Paul Buckley, the GMC’s Director of Strategy and Communication, looks at what we could improve with more effective use of data.
In the 1970s, survey satellite readings started telling researchers that Antarctic polar ozone levels had declined far more than expected. The reduction was tracked by satellite for years, but the unexpected readings were rejected as unreasonable.
Only in the mid-1980s, when British scientists re-ran the data with the hindsight of on-site observations showing ozone depletion, did scientists see that the ozone hole had been growing rapidly since 1976.
It’s a cautionary tale that supports the contention that failing to try to understand the significance of data, even where incomplete, is at best a wasted opportunity and at worst an abdication of responsibility.
If incomplete data had been triangulated rather than ignored then scientists would have made the ozone discovery far sooner – a reminder to us all that identifying, sharing and better using the data we do have has to be a major pillar of modern regulation.
Uncovering root causes
Those principles have been talked about a lot since the Francis Report which, though it focused on England, was relevant to all parts of the UK. And some good progress has been made.
We are responsible for a wealth of information about medical practice as well as working and training environments, which can help us and our partners (where appropriate) see and act on patterns of both risk and good practice.
We now routinely share non-personalised data with healthcare system partners across the UK for operational purposes, such as to support CQC inspections in England, and during related risk summits when a provider is facing significant challenges.
But there’s more to do to understand the root causes of the problems we repeatedly see, particularly in fitness to practise (FTP) cases and medical education, and to identify excellence too.
For example, we introduced our Welcome to UK Practice programme (our free half-day learning session for doctors new or returning to practice or to the UK) in the light of data showing that these groups of doctors often faced significant challenges in getting to grips with the UK context around consent, confidentiality and other ethical issues.
Whereas once we would not have seen this kind of intervention as part of our business, we now very clearly regard our core role as helping doctors stay on ‘the right side of the line’ – because that’s good for patients, good for employers and it’s good for doctors too.
The appliance of (data) science
That’s just one example – but we need a deeper understanding of all the causes of individual and system failure, not just the ability to describe what’s gone wrong and bolt the stable door shut. We’ve got to move from monitoring events and ‘rear view mirror’ regulation to getting ahead of the game. We need to predict what opportunities and problems may erupt in an environment or within specific cohorts of the profession, and target support to help.
We are investing more resource into collating and interpreting data – both our own and that of our many partners in the system – to create a coherent understanding of the state of practice and medical education across the four UK nations, so we can spot the early signs of trouble.
Until recently, regulation has been much more of an art than a science. There will always be an important role in regulation for judgment and discretion – but the judgments regulators make must be backed up by the best available data. In other words, regulation must become less philosophical and more scientific.
The 2014 consensus statement on the role of the doctor includes:
‘the doctor must be capable of assessing and managing risk; this requires high-level decision-making skills and the ability to work outside defined protocols when circumstances demand….They must be capable of effectively managing uncertainty, ambiguity and complexity’.
We also expect them to use data to inform their practice. As a description of a modern regulatory approach this could hardly be improved on.
Understanding what drives doctors
It’s vital, especially in times of huge pressure and change, that we deepen our understanding of our registrants’ working lives.
If we are going to provide the support they need to bolster and improve their practice we need to understand more about not only the environment that they work in, but also more about their practice.
For both of those things we need the best data that we can acquire with the least burden on the system and on doctors. It is understandable that some doctors have concerns that the collection and use of data by the GMC could be intrusive, and it is incumbent on us to make the case for how we use data and justify every piece we collect.
Like doctors we are subject to strict information governance protocols (such as ensuring we protect the identity of individual trainees by never publishing National training survey data for a training environment unless three or more trainees responded). But equally, without aggregating information about doctors and working environments we can’t innovate and improve support for the profession – and benefit both patients and employers.
This is analogous in many ways to how patient information has long been used in healthcare for secondary purposes. That is the journey we need to make in regulation, taking the profession with us.
Targeting support to prevent harm
Traditionally regulators have been associated with investigating and sometimes taking action against those who fall below expected standards. In the future we want to direct much more of our work ‘upstream’, targeting support and interventions where it can deliver the most benefit and before patients – and often doctors themselves – come to harm.
The more we understand about the challenges doctors face in their careers, the more we can provide tools and engagement opportunities relevant to what they do, which will help them overcome those challenges. Engaging more with doctors generally through our liaison services and initiatives, such as our Medical professionalism matters programme and involvement in Clinical Fellows schemes, are crucial steps to that understanding.
This kind of insight already helps us take a more intelligent, evidence-based approach to regulation – but it can also help others. We make information and insights widely available through publications such as our annual state of medical education and practice report, and website data tools like our National training survey results. In the future we want to make data about practice even more accessible and current, making maximum use of digital technology.
We want to be a regulator that is relevant to the vast majority of doctors who are providing good care. We want to avoid using disproportionate amounts of resources on the small minority of doctors causing a risk to patients, and we are working hard (despite an outdated legal framework) to make progress towards that.
If you’d like to know more about the products we’re developing to help others understand our data, please contact our Development Manager, Andrew Richardson.