The Royal Australian and New Zealand College of
Obstetricians and Gynaecologists
New Zealand Practice Visit
Visitor Kit for Dr XX
For the Practice Visit of:
Dr XX – “date”
Important note: Practice visits are undertaken under the College’s Protected Quality
Assurance Activity Notice. This means that the process is completely confidential.
The Royal Australian and New Zealand College of
Obstetricians and Gynaecologists
The Royal Australian and New Zealand College of Obstetricians and
Gynaecologists
RANZCOG, New Zealand Office | PO Box 10611 | Wellington 6143
t: +64 4 472 4608 | f: +64 4 472 4609 | w: http://www.ranzcog.edu.au/
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Table of Contents
Page
Purpose of the Practice Visit
4
Section 1 Instructions
Pre-visit
5
The day of the practice visit
6
Post visit
11
Section 2 Documentation received from visitee
Timetable for the day of the practice visit
Pocket 1
Timetable for interviews with visitee’s colleagues
Pocket 2
Practice Profile Questionnaire & Self Assessment Survey
Pocket 3
Patient Satisfaction Questionnaire Report
Pocket 4
Weekly theatre lists for three month period
Pocket 5
Section 3 Forms to be completed and returned by the visitor by the
deadline
Practice Visit Agreement
Pocket 6
Visitor Assessment Survey
Pocket 7
Expense Reimbursement Claim Form
Pocket 8
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Purpose of the Practice Visit
Fellows of RANZCOG are able to receive a practice visit as part of their continuing
professional development. The visits are designed to provide Fellows with a confidential
review by two of their peers in relation to various aspects of their practice.
The practice visit process also incorporates interviews with the multidisciplinary team the
Fellow works with, as well as a review of the clinical works load, case mix and record keeping.
Confidentiality – Protected Quality Assurance Activity
The practice visit process is a protected quality assurance activity under a formal notice
obtained by RANZCOG. This means that all information that becomes known solely as a
result of the practice visit process is strictly confidential. RANZCOG has obtained a notice
from the Minister of Health protecting the confidentiality of the process, with the objective
of encouraging fellows to participate fully and frankly in the practice visit process.
It is important that you know that it is an offence under the Health Practitioners Competence
Assurance Act 2003 to disclose information that comes to light during the practice visit
process outside the College’s processes. There are some exceptions to this, but they are
limited. If you are requested to provide information about the practice visit process you must
check with the Executive Officer, RANZCOG, before providing such information.
Aim of the Practice Visit
The aim of the practice visit programme is to provide feedback about the practice and
facilitate quality improvements where necessary, in a collegial and supportive manner.
Objectives of the Practice Visit
Objectives of the practice visit are as follows:

To improve the practices and competence of fellows by assessing the health services
performed by them

To improve outcomes for patients
Practice visits are not intended to be used as a mechanism for investigating concerns that
have been raised about a fellow’s competence, health or fitness to practise. Where there are
such concerns other mechanisms are available. RANZCOG will endeavour to ensure that
practice visits are not set up in such situations. However, if you are aware that there are
serious concerns that have been raised about the fellow please inform the Executive Office,
RANZCOG immediately, and prior to commencing the practice visit process
Outcomes of the Practice Visit
Contribute to the delivery of safe, quality healthcare outcomes for women, their families,
health professionals and the broader community.
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Section 1:
Instructions
 Pre-visit
 The day of the Practice Visit
 Post visit
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Pre-visit instructions
1.
Read the documentation provided in this kit
2.
Meet with the other visitor prior to the practice visit to review schedule and
documentation provided by the visitee. This can usually be done the evening
before the day of the practice visit.
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The day of the practice visit – instructions
The practice visit will take most of one day per visitee.
The practice visit will include the following components;
1. An initial interview with the visitee (one hour)
2. A review of the practice surroundings, equipment and processes (30-60 mins)
3. Review of 10 randomly selected obstetric and gynaecological case records
4. A patient consultation (30 mins)
5. Interviews with the visitee’s colleagues (15 mins each colleague)
6. Observation in theatre (2 hours)
7. Concluding interview (30-60 mins)
Practice visit schedule
The visitee has provided a schedule for the day of the practice visit.
Please find a copy of the schedule in Pocket 1
Guidelines
To obtain the best results from the practice visit, it is important that the visitors act in a
supportive, helping role. The initial interview provides the opportunity for the visitors to
establish rapport and credibility with the visitee.
Throughout the practice visit, visitors should:
 explain the process and clarify the visitor’s role
 allay concerns when they arise
 ask open questions and let participants tell their story
 summarise what has been said
Instructions for each component of the practice visit
1.
Initial interview with the visitee (one hour)
Discussion during the initial interview should cover the following:
a) Discussion around the confidentiality of the practice visit, and ensuring
understanding of what the protected quality assurance activity protections
mean.
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b) Discussion regarding aspects of the Practice Profile Questionnaire
c) Comments on the Patient Satisfaction Questionnaire Report
d) Review of theatre lists from the previous 3 months
e) Review of the Self-assessment Survey analysing the visitee’s rooms and
practice
f)
Any surgical complications over the previous two years
g) Discussion regarding medical disciplinary issues over the previous two years.
These discussions should include ACC cases, Health and Disability
Commissioner cases and also Medical Council and Disciplinary Tribunal cases.
h) Discussion regarding personal life and health issues
2.
Review of the practice surroundings, equipment and processes
This should take approximately 30-60 minutes and will include a review of record
systems. A worksheet has been provided as a guide and to record information. This
can be found in the Visitor Assessment Survey Pocket 3
3.
Review of 10 randomly selected obstetric and gynaecological case records
These should include cases from both private and public practice where possible. A
worksheet has been provided to record impressions. This can be found in the Visitor
Assessment Survey Pocket 3
4.
Patient Consultation
A review of the doctor/patient relationship is an important component of the practice
visit process. A 30 minute consultation will be organised with a patient who has
provided written consent for one of the visitors to be present throughout the
consultation. Ideally this will be a new gynaecological patient. A worksheet is
provided to record impressions and can be found in in the Visitor Assessment Survey
Pocket 3
5.
Interviews with visitee’s colleagues
A schedule of interviews has been provided by the visitee and can be found in in the
Visitor Assessment Survey Pocket 2.
The interviews are possibly the most important part of the practice visit process.
They will include a number of key people who work closely with the visitee, e.g. a
nurse manager, clinical director, anaesthetist, paediatrician, midwifery manager,
theatre staff, registrars and administrative staff.
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The interviewees will have been briefed about the practice visit process by the visitee.
Each interview should take approximately 15 minutes, and sometimes more than one
visitee will be discussed in one session.
A worksheet of questions is provided in Pocket 7
6.
Observation in theatre
During a two hour period in theatre, the visitors will observe the visitee performing a
major and a minor surgical procedure. Visitors should not assist with the surgery.
Permission from the hospital and/or patient may be required, so please check with
the visitee.
A worksheet to record observations is provided in in the Visitor Assessment Survey
Pocket 7
7.
Concluding interview
The concluding interview is a very important part of the practice visit process and
should take between 30-60 minutes. Impressions and feedback from each area of
the visitee’s practice that has been assessed during the day should be shared and any
positive and negative aspects discussed. It is essential that any areas of vulnerability
are discussed at this time.
The visitee should be informed that a report will be written following the practice visit
which will be submitted to the RANZCOG NZ Practice Visit Sub-committee in
December, and a formal letter from the chair of the sub-committee will then be sent
to the visitee.
The visitee should be advised that they will be credited with 25 Practice Review and
Clinical Risk Management (PR&CRM) points and a certificate will be sent to them at
the conclusion of the process.
The visitee should be thanked for their time and effort involved in arranging the day’s
activities.
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Post visit instructions
Following the practice visit, the visitors should work together to prepare a draft practice visit
report which will be submitted to the RANZCOG NZ Practice Visit Sub-committee for review
in December.
A letter from the chair of the sub-committee based on the practice visit report will then be
sent to the visitee.
The following documentation must be completed and returned to the RANZCOG NZ Office
by the deadline:
2 November 2015
1. Practice Visit Agreement
2. Visitor Assessment Survey
3. Practice Visit Report
Follow-up Survey
As part of the evaluation process, a brief survey will be sent to all visitors approximately six
weeks after completion of the annual programme,. It is hoped that all visitors will take the
time to complete and return this survey so that the practice visit programme can be
continually evaluated and improved where necessary. A similar survey will be sent to the
visitees also.
Reporting Template
A template for the practice visit report is provided. An electronic version is available from the
RANZCOG NZ Office on request.
Please note that the report is strictly confidential and will be reviewed by the RANZCOG NZ
Practice Visit Sub-committee. A letter based on the report will be sent to the visitee, signed by
the chair.
A template for the report follows.
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In the formal assessment section there are sections (a) to (h) to incorporate into the report.
Written responses to these components will be drawn from observation and review of the
visitor and the visitee’s documentation.
With regard to the section headed Recommendations, this section is designed to capture
recommendations that will inform the continuous quality improvement of the visitee’s practice.
In this regard we ask that in putting forward recommendations, the focus be on quality
improvement initiatives in relation to the practice.
The visitee may be offered a follow up practice visit to assist further change and
improvements.
Please note that the recommendation section is optional.
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Reporting template
Confidential: Prepared under RANZCOG’s Protected Quality Assurance
Activity Notice
Practice Visit by Dr <Name of Visitor 1> and Dr <Name of Visitor 2>
Name of visitee and place of work
You have a (e.g. mixed general obstetric and gynaecological specialist workload) in (e.g. both
the public and private) sectors and are developing a special interest in e.g. laparoscopic
surgery). You have been in the post (number of) years.
The (Name of Hospital/Place of Work) group consists of (1, 2, etc) part time O&G
consultations working an identical on call roster. The weekly roster consists of (e.g. one fixed
day per week on call (resident 0800 – 1700), one antenatal clinical (whilst on call adjacent to
the Delivery Unit), one gynaecological clinic and one theatre list. In total 20-24 hours, plus
call.)
Formal Assessment:
Please comment on the following:
(a)
Surgical Logbook:
(b)
Patient Satisfaction Review:
(c)
ACC/HDC/Medical Council: (detail any complaints or enquiries pending).
(d)
Continuing Professional Development (note if requirements are up to date).
(e)
Communication: Report on the visitee’s communication skills with staff and patients.
(f)
Surgery: Make comment on the visitee’s performance in the operating theatre and
(g)
Clinical notes: Comment on the quality of the records reviewed (private and public,
(h)
Clinical surroundings: Provide feedback on the appearance and functionality of the
Refer to the Patient Satisfaction Questionnaire summary
communication with surgical nursing staff
paper and electronic) including back-up, legibility etc
rooms and whether they appear to be well maintained and fit for purpose.
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Strengths:
Please note strengths you have observed in the visitee and their practice. Please consider
organisational skills, professional performance, personal integrity and approach to clinical
audit.
Areas of Vulnerability:
Please note any areas of vulnerability or risk. Please consider record keeping,
communication, workload, work balance etc.
Recommendations:
Please note any recommendations that will inform the continuous quality improvement for
the visitee’s practice.
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Section 2:
Documentation from visitee
 Timetable for the day of the practice visit
Pocket 1
 Timetable for interviews with visitee’s colleagues
Pocket 2
 Practice Profile Questionnaire & Self Assessment Survey
Pocket 3
 Patient Satisfaction Questionnaire Report
Pocket 4
 Weekly theatre lists for three month period
Pocket 5
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Name of Visitee and date of Practice Visit:
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Section 3:
Documentation to be submitted by
deadline:
2 November 2015
 Practice Visit Agreement
Pocket 6
 Visitor Assessment Survey
Pocket 7
 Expense Reimbursement Claim Form
Pocket 8
 Practice Visit Report
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Practice Visit Agreement
Thank you for agreeing to be a visitor as part of the Practice Visit Process. As a visitor you
are acting on behalf of the Royal Australian and New Zealand College of Obstetricians and
Gynaecologists.
Purpose of the Practice Visit
Practice Visits have been designed to identify strengths as well as assess relative risks within
a practice which if modified may lead to improved patient outcomes and satisfaction as well
as a reduction in medico legal problems for the Fellow concerned.
Purpose of the Visitor
Your role as a visitor is to review colleagues and to thoroughly assess their practice with the
aid of the College assessment tools. This will entail providing feedback on systems, and both
team and individual performance. This feedback will aid the systems and clinical care they
provide.
Quality Assurance
You are aware that the Practice Visit process will be a “protected quality assurance activity”
under the provision so of Part 3 of The Health Practitioners Competence Assurance Act 2003.
As a consequence all information collected remains the property of our College and those
engaging in this quality assurance activity are immune from civil liability.
Confidentiality
You will agree to keep the discussions and notes that you make during the practice visit
confidential. This means that you will not discuss cases or the conduct of colleagues outside
the practice visit process or outside any reports that you submit to the Practice Visit and Risk
Management Sub-committee of the New Zealand Committee.
Your Conduct
You agree to act in accordance with the guidelines for the Practice Visit process (refer
Guidelines for Visitors), and at all times act in a professional manner with colleagues. This
means assessing the situation in a fair and open manner while respecting your colleagues
who are being reviewed. You will report your findings and provide feedback with integrity
and responsibility.
Dispute Resolution
Where there is any dispute arising out of your activities the Practice Visit sub-committee will
take responsibility for addressing this.
Name
.......................................................................................................
Signed
.......................................................................................................
Date
.......................................................................................................
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Visitor Assessment Survey
Dr xx
Patient Consultation Session Assessment:
Consultation with
new patient
(0=unsatisfactory; 1=poor; 2=Satisfactory.; 3=good; 4=v.good;
5=Excellent)
Personability
Please circle relevant number
1.1 Greeting
0
1
2
3
4
5
1.2 Allows "patient story"
0
1
2
3
4
5
1.3 Makes early and repeated eye
contact
0
1
2
3
4
5
1.4 Body language
0
1
2
3
4
5
1.5 Minimises interruptions
0
1
2
3
4
5
1.6 Indicates understanding (eg
short summarising statement)
0
1
2
3
4
5
1.7 Asks clarifying questions
0
1
2
3
4
5
1.8 Demonstrates empathy
0
1
2
3
4
5
1.9 Provides information to
"prudent patient" standard
1.10 Asks what additional
information required
0
1
2
3
4
5
0
1
2
3
4
5
1.11 Encourages questions
0
1
2
3
4
5
1.12 Allows care planning options
0
1
2
3
4
5
1.13 Provides "negotiated" care plan
0
1
2
3
4
5
1.14 Tests understanding
0
1
2
3
4
5
Listening and understanding
Options, information and plan
Comments:
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Practice Facilities Assessment:
Reception, waiting and general areas are
appropriate for patients
8.1 Waiting area has adequate space and reasonable seating
8.2 Waiting area has adequate heating, lighting and
ventilation
8.3 Access and seating for disabled and wheelchair use meet
legal requirement
8.4 Reading material and patient information available
8.5 Reception area sufficiently independent of waiting area to
ensure verbal
8.6 Reception
area ensures confidentiality of written
privacy
information
8.7 Appropriate indication of reception, fire exits and toilets
8.8 A separate patient toilet is available
Public
Private
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Comments:
9.1
9.2
9.3
9.4
9.5
9.6
9.7
Patient consultation & management areas
ensure
Consultation
roomscomfort,
adequately
patient
safety and privacy
sized/lit/heated/ventilated
Hand-washing
facilities innoise
each consultation room,
no excessive extraneous
available to patient also
Patients assured of adequately privacy (physical, visual,
auditory) during consultation
"Chaperone" policy exists which is compatible with MCNZ
guidelines
Adequate examination couch and facilities for each exam
room
Reception
area ensures confidentiality of written
privacy
information
Adequate task lighting for examination and procedures
9.8 Disposable equipment used only once
Public
Private
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Comments:
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Availability & management of instruments
patient comfort, safety and privacy
10.1 Medical equipment is well maintained and appropriate
for clinical needs
10.2 Correct usage and monitoring of steam steriliser or
autoclave for reusable instruments
10.3 Appropriate storing of sterilised instruments/materials
10.4 Appropriate use and placement of bio-hazard labelled
puncture resistant sharps containers
10.5 Appropriate (leak-proof) collection, storage and
collection
of bio-contaminated waste
10.6 Secure/Safe
storage of drugs
privacy
10.7 Instruments/fluids/chemicals safely contained (e.g. from
young children in consulting room)
Public
Private
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Comments:
Practice Systems and Information Management
:
Result tracking and recall
Public
11.1 The practice has an efficient recall system (e.g. for cervical
smear recall)
11.2 Tracking test results is robust (e.g. if smear result not
received, would system identify this?)
11.3
Patient Records - based on an audit of 10
medical records, 90% demonstrate
1.1 Full demographic data: Name, NHI, Address, DOB,
Ethnicity, Contact phone, Occupation, Date
1.2 Records Readily interpretable by 3rd party (legible)
Yes
Private
No
Yes
No
(0=unsatisfactory; 1=poor; 2=Satisfactory.; 3=good;
4=v.good; 5=Excellent)
0 1 2 3 4 5
0 1 2 3 4 5
Public
Private
Yes
No
Yes
No
Yes
No
Yes
No
(0=unsatisfactory; 1=poor; 2=Satisfactory.; 3=good;
4=v.good; 5=Excellent)
1.3 History documentation
1.4 Examination findings documentation
1.5 Diagnosis (differential or actual) documentation
1.6 Demonstration of clinical reasoning
1.7 Informed consent process documentation
1.8 Letters referring to GPs enhance collaborative care and
demonstrate management plan (audit of 3 letters to GPs)
1.9 Copies of letters provide to patients
(0-never/1=sometimes/2=when indicated/3=usually/4=always)
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0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4 5
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
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Comments:
Interviews with Colleagues and Staff
(0=unsatisfactory; 1=poor;
2=Satisfactory.; 3=good;
4=v.good; 5=Excellent)
Professional inter-relationships
Theatre coordinator (Public/Private)
13.1 Maintains a positive persona in Theatre
0 1 2 3 4 5
13.2 Relations with Nursing staff are constructive and pleasant
0 1 2 3 4 5
13.3 Relates well to other O&G staff and surgical colleagues
0 1 2 3 4 5
13.4 Is available for discussion/receptive
0 1 2 3 4 5
13.5 Collaborative (cooperative), not command (hierarchical) with stress
0 1 2 3 4 5
Anaesthetist (Public/Private)
13.6 Maintains a positive persona in Theatre
0 1 2 3 4 5
13.7 Relates well with anaesthetic and O&G surgical colleagues
0 1 2 3 4 5
13.8 Is available for discussion/receptive
0 1 2 3 4 5
13.9 Collaborative (cooperative), not command (hierarchical) in
challenging clinical situations
0 1 2 3 4 5
Gynae Ward Charge Nurse (Public/Private)
13.10
Maintains a positive persona in Ward
0 1 2 3 4 5
13.11
Relations with Nursing staff are constructive and pleasant
0 1 2 3 4 5
13.12
Relates well to other O&G colleagues
0 1 2 3 4 5
13.13
Is available for discussion/receptive
0 1 2 3 4 5
13.14
Collaborative (cooperative), not command (hierarchical) with
stress
0 1 2 3 4 5
13.15
0 1 2 3 4 5
Maintains caring relationships with patients
Gynae Outpatient Clinic Staff Nurse
13.16
Maintains a positive persona in Clinic
0 1 2 3 4 5
13.17
Relations with Nursing staff are constructive and pleasant
0 1 2 3 4 5
13.18
Relates well to other O&G colleagues
0 1 2 3 4 5
13.19
Is available for discussion/receptive
0 1 2 3 4 5
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13.20
Is committed to clinics
0 1 2 3 4 5
13.21
Is usually punctual
0 1 2 3 4 5
13.22
Maintains caring relationships with patients
0 1 2 3 4 5
Delivery Suite Supervisor
13.23
Maintains a positive persona in delivery suite
0 1 2 3 4 5
13.24
Relations with midwifery staff are constructive and pleasant
0 1 2 3 4 5
13.25
Relates well to other O&G colleagues
0 1 2 3 4 5
13.26
Attends for handover of patients
0 1 2 3 4 5
13.27
Is available when needed; attendance is timely
0 1 2 3 4 5
13.28
Manages urgent difficult cases collaboratively and with
leadership
0 1 2 3 4 5
13.29
0 1 2 3 4 5
Maintains caring relationships with patients
Clinical Director/Leader
13.30
Team skills
0 1 2 3 4 5
13.31
Flexibility/negotiability
0 1 2 3 4 5
13.32
Relates well with senior colleagues
0 1 2 3 4 5
13.33
Relates well with junior colleagues
0 1 2 3 4 5
Paediatrician
13.34
Relates well to Paediatric colleagues
0 1 2 3 4 5
13.35
Approachable/receptive/collaborative
0 1 2 3 4 5
13.36
Visits neonatal unit when has patients
0 1 2 3 4 5
Junior Medical Staff
13.37
Maintains a positive persona with junior doctors
0 1 2 3 4 5
13.38
Relates well to colleagues
0 1 2 3 4 5
13.39
Is easy to relate to; approachable
0 1 2 3 4 5
13.40
Maintains a caring relationship with patients
0 1 2 3 4 5
Comments:
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(0=unsatisfactory; 1=poor;
2=Satisfactory.; 3=good;
4=v.good; 5=Excellent)
Indicator 14: Systems and Risks
Theatre coordinator
14.1 Maintains a positive persona in Theatre
0 1 2 3 4 5
14.2 Is readily contactable
0 1 2 3 4 5
14.3 Procedures/indications appropriately and clearly annotated on lists
0 1 2 3 4 5
14.4 Is usually punctual
0 1 2 3 4 5
14.5 Operating time-taken is usually appropriate/reasonable
0 1 2 3 4 5
14.6 Does not frequently run over allocated list time
0 1 2 3 4 5
14.7 Lists regular; balanced case mix
0 1 2 3 4 5
14.8 Complications are not excessive and are appropriately dealt with
0 1 2 3 4 5
14.9 Returns to theatre are neither too frequent nor problematic
0 1 2 3 4 5
Anaesthetist
14.10
Meets requirements for notification of lists/patients
0 1 2 3 4 5
14.11
Appropriate work-up and consultation of high-risk patients
0 1 2 3 4 5
14.12
Procedures appropriately and clearly annotated on lists
0 1 2 3 4 5
14.13
Is readily contactable
0 1 2 3 4 5
14.14
Operating time-taken is usually appropriate/reasonable
0 1 2 3 4 5
14.15
Does not frequently run over allocated list time
0 1 2 3 4 5
14.16
Lists regular; balanced case mix
0 1 2 3 4 5
14.17
Complications are not excessive and are appropriately dealt with
0 1 2 3 4 5
14.18
Returns to theatre are neither too frequent nor problematic
0 1 2 3 4 5
Gynae Charge Nurse
14.19
Appropriate post-operative care (i.e. frequency of visits, care
plans communicated
0 1 2 3 4 5
14.20
Is readily contactable
0 1 2 3 4 5
14.21
Ensures and notifies cover arrangements when needed
0 1 2 3 4 5
14.22
Reacts appropriately and in timely fashion when complications
occur
0 1 2 3 4 5
14.23
Complications are not excessive and are appropriately dealt with
0 1 2 3 4 5
14.24
Workload
0 1 2 3 4 5
Gynae Outpatient Clinic Staff Nurse
14.25
Case mix of patients seen meets clinic's needs
0 1 2 3 4 5
14.26
Manages difficult patients well
0 1 2 3 4 5
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14.27
0 1 2 3 4 5
General performance
Delivery Suite Supervisor
14.28
Subjectively appears competent
0 1 2 3 4 5
14.29
Is perceived to have at least average technical expertise
0 1 2 3 4 5
14.30
Informal teaching skills
0 1 2 3 4 5
14.31
Is less busy than average, average, or above average workload
0 1 2 3 4 5
14.32
Appears able to handle sleep deprivation reasonably
0 1 2 3 4 5
Clinical Director/Leader
14.33
Conducts ward-rounds when indicated
0 1 2 3 4 5
14.34
Maintains equitable workload
0 1 2 3 4 5
14.35
Attends peer groups (audit/teaching)
0 1 2 3 4 5
14.36
General performance
0 1 2 3 4 5
14.37
Manages difficult patients well
0 1 2 3 4 5
14.38
Case mix meets unit/team needs
0 1 2 3 4 5
Paediatrician
14.39
Consults paediatric services on high risk pre-partum patients
0 1 2 3 4 5
14.40
Timely involvement of paediatric services in high-risk births
0 1 2 3 4 5
14.41
Neonatal complications compare with usual range
0 1 2 3 4 5
Junior Medical Staff
14.42
Is available when needed
0 1 2 3 4 5
14.43
Has a role model or apprenticeship approach
0 1 2 3 4 5
14.44
Provides sufficient clinical supervision, support and backup
0 1 2 3 4 5
14.45
Does necessary ward-rounds (e.g. post-acute)
0 1 2 3 4 5
14.46
Provides sufficient teaching
0 1 2 3 4 5
14.47
Manages difficult cases well
0 1 2 3 4 5
14.48
Manages complications well
0 1 2 3 4 5
Comments:
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Theatre Observations
(0=unsatisfactory; 1=poor;
2=Satisfactory.; 3=good;
4=v.good; 5=Excellent)
Risk Management
Relationships
16.1 Maintains a positive/approachable persona in theatre
0 1 2 3 4 5
16.2 Relations with Nursing staff are constructive and pleasant
0 1 2 3 4 5
16.3 Relates well with anaesthetic and other med/surgical colleagues
0 1 2 3 4 5
Systems
16.4 Structural arrangements
0 1 2 3 4 5
16.5 Lists per week/Case mix
0 1 2 3 4 5
16.6 Staff role organisation and utilisation
0 1 2 3 4 5
16.7 Reads patient records prior to surgery
0 1 2 3 4 5
16.8 Checks procedure with patient & list before proceeding
0 1 2 3 4 5
16.9 Consent form adequate and checks in theatre
0 1 2 3 4 5
16.10
Relevant test results available/referred to in theatre
0 1 2 3 4 5
16.11
Indications for surgery within professional guidelines
0 1 2 3 4 5
Documentation/audit
16.12
Operation notes/records
0 1 2 3 4 5
16.13
Audits
0 1 2 3 4 5
16.14
1st 24 Hours of post-op plan recorded
0 1 2 3 4 5
(0=unsatisfactory; 1=poor;
2=Satisfactory.; 3=good;
4=v.good; 5=Excellent)
Technical aspects
17.1 Conventional methodology observed
0 1 2 3 4 5
17.2 Sound operative techniques
0 1 2 3 4 5
17.3 Utilises assistant well
0 1 2 3 4 5
17.4 Appropriate use of instruments
0 1 2 3 4 5
17.5 Aseptic technique
0 1 2 3 4 5
17.6 Stance and posture
0 1 2 3 4 5
17.7 Management of stress/unpredicted events/presence of visitor
0 1 2 3 4 5
17.8 Use of antibiotic or anticoagulant prophylaxis
0 1 2 3 4 5
17.9 Discussion with anaesthetist as to post-op meds
0 1 2 3 4 5
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(0=unsatisfactory; 1=poor;
2=Satisfactory.; 3=good;
4=v.good; 5=Excellent)
Post-operative care plan
18.1 Proposed frequency of visits
0 1 2 3 4 5
18.2 Availability in emergencies
0 1 2 3 4 5
18.3 Proposed rate of discharge
0 1 2 3 4 5
18.4 Recommended return to work
0 1 2 3 4 5
18.5 Recommended time for post-op visit
0 1 2 3 4 5
18.6 Relative notified
0 1 2 3 4 5
Comments:
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