TALLINN, 10 OCTOBER 2024 – Although the Ministry of Social Affairs considers the assessment of the competence of healthcare professionals to be an important tool for ensuring the quality of care, participation in it does not provide tangible benefits for healthcare professionals. Competence assessment is voluntary and only a small proportion of healthcare professionals undergo the assessment, but the state has done nothing to increase participation, the National Audit Office finds in a report published today. This poses a risk that professionals with outdated knowledge and little interest in self-development may continue to work without hindrance.
The National Audit Office points out that it is important in the interests of people's lives and health that healthcare professionals are competent when they leave school and decades later, but in reality the Ministry of Social Affairs does not have sufficient information on the extent to which healthcare professionals are upgrading their competence, nor is it interested in finding out.
“Although the audit found that the vast majority of healthcare professionals systematically engage in self-development, professional associations pointed out that professionals with little interest in self-development and insufficient knowledge and skills may work for years without anyone paying attention to their lack of competence,” said Auditor General Janar Holm.
Maintaining the competence is the responsibility of both healthcare professionals themselves and their employers. If the associations suspect that a healthcare professional is not competent enough to ensure the quality and safety of services, they have little choice but to draw the attention of the national authorities to the issues related to the person or refuse to issue them a certificate of competence. The Ministry of Social Affairs, as a policy maker, and the Health Board, as a regulatory body and national supervisor, have so far failed to address the issues regarding the competence of healthcare professionals in any meaningful way.
In Estonia, the assessment and certification of competence is not systematic. Only a small proportion of healthcare professionals participate in competence assessment. Fewer than a quarter of working specialist doctors had a valid certificate of competence assessment as of 1 January this year, the corresponding share among dentists was 60% and among nurses and midwives less than 10%.
Competence assessment is voluntary, but the existence of a certificate gives an advantage in certain cases, for example to private healthcare institutions participating in the Health Insurance Fund's procurements of healthcare services. In fact, it is not possible to carry out a competence assessment in every medical specialty, as the organisation of such an assessment depends on the will and means of the association. Competence assessments have been carried out in 27 out of 41 medical specialties. There are 20 additional medical specialties in Estonia, four of which are subject to competence assessment.
The information on the competence assessment is reflected in the Health Administration Information System, accessible to the public through the Health Board's website. The inaccuracy and incompleteness of the information there is a problem.
Criteria for assessing competence differ between professional and occupational associations, and verification of competence is not comparable in terms of thoroughness and depth across specialties. Competence assessment is organised by the associations themselves. There are similarities in the assessment criteria, such as participation in training, publication of papers and mentoring. However, there are more differences. For example, the volume of continuing training required or the volume of practical work in the previous period varies widely. A certain variability in the evaluation criteria is inevitable due to the nature of the specialties (for example, in the case of surgeons, there is a very strong emphasis on practical work), but harmonisation of the evaluation is also considered necessary by the associations themselves.
Continuing training, the completion of which in the extent of 60 hours per year is set forth by law is one of the bases for ensuring competence, is not available to all healthcare professionals. Non-compliance with the requirement for continuing training was identified as a problem by the professional associations, but the extent of this is not specified. While the lack of funding for training is usually the main problem, in health care the lack of substitute workers for the period of training is the biggest obstacle.
According to the National Audit Office, the Ministry of Social Affairs has surrendered to fate: it considers the competence assessment strongly recommendable, but making it mandatory unfeasible, as the capacity and willingness of professional associations to engage in the assessment is different. Some of the professional associations of healthcare professionals that responded to the National Audit Office’s survey see a need for mandatory assessment. A smaller share of the associations prefers to continue with the voluntary system. The models used vary by countries.
According to the National Audit Office, it is possible to increase the demand for and participation in competence assessment, regardless of whether it is mandatory or voluntary. The Ministry of Social Affairs, in cooperation with the Health Board and the Health Insurance Fund, has the opportunity to make competence assessment a substantive and routine part of the development of healthcare professionals. To this end, support should be provided to the associations, firstly by, for example, harmonising the criteria for the assessment of competence and simplifying the assessment process, including through digital solutions and the publication of information on the assessment of competence.
According to the National Audit Office, it is important to ensure that healthcare professionals participate in continuing training at least in the extent required. The most important thing is to make continuing training more accessible by ensuring that there is sufficient funding for training and that attendance is not dependent on the type, size and capacity of the institution to deliver the training. In addition, monitoring of compliance with the requirement for continuing training needs to be put in place.
Background
Assessing the competence of healthcare professionals is an important component in ensuring the quality of health services. The National Audit Office addressed the issues of ensuring the quality of healthcare services in its report “The role of state institutions in ensuring the quality of healthcare services” published in 2024. The review published today aimed to provide an overview of the state of play in assessing the competence of healthcare professionals, highlighting the bottlenecks and possible solutions or options.
This review focused on the tasks of the Ministry of Social Affairs and the agencies under its government – the Health Board and the Health Insurance Fund. In addition to public authorities, the review gathered information from healthcare providers, professional and trade associations, the Supreme Audit Institutions of Finland and Latvia, and the World Health Organisation.
Priit Simson
Communication Manager, National Audit Office
+372 640 0777
+372 5615 0280
[email protected]
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http://www.riigikontroll.ee/
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Posted:
10/10/2024 10:00 AM
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Last Update:
10/10/2024 9:15 AM
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Last Review:
10/10/2024 9:15 AM