as treating practitioners, medical indemnifiers, unions and employers. We recognise that we all have an interest in the practitioner being able to practise their chosen profession safely and therefore we aim to work together to enable this where possible.
In our first 12 months of operation, we have seen:
The Community Advisory Council (CAC) continued to be the primary source representing the community voice. The CAC provided a consumer and community perspective on Ahpra and National Board strategies, standards, codes, guidelines, policies and publications; how and where other consumer and community voices are required; and how best to consult with specific consumers and communities.
CAC members participated on reference and working groups and collectively engaged on the following issues and activities: desired community member attributes for decision-making committees; the review of regulation of medical practitioners who provide cosmetic medical and surgical procedures; the blueprint to better protect patients from sexual misconduct in healthcare; the Independent review of overseas health practitioner regulatory settings; the review of the National Scheme and engagement strategies; and a range of broader reforms to keep patients safe.
The CAC has a particular focus on underserved consumers and communities whose health and wellbeing is affected by limited access to healthcare, and equity and inclusion barriers. The CAC also provided general feedback about the need to use clear and unambiguous language, with less use of technical and difficult terms.
The CAC met seven times and was chaired by Ms Patricia Hall. Communiqués of its meetings are published on our website.
The Professions Reference Group (PRG) met eight times. It was chaired by Mr Nello Marino from the Australian Podiatry Association from July to December, and by Ms Julianne Bryce from the Australian Nursing and Midwifery Association from January. The PRG brings together professional associations for each of the regulated health professions. It provided feedback on the Independent review of overseas health practitioner regulatory settings, our reforms to improve the safety of cosmetic surgery and procedures, the development of practitioner resources to support professional practice, and the refresh of the Ahpra and National Board websites.
Ahpra updated PRG members on the work of the Expert Advisory Group on identifying and minimising distress for practitioners involved in a notifications process, our blueprint to improve public safety, Ahpra’s Business Transformation Program, our graduate registration and practitioner renewal campaigns, the implementation of legislative amendments to the National Law and updates on our accreditation work.
Our attention turned to implementing the more than 30 reforms in the Health Practitioner Regulation National Law and Other Legislation Amendment Act 2022, passed in the Queensland Parliament (as host jurisdiction for the National Scheme) in October. The reforms keep our law fit for purpose and include a stronger focus on protections for the public.
The Health Practitioner Regulation National Law (Surgeons) Amendment Bill 2023 was introduced into Queensland Parliament on 22 May. The Bill proposes to protect the title ‘surgeon’ when used by medical practitioners, and is an important element of cosmetic surgery reforms agreed to by all Australian health ministers.
Ahpra maintains a strong working relationship with the Australian, state and territory health departments, including through its Jurisdictional Advisory Committee.
As a World Health Organization (WHO) Collaborating Centre for Health Workforce Regulation, Ahpra works in partnership to strengthen the capacity and skills of regulators in the Western Pacific Region of WHO. As part of this work, we lead the Western Pacific Regional Network of Health Workforce Regulators, with members from approximately 20 countries. We held four regional network webinars on important health workforce regulation topics.
We made significant progress in the third year of implementing the Health and Cultural Safety Strategy.
The creation of a culturally safe notification process, led by Aboriginal and Torres Strait Islander Peoples, is a major milestone in the implementation of the strategy.
Committees comprising a majority of Aboriginal and Torres Strait Islander practitioners from each of the professions, along with community members, make decisions about notifications concerning Aboriginal and Torres Strait Islander Peoples, culturally safe healthcare and racism. In the most serious matters, this includes decisions about whether to refer a practitioner to an independent tribunal.
Aboriginal and Torres Strait Islander workforce participation has increased, with the appointment of nine people to Identified and non-Identified roles at Ahpra in 2022/23, taking our total number of Aboriginal or Torres Strait Islander staff to 15.
Targeted recruitment campaigns also resulted in the appointment of eight new Aboriginal and Torres Strait Islander Board and committee members, bringing the current total to 33.
Delivery of the Moong-moong-gak cultural safety training program concluded in September. A total of 1,596 participants have attended the training since it began in 2021. An evaluation of the program was delivered, which will inform future delivery of the training to new employees, Board and committee members.
In October, an amendment bill was passed in the Queensland Parliament, which saw cultural safety for Aboriginal and Torres Strait Islander Peoples enshrined as a new objective and guiding principle of the National Law. This change acknowledges the National Scheme’s role in ensuring the development of a culturally safe and respectful health workforce that is responsive to Aboriginal and Torres Strait Islander Peoples and their health, and that contributes to the elimination of racism in the provision of health services.
As part of the commitment to increasing participation in the registered health workforce, in July we established a new Aboriginal and Torres Strait Islander Engagement and Support team within Registration. The team provides culturally safe services to Aboriginal and Torres Strait Islander students, graduates and health practitioners across all professions.
In April, Ahpra appointed an Aboriginal race scholar, Professor Yin Paradies, to develop an Anti-Racism Policy for Aboriginal and Torres Strait Islander Peoples working in or accessing the National Scheme. This was the final remaining commitment to be delivered from our 2021–2023 Innovate Reconciliation Action Plan (RAP).
The National RAP Group was re-formed to include senior leaders from every area of Ahpra, to ensure that RAP work is core business. National Boards enthusiastically agreed to partner with Ahpra on the development of a National Scheme RAP.
In August and September, Ahpra held a series of Aboriginal and Torres Strait Islander health workforce events. The series was an opportunity for key stakeholders to meet and discuss important factors affecting the Aboriginal and Torres Strait Islander health workforce and identify actions needed to best support Aboriginal and Torres Strait Islander practitioners. Through listening to experiences of Indigenous practitioners and critically reflecting on our own practices, we identified opportunities to increase the Aboriginal and Torres Strait Islander health workforce and improve the support structures around them. Three national webinars were held, which identified clear calls to action.
Arranging our strategy into themes helps to communicate how we will achieve our vision.
We are responsive to the rapidly evolving nature and scope of health practice and develop management approaches that are sustainable in the long term.
We are focused on strengthening the trust and confidence that the public, health practitioners, organisational partners and other stakeholders have in the National Scheme.
We use our data to develop insights that help us better manage critical issues in health practitioner regulation and the healthcare environment. We make sure that our standards, codes and guidelines continue to be supported by strong evidence. We develop and improve our systems and processes to identify risk and make sure we have a strong, reliable and consistent framework for data analysis, evaluation and reporting. We proactively share our data and insights with key stakeholders.
We strive to create a workplace that is psychologically and physically safe for all, that enhances capability, learning and development, and that motivates our people to actively participate and achieve positive outcomes.
The ongoing impact of COVID-19 led to an urgent and concentrated focus on addressing system pressures on the Australian health workforce. Increased hospitalisations and staff absences in the sector, as well as the ongoing impact of stress, burnout and resignation of frontline health workers, poses real and significant risks to patient safety.
Aligned to our ‘regulatory effectiveness’ and ‘trust and confidence’ strategic themes, we created a National Scheme Health Workforce Program to respond to these workforce and safety issues. The program included these activities:
Outcomes of the program to date include increased staffing capacity in registration and assessment, improved systems and communications through a consolidated webpage and a dedicated liaison team, increased access to existing assessment facilities and planning for additional facilities. Planning was also accelerated to deliver online registration forms through our Business Transformation Program.