PHYSICIAN PRACTICE ENHANCEMENT PROGRAM

Performance Review and Action Plan

The Physician Practice Enhancement Program (PPEP) is a collegial program that proactively assesses and educates physicians to ensure they meet appropriate and current standards of practice throughout their professional lives. Our vision is to promote a culture of quality improvement among BC’s physicians.

We seek to support the success of continuous quality improvement in community-based physicians’ medical practice by highlighting areas of excellence and identifying opportunities for professional development.

PHYSICIAN PRACTICE ENHANCEMENT PROGRAM College of Physicians and Surgeons of British Columbia

Performance Review and Action Plan

Table of Contents

Introduction .................................................................................................................................................. 1

Reviewing and Reflecting on Your PPEP Assessment Report ....................................................................... 2

The Physician Practice Improvement Cycle .................................................................................................. 4

Comments from the Medical Advisor and Next Steps .................................................................................. 5

PHYSICIAN PRACTICE ENHANCEMENT PROGRAM College of Physicians and Surgeons of British Columbia

Performance Review and Action Plan Page 1 of 9 Dr. [First name] [Last name] – Month YYYY

Introduction

Thank you for your participation in the Physician Practice Enhancement Program (PPEP). We hope that the results provided by the PPEP will give you useful feedback about your practice and provide you with ideas about improvement opportunities.

Historically, for many physicians, performance feedback ceases after internship or residency, leaving them only with their own perceptions about their performance. The College fully endorses the principle that continuing medical education (CME) and continuing professional development (CPD) are essential components of medical professionalism. The PPEP provides an external evaluation using multiple measures to assess performance, knowledge, and skills, as well as initial educational support for physicians to ensure they meet appropriate and current standards of practice throughout their professional lives.

By now you will have interacted with the program at several stages. You answered the pre-visit questionnaire (PVQ), provided names of referees for the multi-source feedback (MSF), completed your own self-assessment questionnaire and collected patient questionnaires. Following that, you received a copy of your MSF report and were asked to fill in an MSF reflection tool.1 In the next step, the peer practice assessment (PPA), your patient records were reviewed by a peer assessor in the clinical setting and an office assessment (OA) was carried out. Following this, there was an interview with the assessor (either in person or by phone).

This report is intended to give you feedback on multiple components of clinical performance. The PPA component provides feedback on clinical care through a review of your medical records. The MSF component provides information on your communication, professionalism, collaboration and management competencies. 1 Some physicians will have been exempted from one or all components of the MSF.

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Reviewing and Reflecting on Your PPEP Assessment Report

The above data have now been reviewed by a PPEP medical advisor, who has provided comments and recommendations within this global PPEP report. This report highlights areas of appropriate (or excellent) care and also details areas for improvement; all with the ultimate goal of improving patient care. When reviewing the report components, recall that different components review different skills and competencies.

Each component helps inform and guide the assessor’s interview with the physician, which in turn informs and guides the recommendations made by the medical advisors. This contributes to a comprehensive and robust assessment, which aims to support you in making and maintaining positive practices, while also identifying pathways and resources for your continuous quality improvement.

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As you review your report we recommend you:

Commend yourself on the things you did well in your practice.

Do not be disappointed if the assessor identifies areas for improvement or if your scores are lower than expected. We encourage you to view the feedback as an opportunity to make changes that will improve patient care, safety, and security.

Notice what surprised you, anything that frustrated or irritated you, and whether there are any patterns (between or within any components of the assessment).

Think of your assessment as a tool for setting priorities—focusing first on those that will have the greatest impact on you, your patients, your practice, and patient care. Even the best physicians are weaker in some aspects of practice than others. The purpose of this report is to help you identify the priorities that are most likely to benefit your patients, not to draw comparisons across physicians. As you review each component, think about how the findings can contribute to an action plan for your professional development. In thinking about change it may be helpful to identify the quick wins or changes you can make in the short term, and strategize on how you might achieve long-term goals.

Consider engaging a mentor or coach who knows your practice to discuss your report and the feedback provided, and for guidance on making changes.

Consider whether there are factors that might be contributing to the findings (e.g. patient load, recent adoption or change of an electronic record, ability to type or dictate, personal factors) and could be addressed to help you accomplish the practice improvements you have set as a priority.

Next, we will ask you to reflect on what you would like to improve, and develop an action plan (this activity is eligible for CME credits through the College of Family Physicians of Canada).

Reflection on learning and practice is a powerful learning tool, supporting the mandate that physicians must reflect on all aspects of their professional work. The objective is to build a framework for ongoing development that will enable you to constantly review and update the information you collect about yourself and to monitor your progress.

We encourage you to carefully consider the assessor’s interview comments, medical advisor’s recommendations, and your MSF physician reflection tool to think about the changes that you could or should make. We recognize that not all participants will initially agree with the findings and recommendations. Rather than reflexively dismissing anything with which you do not agree, we would encourage you to use the information and your action plan to generate further discussion with colleagues as well as deeper exploration regarding why any results that disappoint you may have arisen.

We wish you success with your practice and practice improvements.

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The Physician Practice Improvement Cycle

Setting specific, measurable, achievable, relevant, and time-bound (SMART) goals is essential for your professional improvement. The following physician practice improvement (PPI) cycle has been developed by the Federation of Medical Regulatory Authorities of Canada, as a tool to support the principles of continuous quality improvement for physicians and their practices.

Adapted with permission from the Federation of Medical Regulatory Authorities of Canada

We ask you to now consider the comments and recommendations from a PPEP medical advisor in the sections below, and use this to plan for your own professional development. We have guidelines for creating an action plan (Appendix A), as well as copies of your assessor report (Appendix B), and (if applicable) your MSF report (Appendix C). In a separate file, you will find a template for creating your action plan (Appendix A supplement). This is a fillable form that can be opened/filled in with Adobe Reader.

Plan-Do-Study-Act (PDSA) is another fundamental tool in quality improvement work. It can help you to determine whether an action was sufficient, effective, efficient, and sustainable. Health Quality Ontario has a useful template: http://www.hqontario.ca/portals/0/Documents/qi/rf-document-pdsa-cycles1-en.pdf

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Comments from the Medical Advisor and Next Steps

• Introduction

• Comments and Recommendations

o Medical Records

o EMR Resources/Peer Mentoring/Training

o Clinical Practice

o Multi-source Feedback

o Office Assessment

o Feedback Summary

• Next Steps

o Additional Comments

Credits for Participation

The PPEP is eligible for Mainpro+ educational credits through the College of Family Physicians of Canada (CFPC) as a certified assessment activity. In your member portal, select “Assessment,” then “Certified,” and then “Provincial Practice Review and Enhancement Programs” from the menu options. For further information, please refer to their website.

Questions about the Report or Program If you have any questions about the program please email actionplan@cpsbc.ca or phone the College at 604-733-7758.

Feedback to/Evaluation of Program In three months’ time, you will be contacted via email and asked to provide feedback on your experience with the program and changes that you may have implemented since your assessment. We

Requirements

PHYSICIAN PRACTICE ENHANCEMENT PROGRAM College of Physicians and Surgeons of British Columbia

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appreciate the opportunity to receive this feedback as it is an important aspect of our own quality improvement.

Closing Thank you again for your participation in the PPEP. We hope you find this program supportive and helpful as you move forward with your continuous quality improvement.

Resources

College Resources

The College’s Professional Standards and Guidelines can be found at: https://www.cpsbc.ca/for-physicians/standards-guidelines

Please review the standards for:

• Care Coverage Outside Regular Office Hours https://www.cpsbc.ca/files/pdf/PSG-Care-Coverage-Outside-Regular-Office-Hours.pdf

• Medical Records https://www.cpsbc.ca/files/pdf/PSG-Medical-Records.pdf • Walk-in, Urgent Care and Multi-physician Clinics https://www.cpsbc.ca/files/pdf/PSG-

Walk-In-Urgent-Care-Multi-Physician-Clinics.pdf • Safe Prescribing of Opioids and Sedatives https://www.cpsbc.ca/files/pdf/PSG-Safe-

Prescribing.pdf Please see guidelines for:

• Prescribing Practices, Countersigning Prescriptions and Internet Prescribing https://www.cpsbc.ca/files/pdf/PSG-Prescribing-Practices-Countersigning-Prescriptions-Internet-Prescribing.pdf

• The Expectations of the Relationship between the Primary Care/Consulting Physician and Consultant Physician https://www.cpsbc.ca/files/pdf/PSG-Expectations-of-the-Relationship-Between-Physicians.pdf

The PPEP assessment standards can be found at: https://www.cpsbc.ca/programs/ppep/assessment-standards

Record Keeping

PPEP Practical Suggestions for Medical Record Keeping https://www.cpsbc.ca/programs/ppep/resources

CMA Practice Management Module 6: Medical Records Management https://www.cma.ca/Assets/assets-library/document/en/practice-management-and-wellness/pmc-module-06-e.pdf Canadian Medical Protective Association’s website (e.g. the “Documentation” e-module found under the “Communication” tab of the Good Practices Guide) at https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/communication/communication-e.html

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CPSBC Medical Record Keeping for Physicians course: Upcoming sessions listed at: https://www.cpsbc.ca/for-physicians/professional-development/upcoming-events or contact Mimi Wong at 604-733-7758 ext. 2395 or by email at mwong@cpsbc.ca for further information.

Electronic Medical Record (EMR)

Doctors of BC. “Doctors Technology Office (DTO).” https://www.doctorsofbc.ca/news/dto-%E2%80%93-technology-support-doctors or contact DTO Technology Solutions and Support at 604-638-5841 or dtotechsupport@doctorsofbc.ca

General Practice Services Committee. Optimize your EMRs with simple and useful EMR-enabled tools. http://www.gpscbc.ca/news/psp/optimize-your-emrs-simple-useful-emr-enabled-tools (Screening and diagnostic tools for chronic pain, adult and child & youth mental health, heart failure and COPD)

Family Medicine

Divisions of Family Practice https://www.divisionsbc.ca

Non Family Medicine Disciplines

Royal College of Physicians and Surgeons of Canada http://www.royalcollege.ca/portal/page/portal/rc/public

Doctor-Patient Relationship

UBC CPD Communications Course. Optimizing Communication for Excellence in Patient Care. http://ubccpd.ca/course-group/communication

Medical Council of Canada – Communication Skills Module http://physiciansapply.ca/commskills/introduction-to-medical-communication-skills/

Physician Resilience

UBC Continuing Professional Development. Practice Survival Skills Conference. https://ubccpd.ca/course/practice-survival-skills-2017

Senior Physicians/Retirement

Vancouver Division of Family Practice. (2016). How to Retire Guide. http://www.practiceinbc.ca/sites/default/files/VDoFP%20How%20to%20Retire%20Guide-2.pdf

Prescribing

How to obtain and access PharmaNet: http://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/system-access/medical-practice-access-to-pharmanet

2017 Canadian Guideline for Opioid Therapy and Chronic Non-Cancer Pain (and additional resources).Last accessed: June 23, 2017. http://nationalpaincentre.mcmaster.ca/guidelines.html

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College of Physicians and Surgeons of British Columbia-Professional Standards and Guidelines for “Safe Prescribing of Opioids and Sedatives” https://www.cpsbc.ca/files/pdf/PSG-Safe-Prescribing.pdf

Sample pain treatment agreement: https://www.cpsbc.ca/files/pdf/PRP-Sample-Pain-Treatment-Agreement.pdf

The Foundation for Medical Excellence. Chronic Pain Conference https://tfme.org/2019-pain-and-suffering-symposium/

CPSBC Prescribers Course: https://www.cpsbc.ca/for-physicians/professional-development/upcoming-events or contact the Prescription Review Program on 604-733-7758 ext. 2629

Centers for Disease Control and Prevention Turn the Tide pamphlet: https://www.cdc.gov/drugoverdose/pdf/TurnTheTide_PocketGuide-a.pdf Deprescribing Guidelines http://deprescribing.org/ Safe Prescribing Tool Kit https://www.cpsbc.ca/files/pdf/DP-Safe-Prescribing-Tool-Kit-F.pdf Michael G. DeGroote National Pain Centre at McMaster University http://nationalpaincentre.mcmaster.ca/index.html

• Appendix B-6: Benzodiazepine Tapering http://nationalpaincentre.mcmaster.ca/opioid/cgop_b_app_b06.html

• Appendix B-12: Opioid Tapering http://nationalpaincentre.mcmaster.ca/opioid/cgop_b_app_b12.html

Opioid Manager point-of-care tool https://www.opioidmanager.com/images/omcontent/documents/opioid_chart_feb_2011_b_4.pdf Narcotic Log: Narcotic and Controlled Drug Administration and Purchasing Record https://www.cpsbc.ca/files/pdf/PRP-Narcotic-Administration-Purchasing-Record.pdf The Pharmacists Clinic at UBC https://pharmsci.ubc.ca/pharmacists-clinic Tobin, D.G. et al. (2016) Prescribing opioids in primary care: Safely starting, monitoring, and stopping. Cleveland Clinic Journal of Medicine. 8 (3), 207-215.

Office Practice Management

Divisions of Family Practice Toolkit: https://divisionsbc.ca/provincial/resources/practice-toolkit

Medical Emergencies: http://www.aafp.org/fpm/2013/0300/p13.html

College of Family Physicians of Canada: http://www.cfpc.ca/ProjectAssets/Templates/Resource.aspx?id=1598

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CMA Practice Management Modules: https://joule.cma.ca/en/learn/practice-management-curriculum.html

Clinical Guidelines

BC Guidelines: http://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines

Virtual Care

College standard Telemedicine: https://www.cpsbc.ca/files/pdf/PSG-Telemedicine.pdf CMPA Thinking of working with virtual clinics? Consider these medical-legal issues: https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2018/thinking-of-working-with-virtual-clinics---consider-these-medical-legal-issues College Connector Telemedicine as a stand-alone, episodic care service rarely meets expected standards: https://www.cpsbc.ca/files/pdf/CC-2017-V05-01.pdf

Note: Information captured by PPEP is protected under section 26.2 of the Health Professions Act, RSBC 1996, c.183 and can only be used by you and within the program. Unless you have given your permission, material cannot be shared through freedom of information or legal requests, or with any other College department or committee. It is only in the event of egregious clinical conduct or repeated non-compliance that the Physician Practice Enhancement Panel (comprised of physician and public members) can refer a registrant to the College’s Inquiry Committee (the Inquiry Committee then carries out an independent investigation). Should you have any questions in this regard, please refer to our website and/or feel free to contact program staff via phone at 604-733-7758 or email at actionplan@cpsbc.ca.

PHYSICIAN PRACTICE ENHANCEMENT PROGRAM College of Physicians and Surgeons of British Columbia

Performance Review and Action Plan

Appendix A: Action Plan

PHYSICIAN PRACTICE ENHANCEMENT PROGRAM College of Physicians and Surgeons of British Columbia

Performance Review and Action Plan

Research suggests that change is more likely to be implemented successfully when people draft a plan that is as specific and concrete as possible, anticipate barriers and how they will overcome them, share their goals with others, and remind themselves of the benefits of the change.

You may recall the MSF Physician Reflection Tool that you had completed in advance of your peer assessment and discussed with your peer assessor. Now, with the benefit of feedback from additional sources in this report, you may want to revisit that tool as a first step to your Action Plan.

Action Plan Instructions 1. Review. Look back to the contents of your PPEP Assessment Report and your MSF Reflection

Tool, and think about the items in terms of your whole assessment. What strengths were noted? What areas for improvement do you see? What surprised you? What bothered you?

2. Reflect. Think of your profile as a tool for setting priorities. Ask yourself whether there is a gap between the quality of health care you want to offer, and what is reflected in your report? What do you need to change?

3. Draft an action plan. Taking into account the improvement opportunities identified above, write down the area(s) where you would like to focus your efforts and describe the benefits of reaching these goals. Prioritize areas that need improvement, focusing first on those with the greatest impact on patient care. Think about the action(s) you will take to achieve your goals and how you will follow-up, and how you will assess whether you have met your targets. Consider the following:

• Which piques your interest? Which are possibly of less interest, but you now recognize are important?

• Which are highest priorities for your patients, and your practice?

• What additional resources might you need?

• Who might you contact for support or mentoring?

• If some of these look complex or time-consuming, how might you break these down into more easily attained goals?

For each change that you would like to implement, complete the chart as follows:

ACTION PLAN

Action item: Using CPP/face sheets

Objectives and benefits Identify your goal and the potential benefits you’d expect once you achieve it.

Example

Objective: Begin using CPP/face sheets regularly on all medical records

Benefits: Clearer records for locums and other physicians in the office

PHYSICIAN PRACTICE ENHANCEMENT PROGRAM College of Physicians and Surgeons of British Columbia

Performance Review and Action Plan

ACTION PLAN

Action item: Using CPP/face sheets

Potential barriers and solutions

What might get in the way of implementing this goal? What solutions would you try to overcome that barrier?

Example

Barrier(s): Current office medical record template not designed for CPP/face sheets

Solution(s): Call PPEP for copy of latest CPP template, ask MOAs to begin inserting copies in medical records going forward

Resources I will use to do this

Identify any resources—articles or research you might need (the College library is an excellent resource), specific people who could help, or other materials you would need to achieve the change you desire.

Example

College guidelines detailed in their correspondence to me

Discuss goals with? (Optional)

Identify someone with whom you will discuss your plans for change. This may be people who will be directly affected, but can also include colleagues or others who might have advice to offer based on their own experience.

Example

Office medical director, office MOAs

Assess—measure impact of changes/improvement

What data will you analyze to describe the results? How do the results compare with your predictions? What did you learn from this cycle?

Example

Do a spot check of records of patients seen since change implemented, and compare to College guidelines. How many pass muster?

Complete by Set a firm deadline. Even if you revise it, having a set date will help make more concrete your efforts to implement change.

Example

8/15/2017

PHYSICIAN PRACTICE ENHANCEMENT PROGRAM College of Physicians and Surgeons of British Columbia

Performance Review and Action Plan

Appendix B: Assessor Report

College of Physicians and Surgeons of British Columbia300–669 Howe Street Vancouver BC V6C 0B4 www.cpsbc.ca

Telephone: 604-733-7758 Toll Free: 1-800-461-3008 (in BC) Fax: 604-733-3503

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PHYSICIAN PRACTICE ENHANCEMENT PROGRAM

Office AssessmentPHYSICIAN INFORMATION

Physician name: CPSID:

Clinic assessed: Medical director:

Assessor: Date assessed:

OFFICE ASSESSMENT TOOL

Italic items serve as prompts and aid in scoring; some items may not be applicable for some clinical offices.

Part I: Processes/operations

Yes No N/A

1. Is there a process in place to review and respond to critical and abnormal incoming lab results, diagnostic and consultation reports? • Receiver (MOA, administrative assistant) notifies/flags the report to the physician • Result is reviewed by physician or covering physician • Review of result by physician is signed off • Patient is contacted immediately and provided with direction by physician • Process and action is documented in patient chart

2. Is there after-hours coverage? • Are patients provided with direction on phone answering service when they call and

office is closed? • If applicable, is there an agreement with the emergency department that patients

should go there if required (see Walk-in, Urgent Care, and Multi-physician Clinics standard)?

3. Is there a process for patient repeat prescription requests? • System in place for physician to review request • All requests are documented in the patient's medical record • Physician has criteria or parameters that guide his/her decision to renew prescription

4. Is paper and/or computer charting secure (e.g. billing, medical records)? • Lock screen when computer is unattended • Password protection • Paper records are stored securely within the clinic or office, not viewable to the public

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College of Physicians and Surgeons of British ColumbiaOffice Assessment

Physician name: Date: Assessor:

Yes No N/A

5. Is the physical space adequately conducive to patient confidentiality and privacy? • Sound barrier from MOA area or other mechanism (e.g. music) • Staff maintain patient confidentiality during phone and in-person patient interactions • Soundproof between exam rooms • Patients are not visibly exposed when staff are entering into or exiting the exam room

(e.g. curtains, location of door) • Draping for patient during exam • Chaperones available for certain exams if required or requested

Item-specific notes (if any):

Part II: Patient safety/clinical

Yes No N/A

Vaccine handling and administration

a. Max-min thermometer present in vaccine refrigerator

b. Log book for temperature monitoring present and used

c. Temperatures are recorded twice a day

d. Vaccines stored on middle shelf

e. Vaccines are not expired

f. No food in fridge

Medications

a. Medications are not expired (check dates)

b. Medications (including samples) are safely stored away from public access

c. Narcotics are in a secure, locked cabinet and use is logged

Emergency kit

a. Emergency kit is available and easily accessible when required

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College of Physicians and Surgeons of British ColumbiaOffice Assessment

Physician name: Date: Assessor:

Yes No N/A

b. Required medications present: • diphenhydramine (50 mg of oral/parenteral preparations) • epinephrine (1 mg of 1/1000 solution or prefilled syringe) • salbutamol metered dose inhaler • nitroglycerin spray (0.4 mg) • acetylsalicylic acid (80 mg)

c. The clinic has a process in place to check medication expiry dates

d. Required equipment present: • blood pressure cuff (pediatric, small adult, large adult) • glucose meter • oral airways (pediatric, small adult (size 3-4), medium adult (size 4-5), large adult (size

5-6)) • nebulizer or metered dose inhaler spacer and face masks • personal protective equipment (latex-free disposable gloves, fluid-resistant mask, eye

protection

e. The clinic has a process in place to check that equipment is functional and intact

Medical device reprocessing (MDR)

a. Is there an autoclave/sterilizer used to reprocess reusable medical devices (instruments)?

b. Are some medical devices disinfected by soaking them in a chemical solution?

c. Are any disposable medical devices used?

Sharps disposal containers

a. Rigid, puncture and leak resistant

b. Able to close with a tight-fitting lid—no sharps can come out

c. Upright and stable during use

d. Properly labeled

e. Visible and located near point of use for immediate disposal of sharps

f. Away from children's reach

g. Fill line is visible and not over three-quarters full

Item-specific notes (if any):

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College of Physicians and Surgeons of British ColumbiaOffice Assessment

Physician name: Date: Assessor:

Comments:

The information in this form is collected under the authority of section 26.1 of the Health Professions Act, RSBC 1996, c.183 (the Act) and sections 1-19 and 9-1 of the Bylaws under the Act. The information provided will be used for the conduct of a peer practice assessment. If you have any questions about the collection and use of this information, please contact the College at 300–669 Howe Street, Vancouver, BC, V6C 0B4 or by phone at 604-733-7758 extension 2390 or 1-800-461-3008 (toll free in BC).

College of Physicians and Surgeons of British Columbia300–669 Howe Street Vancouver BC V6C 0B4 www.cpsbc.ca

Telephone: 604-733-7758 Toll Free: 1-800-461-3008 (in BC) Fax: 604-733-3503

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PHYSCIAN PRACTICE ENHANCEMENT PROGRAM

Practice Assessment ReportFAMILY MEDICINE AND GENERAL PRACTICE

PHYSICIAN INFORMATION

Physician name: CPSID:

ASSESSMENT INFORMATION

Assessor: Date assessed:

Name of clinic/address of assessment:

RELEVANT BACKGROUND INFORMATION

Provide a brief description of pertinent contextual information about the physician's practice (e.g. clinical environment, relevant training and experience, type and scope of practice, key patient population characteristics, recent and/or planned changes to practice).

RATINGS AND COMMENTS

• Little to no improvement is needed when the trend shows that most elements of quality were evident and deficiencies, if any, were minor

• Moderate improvement is needed when the trend shows some elements of quality were lacking, but the likelihood of adverse patient outcomes were low

• Significant improvement is needed when the trend shows that many elements of quality were lacking, and/or when patient outcomes could be adversely affected

History: A record of information (appropriate to the clinical presentation) gathered through questioning the patient or others (e.g. family members, substituted decision-maker) and reviewing pertinent documents to determine the next steps in care.

Rating: Little to no improvement is needed

Moderate improvement is needed

Significant improvement is needed

Areas of quality care (what the physician is doing well) and suggestions for future professional development:

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College of Physicians and Surgeons of British ColumbiaPractice Assessment Report – Family Medicine and General Practice

Physician name: Date: Assessor:

Specific concerns requiring attention and recommendations for practice change (required if moderate or significant improvement is indicated)—when outlining concerns, include both the nature and extent of the concerns, as well as specific recommendations for improvement in this area:

Examination: Guided by the presenting problem, a systematic evaluation of the patient's physical and/or mental state.

Rating: Little to no improvement is needed

Moderate improvement is needed

Significant improvement is needed

Areas of quality care (what the physician is doing well) and suggestions for future professional development:

Specific concerns requiring attention and recommendations for practice change (required if moderate or significant improvement is indicated)—when outlining concerns, include both the nature and extent of the concerns, as well as specific recommendations for improvement in this area:

Investigation: Guided by the history and examination, these procedures or tests are performed to detect, diagnose, or monitor disease processes and guide a course of treatment.

Rating: Little to no improvement is needed

Moderate improvement is needed

Significant improvement is needed

Areas of quality care (what the physician is doing well) and suggestions for future professional development:

Specific concerns requiring attention and recommendations for practice change (required if moderate or significant improvement is indicated)—when outlining concerns, include both the nature and extent of the concerns, as well as specific recommendations for improvement in this area:

Diagnosis: The identification of a possible disease, disorder, or injury in a patient. To include, as appropriate, the differential diagnosis, a working diagnosis, and/or final diagnosis.

Rating: Little to no improvement is needed

Moderate improvement is needed

Significant improvement is needed

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College of Physicians and Surgeons of British ColumbiaPractice Assessment Report – Family Medicine and General Practice

Physician name: Date: Assessor:

Areas of quality care (what the physician is doing well) and suggestions for future professional development:

Specific concerns requiring attention and recommendations for practice change (required if moderate or significant improvement is indicated)—when outlining concerns, include both the nature and extent of the concerns, as well as specific recommendations for improvement in this area:

Management plan: A plan of care tailored to the patient's needs that includes objectives, interventions, time frame for accomplishment and evaluation.

Rating: Little to no improvement is needed

Moderate improvement is needed

Significant improvement is needed

Areas of quality care (what the physician is doing well) and suggestions for future professional development:

Specific concerns requiring attention and recommendations for practice change (required if moderate or significant improvement is indicated)—when outlining concerns, include both the nature and extent of the concerns, as well as specific recommendations for improvement in this area:

Medication: The prescribing, titrating, and tapering of drugs to reach intended drug therapy goals.

Rating: Little to no improvement is needed

Moderate improvement is needed

Significant improvement is needed

Areas of quality care (what the physician is doing well) and suggestions for future professional development:

Specific concerns requiring attention and recommendations for practice change (required if moderate or significant improvement is indicated)—when outlining concerns, include both the nature and extent of the concerns, as well as specific recommendations for improvement in this area:

Follow-up and monitoring: The ongoing observation and assessment of the patient's progress to assess treatment efficacy and need for treatment change or termination.

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College of Physicians and Surgeons of British ColumbiaPractice Assessment Report – Family Medicine and General Practice

Physician name: Date: Assessor:

Rating: Little to no improvement is needed

Moderate improvement is needed

Significant improvement is needed

Areas of quality care (what the physician is doing well) and suggestions for future professional development:

Specific concerns requiring attention and recommendations for practice change (required if moderate or significant improvement is indicated)—when outlining concerns, include both the nature and extent of the concerns, as well as specific recommendations for improvement in this area:

Documentation for continuity of care: Documentation in the patient record, as well as other written communications, intended to share information with care providers or referring sources to ensure effective continuity of care. This includes the presence of, and contribution to, the cumulative patient profile (CPP).

Rating: Little to no improvement is needed

Moderate improvement is needed

Significant improvement is needed

Areas of quality care (what the physician is doing well) and suggestions for future professional development:

Specific concerns requiring attention and recommendations for practice change (required if moderate or significant improvement is indicated)—when outlining concerns, include both the nature and extent of the concerns, as well as specific recommendations for improvement in this area:

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College of Physicians and Surgeons of British ColumbiaPractice Assessment Report – Family Medicine and General Practice

Physician name: Date: Assessor:

PHYSICIAN INTERVIEW SUMMARY

Based on your analysis of (as applicable) the office assessment, prescribing profile, multi-source feedback (MSF) report, MSF reflection tool, and chart review, provide a summary of your overall assessment and your conversation with the physician regarding their practice and quality of clinical care. Include, as appropriate, areas of innovation and areas for further improvement that were not previously addressed above.

This form has been produced in collaboration between the Colleges of Physicians and Surgeons of BC and Ontario. Please direct any questions regarding its use to peerassessments@cpsbc.ca.

The information in this form is collected under the authority of section 26.1 of the Health Professions Act, RSBC 1996, c.183 (the Act) and sections 1-19 and 9-1 of the Bylaws under the Act. The information provided will be used for the conduct of a peer practice assessment. If you have any questions about the collection and use of this information, please contact the College at 300–669 Howe Street, Vancouver, BC, V6C 0B4 or by phone at 604-733-7758 extension 2390 or 1-800-461-3008 (toll free in BC).

College of Physicians and Surgeons of British Columbia300–669 Howe Street Vancouver BC V6C 0B4 www.cpsbc.ca

Telephone: 604-733-7758 Toll Free: 1-800-461-3008 (in BC) Fax: 604-733-3503

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PHYSICIAN PRACTICE ENHANCEMENT PROGRAM

September 26, 2018 (Version 1.1)

Patient Record SummaryFAMILY MEDICINE AND GENERAL PRACTICEThis is the summary for all patient records reviewed. Each record should include a patient identifier (please refrain from using full patient name). If there are no concerns, please ensure that you have briefly given some indication as to why the care/documentation is appropriate. Please use the date convention YYYY-MM-DD.

See the Family Medicine/General Practice Peer Assessor Guide for full instructions.

Assessed physician name: CPSID:

Total number of records reviewed:

RECORD SUMMARY

Record number: Record selected by: Assessor Assessed physician

Patient identifiers: PHN Initials Date of birth

Record selected to demonstrate care in:

COMMENTS/CONCERNS/RECOMMENDATIONS REGARDING PATIENT CARE

History:

Exam:

Investigation:

Diagnosis:

Management plan:

Medication:

Follow-up and monitoring:

Documentation/ continuity of care:

Evidence of opportunistic care found during interview:

Key positives/concerns and clarification from physician:

Add new record summary Delete last record summary

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College of Physicians and Surgeons of British ColumbiaPatient Record Summary – General Practice and Family Medicine

September 26, 2018 (Version 1.1)

This form has been produced in collaboration between the Colleges of Physicians and Surgeons of BC and Ontario. Please direct any questions regarding its use to peerassessments@cpsbc.ca.

PHYSICIAN PRACTICE ENHANCEMENT PROGRAM College of Physicians and Surgeons of British Columbia

Performance Review and Action Plan

Appendix C: Multi-source Feedback (MSF) Report

PHYSICIAN PRACTICE ENHANCEMENT PROGRAM College of Physicians and Surgeons of British Columbia

Performance Review and Action Plan

Purpose The objective of multi-source feedback is to give you multiple points of view about your non-clinical competencies and skills including communication, collaboration, management and professionalism. Further information on the MSF can be found on the College’s website: https://www.cpsbc.ca/programs/ppep/assessment-process/msf . In the tables and summary sections of the MSF component, you will find two pieces of information: your mean score, and any flags resulting from your mean score for each attribute.

Scores are broken down into three sections reflecting the feedback of each responding group: your medical colleagues; other co-workers; and patients (if applicable). On the final two pages of the results section, your self-assessment scores will be compared with your medical colleagues’ perceptions and the average score for each question.

Check your personal scores “Your mean” gives the average (mean) response to each statement or attribute. Each score is based on a five-point scale, with 1 labeled as “poor” and 5 labeled as “excellent.” It is important to recognize that MSF data are typically restricted to a narrow range such that small differences (such as a 4.1 versus a 4.5) may reflect important distinctions in the perceived quality of particular details of your practice. The key issue to focus on when considering your scores is not the absolute values of the scores you received, but the indications they provide of where you were perceived to be relatively stronger or weaker. That is, every physician will have variability in their scores and the relative rank should be used to provide guidance as to where your performance improvement efforts might be best directed.

Each assessment section opens with a summary chart (example presented below). The chart presents a blue line indicating your mean on each attribute, also shown numerically in the “your mean” box. The orange lines indicate the 10th percentile and the 90th percentiles for all physicians in your comparison group, which is made up of physicians in your discipline. To review your mean scores on individual items that make up each attribute, turn to subsequent pages in each section of the MSF assessment.

Your Mean Flag

4.7

1 2 3 4 5

Poor Excellent

Note: Attribute and individual question results are not reported if an insufficient number of responses were received. These are indicated by “NA.”

Flags

Flags are used throughout the profile to signal areas deserving particular attention as you build your action plan. Again, however, we would encourage you to consider the relative ranking of your own scores to generate your action plan rather than focusing exclusively on where flags were assigned.

Commendation flag appears beside any mean score equal to or above the 90th percentile.

Information flag appears beside any mean score equal to or less than the 10th percentile. This flag indicates an area for further understanding and potential improvement.

College of Physicians and Surgeons of British ColumbiaMulti-Source Feedback Report

Dr. FirstName LastName

File Number #####

Medical Colleague Assessment Section

The medical colleague assessment section contains three attributes:● clinical performance● communication and professionalism● coordination of care

The graphs and tables show results for each attribute and the corresponding individual questions. Your mean scores are based on the responses of 6 medical colleagues from whom complete assessment forms were received and processed.

Your Mean

4.9

Your Mean Flag

Your Mean

ThresholdScores

NormativeRange Commendation Information

The physician makes a correct and timely diagnosis using appropriate diagnostic tests; selects an appropriate treatment strategy and performs technical procedures skillfully. The physician appropriately manages patients with acute complex medical problems or chronic diseases. Overall, the physician demonstrates good judgment within the scope of his/her practice, including recognizing the psychological and social aspects of illness, and making appropriate referrals to non-physicians and other community resources. The physician’s colleagues would feel comfortable with him or her caring for their patients or family members.

Clinical Performance

Physician Practice Enhancement Program ReportMulti-source Feedback Component

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PHYSICIAN PRACTICE ENHANCEMENT PROGRAMCollege of Physicians and Surgeons of British Columbia

QuestionYour

mean FlagRecognizes the psychological and social aspects of illness 5.0

Makes appropriate use of community resources (e.g., social services, mental health services, home care) 4.8

Appears current with advances in medical knowledge 4.8

Selects diagnostic tests appropriately 4.8

Makes the correct diagnoses with the best available evidence 5.0

Makes the diagnosis in a timely fashion 4.8

Demonstrates appropriate judgment within the scope of services he/she provides 4.8

Performs technical procedures skillfully within the range of services provided 4.5

Selects the appropriate management 4.8

Manages patients with acute complex medical problems appropriately 5.0

Manages patients with chronic diseases (e.g., hypertension, diabetes, asthma) appropriately 5.0

Is someone with whom I would be comfortable sharing the care of my patients 5.0

Would meet my expectations if a member of my family needed care 4.8

Your Mean

4.9

Your Mean Flag

Your Mean

ThresholdScores

NormativeRange Commendation Information

The physician works well with, and speaks respectfully of, medical colleagues and communicates effectively with other health-care professionals, patients and their families. The physician respects the rights of patients, shows compassion toward them and maintains confidentiality. The physician recognizes his or her professional limitations, accepts responsibility for his or her actions, and strives to balance professional and personal life in a healthy way.

Communication and Professionalism

Physician Practice Enhancement Program ReportMulti-source Feedback Component

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

QuestionYour

mean FlagWorks well with physician colleagues 5.0

Speaks respectfully of physician colleagues 4.8

Communicates effectively with other health care professionals (i.e., non-physicians) 5.0

Respects the rights of patients (e.g., right to choice, privacy, refusal of treatment) 5.0

Maintains confidentiality of patients and their families 5.0

Appears to communicate effectively with patients 4.8

Appears to communicate effectively with patients' families 4.8

Communicates purpose and results of consultations to patients 5.0

Shows compassion for patients and their families 4.8

Accepts responsibility for own professional actions 4.8

Balances professional and personal life in a healthy way 4.8

Recognizes professional limitations 4.8

Your Mean

5.0

Your Mean Flag

Your Mean

ThresholdScores

NormativeRange Commendation Information

The physician coordinates patient care with other health professionals, makes appropriate patient referrals, provides a clear understanding about who is responsible for a patient’s continuing care, and assumes responsibility for transferring care. The physician refers patients appropriately, arranges for care outside of office hours, and documents findings and care appropriately.

Coordination of Care

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

QuestionYour

mean FlagDocuments findings and care appropriately 5.0

Refers patients appropriately 5.0

Assumes appropriate responsibility for transfer of care 5.0

Provides a clear understanding about who is responsible for the continuing care of the patient 5.0

Coordinates patient care effectively with physicians and other health care professionals 4.8

Makes arrangements for care outside of office hours (e.g., after hours, on weekends, and vacation) 5.0

Physician Practice Enhancement Program ReportMulti-source Feedback Component

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

Co-worker Assessment Section

The co-worker assessment section contains three attributes:● co-worker collegiality● patient interaction● practice management

The graphs and tables show results for each attribute and the corresponding individual questions. Your mean scores are based on the responses of 7 co-workers from whom complete assessment forms were received and processed.

Your Mean

5.0

Your Mean Flag

Your Mean

ThresholdScores

NormativeRange Commendation Information

The physician interacts and collaborates with co-workers in an effective, courteous manner, which recognizes his/her professional skills and knowledge. The physician demonstrates concern for co-worker safety and is available for discussions about mutual patients. The physician speaks respectfully of physicians and other health care professionals and manages stressful situations constructively.

Co-worker Collegiality

QuestionYour

mean FlagCommunicates effectively when speaking with co-workers (e.g., nurses, office staff, pharmacists) 5.0

Works well with co-workers (e.g., nurses, office staff, pharmacists) 5.0

Respects the professional knowledge and skills of co-workers (e.g., nurses, office staff, pharmacists) 5.0

Demonstrates concern for co-worker safety (e.g., with equipment, abusive patients, when staff are alone in work place) 5.0

Is available for discussion with me about mutual patients 5.0

Manages stressful situations constructively 5.0

Speaks respectfully of physicians and other health care professionals 5.0

Is courteous to co-workers (e.g., nurses, office staff, pharmacists) 5.0

Treats me with respect 5.0

Physician Practice Enhancement Program ReportMulti-source Feedback Component

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

Your Mean

5.0

Your Mean Flag

Your Mean

ThresholdScores

NormativeRange Commendation Information

The physician is courteous toward patients and their families, communicates effectively with them while being respectful of their rights to make informed decisions and to share in decision-making. The physician is committed to health promotion and patient safety, and makes appropriate use of community resources. The physician accepts responsibility for him or herself as well as for patient care and maintains patient confidentiality. Co-workers would consider this physician if a member of the co-workers family needed care.

Patient Interaction

QuestionYour

mean FlagCommunicates effectively with patients 5.0

Accepts responsibility for patient care 4.9

Is courteous to patients and their families 5.0

Shows compassion to patients and their families 5.0

Engages patients in shared decision making 5.0

Respects the rights of patients to make informed decisions 5.0

Maintains confidentiality of patients and their families 5.0

Accepts responsibility for professional actions 5.0

Makes appropriate use of community resources (e.g., social services, mental health, home care) 4.9

Demonstrates commitment to health promotion (e.g., encourages patients to stop smoking, manage weight, exercise) 5.0

Implements practices that promote patient safety (e.g., discusses home situation, driving, medication safety) 5.0

Would be considered if a member of my family needed care 5.0

Physician Practice Enhancement Program ReportMulti-source Feedback Component

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

Your Mean

5.0

Your Mean Flag

Your Mean

ThresholdScores

NormativeRange Commendation Information

The physician writes effective management plans, provides clear information in prescriptions, orders and notes, and manages time effectively.

Practice Management

QuestionYour

mean FlagCommunicates written management plan effectively 4.9

Provides clear information in prescriptions, orders and notes 5.0

Manages time effectively 5.0

Physician Practice Enhancement Program ReportMulti-source Feedback Component

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

Patient Assessment Section

The patient assessment section contains four attributes:● patient interaction● staff interaction● physical office● patient information

The graphs and tables show results for each attribute and the corresponding individual questions. Your mean scores are based on the responses of 25 patients from whom complete assessment forms were received and processed.

Your Mean

4.7

Your Mean Flag

Your Mean

ThresholdScores

NormativeRange Commendation Information

The physician treats patients respectfully, takes enough time listening to understand their health concerns and helps them with any fears or worries. The physician explains what he or she is doing in an examination, presents treatment options, and knows when a patient needs to see the physician or other health professional. The physician explains prescription medicine and any side effects, and answers patient questions so that the patient leaves the office understanding the problem and its treatment. Patients would return to see the physician and they would refer a friend or family member.

Patient Interaction

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

QuestionYour

mean FlagCan ask and get answers to my questions from my doctor 4.8

Understand what my doctor tells me about my problem(s) 4.6

Leave the office knowing what to do to help my problem(s) 4.6

Know why and how I should take my medicine 4.7

Understand that my medicine may have side effects 4.7

Know when I will need to see my doctor or other health care professional 4.6

Treats me with respect 4.7

Listens to me 4.7

Wants to understand my health problem(s) so that he or she can help me get better 4.8

Spends enough time with me 4.6

Explains what he or she is doing and why I am being examined 4.6

Talks to me about the options I have for treating my problem(s) 4.5

Helps me with my fears and worries 4.7

Goes over my prescription medicine with me 4.7

Sends me to other health professionals (e.g., specialist doctors, dieticians, physical therapists, pharmacists) when necessary 4.7

Follows up if I have a serious problem 4.7

I would go back to this doctor 4.8

I would send a friend or family member to this doctor 4.8

Your Mean

4.7

Your Mean Flag

Your Mean

ThresholdScores

NormativeRange Commendation Information

Staff members are helpful, respectful, and careful about patient privacy and know what they are doing. Staff makes appointments quickly for urgent matters, arranges for patients to see the physician soon after arrival, and provides letters, reports or test results as needed.

Staff Interaction

Physician Practice Enhancement Program ReportMulti-source Feedback Component

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

QuestionYour

mean FlagIs easy to reach by phone during the day 4.5

Makes an appointment with me quickly if the problem is urgent 4.7

Arranges for me to see the doctor fairly soon after I arrive 4.7

Lets me know if I have abnormal test results or x-rays, as well as what I need to do about them 4.7

Gives me letters or reports when I need them 4.7

Know what they are doing and do it well 4.6

Are helpful 4.6

Treat me with respect 4.7

Are careful about the privacy of patients and their information 4.8

Your Mean

4.7

Your Mean Flag

Your Mean

ThresholdScores

NormativeRange Commendation Information

The waiting area is clean and comfortable, and examining rooms have enough room and privacy from other patients.

Physical Office

QuestionYour

mean FlagHas a comfortable waiting area with enough room 4.7

Has comfortable examining rooms with enough room and privacy from other patients 4.8

Is clean 4.7

Physician Practice Enhancement Program ReportMulti-source Feedback Component

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

Your Mean

4.6

Your Mean Flag

Your Mean

ThresholdScores

NormativeRange Commendation Information

The physician talks to patients about preventing health problems, enquires about non-prescription medicine and asks about their personal life as it might affect their health. The physician tells patients what to do if the problem does not get better, helps patients get health information, and tells them how to get medical care when the office is closed.

Patient Information

QuestionYour

mean FlagAsks me about my personal life (as it could affect my health) 4.5

Asks if I am taking any non-prescription medicine (e.g., vitamins, herbs, Tylenol®, Aspirin®) 4.5

Lets me know what to do if my problem does not get better 4.5

Makes sure another doctor can help me if my doctor is not available 4.7

Talks to me about preventing health problems (for example, advice about diet, sleep, exercise, weight, alcohol, and smoking) 4.6

Helps me get health information (e.g., brochures,websites) 4.5

Tells me how to get medical care when the office is closed 4.6

Physician Practice Enhancement Program ReportMulti-source Feedback Component

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

Self-assessment Section

The self-assessment section contains the ratings you gave yourself and from your medical colleagues, and your overall average score. Your overall average score reflects the average of assessments received by all physicians in your reference group.

# Question Self - rating

Medicalcolleague

rating

Overall average

score

1 I work well with physician colleagues 5 5.0 4.7

2 I speak respectfully of physician colleagues 5 4.8 4.8

3 I communicate effectively with other health care professionals (i.e., non-physicians) 4 5.0 4.7

4 I respect the rights of patients (e.g., right to choice, privacy, refusal of treatment) 5 5.0 4.7

5 I maintain confidentiality of patients and their families 5 5.0 4.8

6 I communicate effectively with patients 5 4.8 4.7

7 I communicate effectively with patients' families 5 4.8 4.7

8 I communicate the purpose and results of consultations to patients 5 5.0 4.7

9 I document findings and care appropriately 5 5.0 4.6

10 I refer patients appropriately 4 5.0 4.7

11 I assume appropriate responsibility for transfer of care 5 5.0 4.8

12 I provide a clear understanding about who is responsible for the continuing care of the patient 5 5.0 4.7

13 I coordinate patient care effectively with physicians and other health care professionals 5 4.8 4.7

14 I make arrangements for care outside of office hours (e.g., after hours, on weekends, and vacation) 3 5.0 4.7

15 I show compassion for patients and their families 5 4.8 4.8

16 I accept responsibility for own professional actions 5 4.8 4.8

17 I balance professional and personal life in a healthy way 3 4.8 4.6

18 I recognize my own professional limitations 5 4.8 4.7

19 I recognize the psychological and social aspects of illness 4 5.0 4.7

20 I make appropriate use of community resources (e.g., social services, mental health services, home care) 4 4.8 4.7

21 I am current with advances in medical knowledge 4 4.8 4.7

22 I select diagnostic tests appropriately 5 4.8 4.6

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

23 I make the correct diagnoses with the best available evidence 5 5.0 4.7

24 I make the diagnosis in a timely fashion 4 4.8 4.7

25 I demonstrate appropriate judgment within the scope of services I provide 4 4.8 4.7

26 I perform technical procedures skillfully within the range of services provided 4 4.5 4.7

27 I select the appropriate management 5 4.8 4.7

28 I manage patients with acute complex medical problems appropriately 5 5.0 4.7

29 I manage patients with chronic diseases (e.g., hypertension, diabetes, asthma) appropriately 5 5.0 4.7

Physician Practice Enhancement Program ReportMulti-source Feedback Component

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM

Using Your MSF Report

This profile opens new ways of thinking about your practice, and formulates new ways for achieving success. Below are some action steps you may find useful.

1. Think of your profile as a tool for setting priorities. Ask yourself:

● Is there a gap between the quality of the health care I want to offer and what my profile suggests? If so, is that gap meaningful?

● Do I need to change? If so, what, in particular, needs changing?

● What action must I take to make that change happen?

2. Do not tackle everything at once. Rather, prioritize areas that need improvement, focusing first on those with greatest impact on patient care.

MSF Tip:Quality improvement is a lifelong exercise. Do the most important things first.

3. Invest the time to determine if your profile identifies real problems, involving others who know how your practice works. You might want to discuss the profile with a colleague, your staff, your patients, and your spouse. You might corroborate its main messages using other devices:

● interviews with patients, co-workers, colleagues

● staff meetings focused on profile findings

● comment cards in your office

4. List possible causes of problems. Think of your practice as a health-care system with many interdependent processes and elements:

● patients (those who use the system)

● people (those who work in the system)

● places (work environment)

MSF Tip:Problems are rarely the result of a single factor or person. It follows that solutions also require every “P” in the pod.

● procedures (methods/rules of work)

5. Before implementing any proposed solutions, estimate their feasibility and discuss the implications with those who will be involved. Then, before making any major changes, run a pilot test.

6. Set targets for specific aspects of care and measure your results. Measuring quality may be easier than you think. If your profile highlights the amount of time patients are waiting as an irritant, measure that time. If it is the amount of preventative care provided to a target population, measure that. If it is patients’ understanding of their diagnoses and treatment, measure that. If it is the content and timeliness of your letters, measure that.

MSF Tip:All processes show inherent variability in performance. That is why we speak of average performance. Changes to average performance levels usually require a significant change in process. Normally such changes are not made because of an unusual or infrequent occurrence, but to address longstanding concerns.

● provisions (supplies)

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College of Physicians and Surgeons of British ColumbiaPHYSICIAN PRACTICE ENHANCEMENT PROGRAM