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Dutch occupational physicians (OP’s) are well trained professionals but we are looking for ways to improve the quality of their daily practice. The Centre of Excellence of the Netherlands Society of Occupational Medicine (NVAB) has developed a peer to peer assessment model ('visitation') including a medical audit system for OP's. The aims of this are quality improvement, more comparability and transparency in the work of OP’s, protecting employees against malpractice of OP’s, and giving OP’s intrinsic motivation to become better. From 2011, this medical audit is an obligatory part of the re-certification process of individual OP’s.
Methods
OP’s are group wise (3-5 persons) audited by 2 trained auditors on four domains of the care provided: content, context, customer satisfaction and professional development after an initial phase of 6 months, during which every OP has completed several questionnaires. All audit instruments were tested on feasibility and acceptance. For auditing the content of the care, performance indicators to evaluate compliance to NVAB-guidelines on back pain, mental health disorders and ischemic heart diseases have been developed. The audit results in an ‘individual improvement plan (IVP)’ to be approved by the auditors.
Results
So far, about 500 OP's have been audited. Analysis of the preliminary results of the first 200 IVP's shows that better notification of occupational diseases, better adherence to the NVAB-guidelines, and more activities on prevention of occupational health risks are among the most reported intentions for improvement.
Discussion
Group wise medical audit of individual OP’s is a promising and feasible tool to enhance the professional quality of OP’s in daily practice. However, further development of the assessment and audit tools is necessary. The second visitation round (after 5 years) will be the proof of the pudding: i.e. does this obligatory visitation system lead to improvement of professional practice of OP's.