Clinical Performance Enhancement

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A clinical performance enhancement process is an important component of a correctional health care personnel development and training program. The 2014 editions of NCCHC’s Standards for Health Services for jails and prisons provide guidance for the successful incorporation of a clinical performance enhancement process into the correctional health care system.

Annual Performance Evaluation vs. Clinical Performance Enhancement
Before going any further, it is important to explain the difference between an annual performance review and a clinical performance review.

An annual performance review typically evaluates employees on areas such as punctuality, teamwork, attitudes, goals and so forth. These types of reviews may be conducted by an employee’s supervisor regardless of the credentials or profession of either the employee or the supervisor. For example, in some facilities, the health services administrator may be supervised and evaluated by a facility commander on these aspects of performance.

In contrast, a clinical performance enhancement review focuses only on the quality of the clinical care that is provided. This type of review should be conducted only by another professional of at least equal training in the same general discipline. For example, an RN should evaluate other RNs and LPNs, a physician should review the work of a physician and a dentist should review the work of a dentist.

Typically the reviews are done by the health care professionals who are also in administrative or supervisory roles, such as the director of nurses reviewing the nursing staff, or responsible physician reviewing other physicians and midlevel providers. If the supervisors also provide clinical care, they should be reviewed in this process, as well. This can be accomplished by a memorandum of agreement with an outside practitioner, by an outside group such as a medical school or hospital, or through the regional or corporate system.

If at any time in a review there is a serious concern with an individual’s competence, an independent review is initiated by the responsible health authority (RHA) and procedures are implemented to improve the individual’s competence.

Who and When?
The standard requires that the facility’s direct patient care clinicians and RNs and LPNs are reviewed annually. Direct patient care clinicians are all licensed practitioners who provide medical, dental and mental health care in the facility. This includes physicians, dentists, midlevel practitioners and qualified mental health professionals (psychiatrists, psychologists, psychiatric social workers, psychiatric nurses and others who by virtue of their education, credentials and experience are permitted by law to evaluate and care for mental health needs of patients).

NCCHC recognizes that there are many other professions that have licensed practitioners (e.g., dental hygienists) who may be considered direct patient care clinicians. While it is good practice to include these professionals in the clinical performance enhancement process, technically it is not required by the standard.

Components of a Review
The standard requires that the clinical performance reviews incorporate at least the following elements:

• Name of the individual being reviewed
• Date of the review
• Name of the reviewer
• Credentials of the reviewer
• Summary of the findings and corrective action, if any
• Confirmation that the review was shared with the individual being reviewed (normally accomplished through signature of individual)

The standard is less specific on what other components should be included. Although a standardized review form is recommended, these forms may vary in content. When developing a form, keep in mind the intent of the standard, which is to enhance patient care through a peer review of the individual’s clinical practice. Therefore, reviews should look at areas most vital to patient care (e.g., sick call response, chronic care management, continuity of care, clinical skills, appropriate use of nursing assessment protocols, mental health care, dental care and other clinical areas as appropriate).

Finally, the standard requires the RHA to maintain a log or other written record listing the names of the individuals being reviewed and the date of their most recent review.

Designed to Enhance Competence
In summary, a clinical performance enhancement review process is neither an annual performance review nor a clinical case conference. It is a professional practice review focused on clinical skills and is designed to enhance competence and to address areas in need of improvement.

[This article first appeared in the Summer 2015 issue of CorrectCare.]

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