QA Activity Examples

Quality Assurance in Occupational Medicine

It is recognised that there is considerable variety in the practice of Occupational Medicine, including private consultant practice, either solo or in a group, large company occupational health service, academic occupational medicine units, and various government and quasi-governmental positions.

Not all of the following models of quality assurance will therefore be applicable to the individual Fellow. It is expected that Fellows or groups of Fellows will select the type/s of QA most applicable to themselves.

1 Personal learning project

A learning activity initiated by a physician and containing;

1. Development of a question or development of a problem statement, 
2. Stimulus for learning, 
3. Resources or information sources that physicians select to learn, 
4. Determination of the outcome(s) of learning in terms of an impact on practice.

Practical point: the RACGP has developed a series of modules of clinical audit, many of which may be of relevance to occupational medicine.

Subject areas include: interpersonal skills, pain assessment, patient education, patient satisfaction, preventative care and time management. Assessment is carried out by independent bodies, at the participant’s expense. Other organisations have similar modules. The objective of using such commercial modules is not to demonstrate level of existing knowledge, but to incorporate them into a personalised learning programme.

2 Random case review

Case records act as the database. Randomly selected records of an individual Fellow are reviewed against pre-set criteria. Practical Point: random case review may be done as a group. The Fellow being audited may be anonymous. The selected record/s are audited by another Fellow, who presents their findings at a subsequent audit meeting for debate by the meeting. Points discussed and actions agreed are minuted. The minutes are used as proof of audit for MOPS purposes. Recommendations made at the meeting should be implemented and audit used to demonstrate that the improvements are made.

The Faculty encourages the formation of such groups, either within an organisation or between organisations. Occupational physicians who work in isolation may be able to participate by mail.

3 Topic review

A topic is selected representing a process of the practice or service. Examples might include pre-placement health assessment, an immunisation regime, a hearing conservation programme etc. The topic is assessed for effectiveness and efficiency. The question to be answered is “are we doing what we should be doing?” Practical point: the review may be undertaken in the same way as for clinical audit.

4 Clinical outcome measures

Outcomes are what happens as a result of what the occupational physician does. It will be particularly relevant to occupational physicians who provide clinical care. Good practice should be based on published evidence of effectiveness. *Practical point: use published evidence based guidelines where possible. Where these do not exist, identify key issues by referring to the literature. Some aspects of outcome can be assessed using instruments such as patient follow-up surveys.

5 Audit of structure

Elements of structure that can be audited include staffing levels, training and manner, facilities, policy statements, waiting times and scheduling, strategic planning, goal setting and communication.

You may be familiar with generic “quality systems” such as ISO9000 – many similar variants on this system have been developed for different sections of industry. Occupational medicine is a ‘service’ industry, and quality systems are just as relevant to professional medical practice as they are to a fast food outlet!

Quality Assurance is basically an administrative undertaking that involves policy development, documentation of procedures, and regular checking to see if policies and procedures are being followed. Any discrepancies between actual practice and the policies/procedures is regarded as an ‘opportunity for improvement’ – either alteration of the policy/procedure because it is outdated, or amendment of current practice to ensure future compliance with the documented policies/procedures.