Performance assessments

A performance assessment is an assessment of the knowledge, skill or judgment possessed, or care exercised by, a registered health practitioner in the practice of their profession.

Performance assessment is:

• a way to identify strengths as well as deficiencies
• tailored to the individual practitioner and practice setting
• a collaborative process that aims to find ways to make the practitioner safe to practise
• an assessment of the application of the practitioner’s knowledge and skill, not an assessment of how much knowledge and skill (competence) the practitioner possesses
• designed to address patterns of practice rather than one-off incidents or errors, unless the single incident is demonstrative of a broader problem
• designed to lead to education and retraining when deficiencies are identified, while ensuring that the public is properly protected
• broad-based and not limited to the concerns raised in the particular notification that triggered the assessment, and
• a snapshot of where a practitioner is now, not where they were when the behaviour that resulted in a notification occurred.

Performance assessment is not:

• a punishment
• an appropriate method for dealing with one-off incidents or errors
• an alternative to a thorough investigation of a notification. Before requiring a practitioner to undergo performance assessment, the Board will have assessed and analysed the available information to make an informed decision, or
• appropriate for dealing with practitioners whose behaviour may amount to professional misconduct or unprofessional conduct as defined under the National Law.

A performance assessment is not appropriate if any of the following matters are identified in an investigation:

• recklessness (either by inclusion or omission)
• unethical behaviour
• wilful conduct (either by inclusion or omission), or
• criminality.

These issues are likely to be managed through the conduct pathway.

The National Board considers the information contained in the notification, the practitioner’s response, clinical records, an expert opinion (if any) and the relevant professional standards before deciding whether a performance assessment would help it decide whether any change to the practitioner’s registration is necessary to keep the public safe.

When a National Board requests a performance assessment, the Ahpra staff member with experience in organizing performance assessments will make all of the arrangements for the assessment to take place. The practitioner being assessed is advised of the proposed assessors and the date, time and location of the assessment.

The Nartional Board selects assessors whose scope of practice is similar to that of the practitioner being assessed. For example, a rural practitioner would usually be assessed by a colleague familiar with the particular challenges of rural practice.

If the practitioner or the assessors identifies a conflict of interest then another assessor is selected. In specialised areas of practice it may be necessary to obtain an assessor from another state or territory.

The practitioner being assessed is asked to complete a pre-assessment questionnaire, which forms part of the information provided to the assessor. The questionnaire describes the scope and type of practice and this informs the specific assessment to be carried out. The assessor is also given the information which led the National Board to decide that a performance assessment was needed.

Performance assessments are tailored to each practitioner. Depending on the reason for the assessment, the focus might be on assessment of patients, clinical reasoning and decision-making, response to emergency situations, documentation, procedural work or prescribing/dispensing/ administration of drugs.

Some assessments are conducted by directly observing the practitioner in their normal practice/procedural activities. Other assessment methods include:

• Objective Structured Clinical Examination (OSCE)
• Objective Structured Long Case Examination Record (OSLER)
• Workplace Based Assessment (WPBA)
• Mini Clinical Evaluation Exercise (Mini-CEX)
• Case-based Discussion (CbD)
• Chart Simulated Recall (CSR), and
• Mini Peers Assessment Tool (Min-PAT).

Not all of these tools are suitable for all practitioners and professions.

If the assessment includes direct observation of practice (a consultation or procedure), it is usually necessary for someone in the practice to be aware that a performance assessment is being carried out. It important to obtain the patient’s consent to the presence of an assessor before the patient enters the consulting room/treatment area. This may be best done by the receptionist or practice manager ahead of time.

This is not an issue if consent has been sought ahead of time. Otherwise, the patient can be offered a consultation with another practitioner in the practice (if available) or asked to return on another occasion.

The assessors will observe and make notes but will only discuss patient management when the patient has left the room. The only exception to this would be if the assessor observed a dangerous clinical situation, in which case the assessor would take steps to minimise the risk to the patient.

The assessors may also review clinical records (if documentation or creation of management plans is an apparent issue), speak to other staff in the practice (if communication is an apparent issue) or inspect infection control practices (if infection control has been identified as an issue).

Performance assessments are never recorded. This is strictly against Ahpra's performance assessment guidelines.

The purpose of the meeting with a nominee of the National Board is to give the practitioner an opportunity to explain or clarify any issues which arose during the assessment and to discuss the assessor’s recommendations before they are considered by the National Board.

If the practitioner agrees with the assessment report, the Board member will report this to the National Board. If the practitioner does not agree with the assessor’s findings, the Board member will relay any concerns to the National Board, potentially with alternative suggestions for correction of any deficiencies.

The National Board recognises that it can be difficult for practitioners to be assessed in this way, and practitioner feedback has shown that performance assessments can be stressful experiences. Practitioners are encouraged to consider taking a support person along with them on the day of the assessment, however they will not be allowed into the room when the assessment is taking place.

Practitioners may also wish to seek advice or support from their professional association, professional indemnity insurer, an independent legal adviser, general practitioner or another healthcare provider.