Medical revalidation: From compliance to commitment

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Medical revalidation of doctors became a statutory obligation for all employing organisations in 2012, but its origins stretch back to 2000. In that period, the NHS has undergone many changes and been scrutinised by several reviews. It was against this shifting context that The King's Fund carried out a qualitative assessment of the impact to date of medical revalidation on the behaviour of doctors and the culture of organisations within seven case study sites across England.

This paper, commissioned by the NHS Revalidation Support Team, presents the findings from focus group discussions with doctors and interviews with wider staff. It provides analysis from interviewees’ perspectives and offers commentary on how leaders at all levels can use revalidation to help create a culture of excellence in patient care.

Key findings

  • The study identified different assumptions about the overarching purpose of revalidation to assure the public of doctors' fitness to practise. Responsible officers felt the focus should be on using effective appraisal to engender a reflective workforce. For CEOs and chairs, revalidation could help in achieving their organisational goals.
  • Among doctors, there was confusion and some cynicism about the purpose of revalidation, with various messages being heard. However, all participants could identify possible benefits, particularly the developmental potential for doctors.
  • Most impacts in the case study organisations were being driven by the need for compliance to regulation on revalidation and clinical governance.
  • But there was evidence of greater commitment to using revalidation as a tool for quality improvement at all levels, with individuals interpreting revalidation as a force for developing and reflecting on their practice, which underpins innovation and creating culture change.
  • The study found evidence that the culture pre-dating revalidation contributed to how it was received, used or implemented.

Policy implications

  • Positive and sustained changes to behaviours and culture will require engagement with the benefits and intent of revalidation from frontline doctor to executive colleague.
  • Moving revalidation from compliance to commitment will require action by leaders at system, organisational and individual levels. This will engage doctors in contributing to  a shared vision in which revalidation fosters a culture where excellence in patient care and professional practice are interdependently linked.
  • The stability post-implementation can be used to refine the process and clarify the purpose of revalidation, with leaders ensuring consistent messaging on the purpose at a national and organisational level.
  • Implementing change processes at scale requires leaders to encourage a learning culture in which a drive for continuous quality improvement becomes the norm.

More on revalidation

Comments

Dr Alfa Sa'adu

Position
Medical Director,
Organisation
Ealing Hospital NHS Trust
Comment date
15 March 2014
Studies of this kind are important if we wish to truly evaluate the benefit of Medical Appraisal and Revalidation! I think that it is great that an independent organisation such as The King Fund is carrying out this research.

Dr Ike Anya

Position
Consultant in Public Health Medicine,
Comment date
21 March 2014
Useful report with important insights

Paul Shannon

Position
Consultant,
Organisation
Doncaster and Bassetlaw Hospitals NHSFT
Comment date
27 March 2014
I revalidated last year; it was not difficult, though tedious. It was 'low challenge' and 'high support'. This can be characterised as 'a cosy chat'.

It should be much more challenging and linked to organisational objectives. However, at the moment it is viewed by ROs and Consultants as a relationship between the doctor and the GMC; the employing organisation is almost irrelevant. Hence it focuses on minimum standards, rather then striving for excellence. If it were linked to incentives it would be more effective.

anni

Position
nurse,
Organisation
hospital
Comment date
05 August 2015
Im currently using http://www.NurseTools.org for Revalidation.

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