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Establishing a shared set of regulatory principles

In July 2014 the National Boards and AHPRA launched refreshed regulatory principles that underpin our work in regulating Australia’s health practitioners, in the public interest. The principles encourage a responsive, risk-based approach to regulation across all professions within the National Scheme.

We invited feedback on the principles in a formal consultation, which included surveying members of the public and practitioners, as well as board and committee members, and AHPRA staff.

The response to the surveys was overwhelming, with more than 800 members of the public providing feedback to the online survey, in addition to more than 140 board/committee members and AHPRA staff members. The vast majority of respondents supported the principles. In the coming year we will continue to work to embed the regulatory principles in all that we do.

The regulatory principles are set out in Appendix 1 of the Annual Report.

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Facilitating partnerships with the National Boards

A key strength of the National Scheme has been the regular interaction between all National Boards, particularly through their Chairs. This has facilitated cross-profession approaches to common regulatory issues, and cross-profession consultation and collaboration.

Cross-profession collaboration has been sponsored through the Forum of National Board Chairs, particularly in the areas of accreditation, multi-professional approaches, data and research, as well as workforce reform. At 30 June 2015, Mr Paul Shinkfield is the Chair of the Forum of National Board Chairs, in addition to being Chair of the Physiotherapy Board of Australia.

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Embedding a risk-based approach

We want to help increase the use of data and research to inform policy and regulatory decision-making to enable safe workforce reform and reduce harm to the public.

A risk-based regulation unit was formally established in 2014 to provide deeper, evidence-based and analytically driven advice to the National Boards, to inform proportionate, risk-based decisions.

The unit’s team members have a range of qualifications and experience in public health administration and legal practice, mathematics, computer science, statistics, epidemiology and project delivery resulting in research and survey publications.

This year the focus has been on establishing the foundations for the program, and developing methodologies for analysing notification data to detect and predict risk factors. Early analyses have confirmed previous research findings that point to increased risk of future notifications for practitioners who have previously been subject to a notification, and higher notification rates for male practitioners and practitioners aged over 55.

Closer looks at the regulatory data of specific National Boards have highlighted patterns of potential risk requiring further investigation, and have led to the development of an analytical work program that will inform specific regulatory interventions to reduce risk to the public.

The unit also works with a range of external researchers and academic partners. This year AHPRA and the University of Melbourne were awarded a National Health and Medical Research Council (NHMRC) Partnership Grant to undertake a major collaborative project exploring factors that may help to predict the risk of notification. This three-year project will use de-identified data from the National Scheme to highlight opportunities to focus risk-reduction efforts on the most important hot-spots.

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Improving the notifier and practitioner experience

We have made a significant investment to improve the experiences of notifiers and practitioners in their contacts with us, particularly when a notification is made. The overall goal is to improve our customer service, be clear about what people can expect and make it easier for people to interact with us.

This work has been informed by the recommendations in the Health Issues Centre of Victoria’s report Setting things right: Improving the consumer experience of AHPRA.

The report identified changes we could make to improve the experience of notifiers. Some of these changes involve a significant shift in processes and structures, which we are working on implementing, but other actions have been implemented already.

This year, this work has included making improvements to our websites to ensure the information we provide to notifiers is clear and easy to follow, and updating the letters we send when we receive a notification. The letters are now friendlier and more helpful in tone, explain the notifications process in more detail, and outline what to expect if you have made a notification (or are the subject of a notification). These letters are now in use across Australia.

Through our work with the Professions Reference Group and our stakeholders, it became clear that the feedback from notifiers is also echoed by practitioners, and that by addressing the recommendations in the report, improvements will be made to the experience of both groups.

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Providing greater consistency through national training for our investigators

We further strengthened consistency in our approach and performance in managing notifications across Australia by establishing a national three-day training program for all AHPRA investigators. This program is rolled out regularly and all notifications officers will attend the training.

The program is based on modules provided by the Council on Licensure, Enforcement and Regulation (CLEAR) and is customised to reflect the requirements of the National Law.

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Managing risk through improved international criminal history checks

In February 2015, a new procedure for checking international criminal history, which provides greater public protection, was introduced.

Under the Health Practitioner Regulation National Law (the National Law), National Boards must consider the criminal history of an applicant who applies for registration, including any overseas criminal history. The new approach requires certain applicants and practitioners to apply for an international criminal history check from an AHPRA-approved supplier.

More than 4,200 international criminal history checks were undertaken since the procedure changed. From these, 10 positive criminal history results were identified. When a positive criminal history is identified, the National Board or its delegate considers whether the health practitioner’s criminal history is relevant to the practice of their profession.

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Improving how we work

An ongoing focus has been on identifying unhelpful complexities and variations in our operational processes, and identifying ways to streamline. This year we began a strategic process review of how we work. We have identified areas for future work, including reviewing some of our IT systems and improving processes to support greater efficiency.

While this work is ongoing, the results are already coming in.

We have significantly improved our timeframes for dealing with notifications, and we are determined to keep improving. For example, this year, we have reduced by 18% the number of notifications that have been in investigation for more than 12 months. We also decreased the number of open notifications (excluding NSW) from 3,927 to 2,958; a 24.7% reduction.

This year we received 469 administrative complaints about our work, 32.8% fewer than the year before. This includes the 67 complaints referred to us by the National Health Practitioner Ombudsman (a 55% decrease from the year before).

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Auditing compliance with standards

By auditing the compliance of practitioners with their Board’s registration standards, we provide assurance to the public and the National Boards that the requirements of the National Law are understood, practitioners are in compliance with the requirements of their Board’s registration standards, and only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered. In 2014/15, we carried out audits across all 14 professions.

For all audits initiated in 2014/15, 96% showed full compliance with the registration standards audited.

When a practitioner is found to not have met the requirements of the Board’s standard, the Board will work with the practitioner to ensure compliance before the next period of renewal. This can involve cautioning the practitioner as a reminder of the importance of compliance with registration standards. Only 1% of all audited practitioners were cautioned in 2014/15.

During 2014/15, we have carried out more in-depth trend analysis and are now resolving potential issues faster and more efficiently. We have begun work to further enhance our systems to support the audit function better and ensure integration with our work on registration, notifications and compliance.

See page 34 of the Annual Report for further details on our auditing work.

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Improving the processes for panels for greater consistency and quality decision-making

To help support panel members to deliver more consistent decision-making nationally, a new, ongoing training program was developed. This year, 80% of existing panel members (including members of the community and registered health practitioners) completed the program. Feedback on this program has been overwhelmingly positive, with 99% of surveyed participants saying that the training program would assist them in their role as a panel member and 97% indicating they thought they would apply skills and knowledge learned through the program in their role as a panel member.

A single list of approved community members who are eligible to sit on panels across professions has been developed, with the approval of all National Boards. This approach reduces unnecessary administrative double handling and supports increased flexibility, intelligence sharing, and better quality decision-making.

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Developing standards and engaging in formal consultations

During 2014/15, there were 15 public consultations undertaken by National Boards on 17 registration standards and 13 guidelines (see Appendix 2 of the Annual Report for full details).

All National Boards consulted on draft guidelines for the regulatory management of registered health practitioners and students infected with blood-borne viruses.

The consultation was open from July to September 2014. A Twitter chat was held on this consultation.

A number of registration standards for the 14 currently regulated health professions were submitted for approval by the Australian Health Workforce Ministerial Council (AHWMC) during 2014/15, in accordance with the National Law (see Appendix 3 of the Annual Report for full details).

The revised criminal history registration standard for all 14 Boards and the revised English language skills registration standard for 13 Boards were approved by the AHWMC in March 2015, as well as standards and guidelines for some of the individual Boards.

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Collaboration to improve accreditation

The National Boards, AHPRA and the accreditation authorities have worked collaboratively to identify opportunities for improvement; aspects of accreditation that need greater consistency of approach (such as reporting of accreditation decisions); as well as areas within accreditation that lend themselves to cross-professional approaches.

Steady progress continues and further cross-profession initiatives, such as work on interprofessional learning and embedding models for simulated learning environments in clinical training, are being implemented or are planned, with the aim of further demonstrating good practice in health profession accreditation. The Accreditation Liaison Group (ALG) is the primary vehicle for collaboration on accreditation.

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Working with governments

AHPRA and the National Boards continue to strengthen their work with governments on matters of shared interest relevant to the National Scheme. Our work with governments covers a broad spectrum of activities, including contributing to public and regulatory policy development through making joint AHPRA and National Board submissions as much as possible to government consultations, including the independent review of the operation of the National Scheme.

We also brief health ministers on local and national issues relevant to the regulation of health practitioners in Australia, and raise issues with, and receive the collective views of, AHMAC’s Health Workforce Principal Committee (HWPC) on draft regulatory policies, guidelines and standards, and other matters to inform advice to health ministers.

We facilitate the recruitment processes with jurisdictional representatives to enable health ministers to appoint board members.

We have drawn on the expertise of advisory groups with government representation on priority issues, including to identify any unreasonable workforce barriers and also enablers of reform in registration standards, codes and guidelines. We have also called on their expertise to support the development and review of regulatory policy related to the prescribing of scheduled medicines in the National Scheme.

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Engaging with stakeholders and improving our communications

We continue to work closely with our two external advisory groups, the Community Reference Group and the Professions Reference Group. Communiqués from both groups are published on the AHPRA website after each meeting. Both groups provide feedback on how we can continue improving the way we communicate so that we can engage more effectively with our stakeholders.

We refreshed the homepages across all 15 National Board and AHPRA websites to make important information easier to find, and included new information for employers and practitioners as tabs on the login window. Following feedback from the Community Reference Group, we included the Register of practitioners search on the homepage, and introduced brightly coloured ‘tiles’ to highlight important topics.

We have made it easier for members of the public and practitioners to learn about tribunal cases and outcomes by publishing summaries on our websites and sharing them in the media and National Board newsletters. This year, the tribunal summaries were some of the most popular content on our social media channels.

We have continued to develop plain language materials for a range of uses, and all AHPRA staff now undergo communications and plain language training as part of the induction program.

It is easier for members of the public and practitioners to get in touch with us as we have expanded our social media presence and are now on Twitter, Facebook, YouTube and LinkedIn.

Our work to ensure our websites are accessible and compliant with Web Content Accessibility Guidelines (WCAG) standards is ongoing.

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