Skills decline – a problem on the rise

In the 2-year course of our Osler journey, my business partner Jeff has said to many time who in the hospital he’d want looking after him if he needed a procedure performed : the senior registrar.

 

As Jeff sees it, senior registrars are about as sharp skills-wise as they are ever going to get.  They do the most procedures, they learned the most recently and they are yet to be cloaked by an air of invincibility.

 

And he’s not far off the mark.

 

But what it highlights is an increasingly recognised phenomenon – skills attrition in consultants.

 

In many procedural specialties, there is an almost precipitous drop off in exposure to invasive procedures from the day you pass your fellowship exam.  There is a changing of the guard, where those who once did, now supervise.  Add to that the competition for access to increasingly rare opportunities and there is little doubt that emergency physicians, retrievalists, rural generalists and intensivists are starved of exposure.

 

It’s more likely that the problem has been quietly suspected for some time, but as an industry we’ve been more inclined to turn a blind eye to it, for the solution presents an even bigger problem – if we’re all diminishing in our skills capacity, what on earth are we going to do about it?

 

But the problem is now becoming too big to ignore.  Andrew Tagg, an emergency physician from Melbourne, wrote about this recently.  Access to opportunities to perform procedures are becoming so rare that inevitably we are all deskilling.

 

So what to do?

 

The first step in any quality assurance process is to measure.  Any textbook on clinical audit will tell you the three key areas that we can measure – activity, process and outcome.

 

The first should be easy.  Documenting our activity is an important first step in detecting gaps in our experience.  There is a fairly clear relationship between recency of performance and ability to execute, so it makes sense to track the volume and timing of our activity.

 

The second examines our method.  Is it really too much to ask to submit ourselves to periodic review of our performance by our peers? Is there a better way to validate that my practice is consistent with modern standards?  While inevitably there are logistical challenges with this style of approach, the potential benefit in safety terms more than justifies applying it.

 

Finally, and most problematic, is to measure outcomes.  It’s difficult for many reasons, not the least of which are standardising definitions, accurate data collection (particularly of delayed outcomes) and the relatively low incidence of complications for most things we do.

 

We should not refuse to measure ourselves because we are afraid of what it might tell us.  The more mature response is to find out where our limitations lie, and find a solution.

 

We owe that much to our patients.

 

The old adage is that “Not all that is important can be measured, and not all that can be measured is important.” However, there is plenty that can be measured and is of value to us.

 

We owed it to our patients to try.

Hospital Safety Report Provides Opportunity for Innovation

A new report into managing critical safety risks in the hospital system makes important recommendations and highlights the need to prevent patient injury and death in the first place, says a high-tech medical start up.

 

The just-released Duckett review into DHHS management of incidents, such as a spate of perinatal deaths in Victoria in 2013-4, underlines the ongoing national tragedy of 1800 Australians who die each year and another 6800 who are impacted by such adverse events.

 

Osler Technology, the brain child of intensive care and retrieval medicine specialist Dr Todd Fraser, provides real time, meaningful data on patient outcomes within the clinical workspace, and enables clinician leaders to respond rapidly and creatively to prevent future events.

 

By tracking individual training and activity data, it ensures all staff practice within their scope.

 

“The recommendations of the Duckett review create a better environment for patient safety across the wider health system but this is only half the battle. Left unanswered is how health systems prevent patient injury in the first place,” said Dr Fraser.

 

“If meaningful change is to be made, clinical staff will be the ones to make it, and they can only do so with the right tools and information at their disposal. This is where a system like Osler plays a role by taking the high level principles identified in the Duckett review and applying them at individual patient, clinical manager and clinician levels.”

 

Read the full media release here:

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“How many of these have you done?”

A recent opinion piece in the Journal of the American Medical Association drew attention to the issue of procedural experience in healthcare.

 

Titled “How many have you done?”, the piece described the experience of a doctor who required a procedure herself, in this case, an amniocentesis.

 

Of course, what the patient was really asking is, “How can I be reassured you know what you are doing?”

 

The thrust of the piece was that the training doctor who performed the procedure had felt compelled to misrepresent their experience with the technique, deftly deflecting questions by the patient and her partner that explored his competence.  The author calls for a more honest response to these types of questions, while acknowledging that this is often difficult to do.

 

But is it any wonder a young doctor has trouble answering this question?

 

Healthcare continues to battle with the issue of competency.  It is still rare for doctors to be formally certified to perform specific procedures.  In fact, the industry still does not have a shared understanding of what competency actually is!

 

Furthermore, because it is uncommon for doctors to assiduously record their activity and outcome data, and even more rare for them to benchmark against their peers, most clinicians are simply oblivious to performance level.

 

So when patients are searching for reassurance that they will be cared for as best they can be, most of us struggle to be clear and meaningful in our response.  Because most of the time, we just don’t know.

 

Wouldn’t it be much better for the junior doctor to answer with authority?

 

“Well, I’ve completed a recognized pathway and been certified to practice after a period of supervision by experts.  Furthermore, I continuously review my performance results and feel comfortable that I’m doing well.”

Osler Community Survey – Results

Thanks to all the respondents to our first Osler Community Survey!  The response rate we received was highly encouraging, and the feedback quite insightful in relation to professional development, clinical governance, credentialing, logbooks and desirable Osler product features.   We look forward to putting the input and feedback received to good use in the next versions of Osler and we will keep you apprised of the upcoming launch of Osler Community later this year via our newsletter and here on the blog.

 

Congratulations to N Kumta (Australia), M Hoops (Australia) and DP Bowles (UK), our three winners of the free 12 month subscription to Osler!

 

The infographic below provides a summary of your feedback and our findings.

Osler Clinical Performance

 

Or, you can download it from the link below:

Osler Survey (June 16) Results

Everyday heroes. Saving lives, one at a time…

I’m the COO here at Osler Technology.  I’ve had decades of experiences building businesses, developing software and helping clients achieve benefits through the use of that software.   But until I got involved at Osler, I was a complete novice in the inner workings of our health care system (still am!).  A recent event reminded me about why we are building Osler.

 

Earlier this week, one of our content editors (and a practicing nurse) witnessed a woman collapse on the steps to a supermarket across the road from our HQ in Noosa Heads, Queensland.  She immediately swung into action and commenced CPR and basic life support activities and called Todd, our founder (and a practicing intensivist), who was up the road having a coffee.   Between the two of them,  they kept this woman alive until transported to Noosa Hospital. 48 hours later, with a new stent in place, she was sitting up in bed, calling Jo & Todd her guardian angels.   Without the lucky coincidence of the timing and location, this woman probably would not have survived.

 

As our CEO remarked,  “Truly amazing to be involved in a software company where our team members actually go on to the street and resuscitate people who have had a heart attack.”

 

We’re building tools to help clinicians acquire new clinical skills and improve their clinical performance,   and to help providers be more efficient in developing and maintaining those skills among their workforce.  We know that these everyday heroes get it right 99% of the time.   But if Osler can help improve clinical governance, patient safety, and help those heroes get it right 99.1% of the time,  then it will be a huge win for public health,  patient safety,  and of course, our amazing team.

Free Trial – Osler’s Clinical Governance application

Osler’s Clinical Performance Platform (CPP) is now available to trial on the AppExchange.

If you want to see how Osler CPP can:

 

  • improve your hospital’s approach to clinical governance
  • reduce costs of delivering mandatory training
  • help your staff improve their procedural skills by recording and measuring their procedural activity
  • provide immersive e-learning for a range of clinical procedures
  • give you at-a-glance views of your team’s clinical skills and procedural competence
  • improve patient safety

then go to the AppExchange Listing to sign up for a free 30 day trial with a fully configured application, including sample data.    Download the Osler TrialForce User Guide under the Details tab to help you get started,  and then click the [Get It Now] button.   You’ll be up and running in about 15 minutes!

 

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The science behind learning a skill and keeping it

Associate Professor Marcus Watson is the Executive Director of the Skills Development Centre for Queensland Health in Brisbane, Australia.

 

In this exclusive interview with Todd, Marcus discusses the research underpinning modern approaches to skills training, competency and maintenance of expertise.

 

 

Listen to the interview with Marcus Watson here