More space to prioritize safe health services – discussion and history

Published Date: 10/28/2022 08.41

Health comment on the job: Freud SolbergSenior Advocate and Assistant Director of the Norwegian Medical Association

from 1 July Important changes in health legislation have entered into force. The purpose is to contribute to more effective and rapid supervision of health care services. There are some important changes in the rules for administrative feedback, the warning reaction has been abolished, and a new system of professional orders has been introduced, among others. The change is in line with the goal being promoted now that there is an increased focus on learning and to a lesser extent on what many experience as a form of punishment.

Changes in the law have given supervisory authorities more scope to set priorities, and new tools to support a safe health service.

resource usage. Government officials have experienced a surge in requests to assess breaches of duty, and the bottom line for initiating supervisory actions is that they are “not clearly unfounded.”

There was an opinion that this threshold for opening a case was too low, and as such was using a lot of resources that would have been used in cases where it would be appropriate to proceed with supervision.

The vast majority of supervisory cases are completed without reaction, but are resource-intensive and often a burden to the person who has the case addressed to them.

Follow-up. It was also criticized that the processing time was too long. When the reaction comes long after the accident, the learning effect is less, and it can be felt as meaningless when, in the period between the accident and the inspection decision, appropriate measures are taken.

The inspection body is now given more opportunity to assess whether, and how, the application should be pursued. The core activities of the inspection body will largely be to give priority to cases where continuous practice may expose patients to serious failure.

It is assumed that more cases will be followed up in the health service itself, and the duty of companies to respond to and follow up on inquiries of patients and relatives is also highlighted. This should demonstrate that systematic quality work and patient safety must be prioritized in hectic daily life.

With warnings. Being open about risks and errors is crucial to good learning and work, as well as having a close and good dialogue between the patient and health care staff, as well as about errors.

A big change is that the warning should no longer be used. This interaction has typically been used in the event of inappropriate treatment, insufficient investigation/follow-up, inappropriate discharge, breach of confidentiality, reprehensible behavior and inadequate record keeping.

The idea of ​​the break is to shift the focus away from the reaction itself and toward learning. The learning perspective will also provide better opportunities for interaction between supervision, health workers and the employer. This should be taken care of by the new reaction, which is called a professional order Article 56 of the Health Workers Law. These orders can be, for example, measures to enhance efficiency, improved visibility in various contexts and also orders towards the employer. In such cases, the employer must contribute to the health workers taking measures, for example in the form of training, hospitalization and supervision.

There are doubts about practical implementation, particularly how healthcare staff who do not have an employer will be able to adjust here. If professional orders are not followed, it may be appropriate to forfeit permission, see Section 57 second paragraph of the Health Workers Act.

suspension. Delegating limitations is not a new reaction, but it can now also be used when professional demands are not considered sufficient. For example, a physician may not be permitted to perform certain tasks for reasons of patient safety. It is often the case that if a doctor lacks skills in one area, they can do well in others.

It has also been given new authority for limited suspension. Some cases make a full suspension disproportionate. This means that the supervisory authority prohibits the implementation of a certain type of activity until the case is completed. These rules are included in the Health Workers Act Section 58 Paragraph One and Two.

In the past, failure to respond to supervisory authorities meant several reminders and warnings – before permission was lost. Following the change in the law, authorization can now be suspended until the information is delivered. Suspended permission means that the doctor cannot act as a doctor. When the doctor answers, the suspension is lifted.

Trust and quality. The doctors’ union mainly supported the changes, but stressed that practice was the deciding factor. As mentioned, there are unanswered questions about how professional orders are enforced, for example, general practitioners, contract specialists, and fully private doctors who do not have an employer. It is also important for trust, and perhaps especially when it comes to professional orders, that the supervisory authority is able to associate well-qualified professionals who can inform cases and provide a good basis for decision-making.

The medical association’s focus is that safe physicians provide quality patient care, and that the supervisory system must support the established goals of the health service. The key words here are trust, quality and patient safety.

additional informationThe author of the article clarified that the opinions expressed in the article are his own and not an expression of the opinion of the Medical Syndicate.

medicine todayFrom the facts and debate section in the thirteenth edition