Eligibility

1.1 What is the Incentivising Better Patient Safety program?

Errors, failures and deficiencies in maternity care can endanger life and lead to substantial liability claims. To reduce harm and the factors that lead to adverse outcomes, VMIA has worked closely with the health sector to identify three main areas where patient safety in the maternity setting can be improved through evidence-based skills training and education:

  • Multidisciplinary maternity emergency training
  • Fetal surveillance, and
  • Neonatal resuscitation.

These three areas were used to develop the Incentivising Better Patient Safety program, which will improve safety, lead to better health outcomes and deliver financial benefits to participating health services.

The eligibility criteria contains:

  • Focus areas: The three areas of maternity care in which VMIA is incentivising further education and training.
  • Training criteria: The elements within education and training programs that must be included to be eligible for consideration within the attestation criteria. VMIA has suggested a number of education and training programs that meet the training criteria (not an exhaustive list), however, health services are able to choose their own, provided it meets the criteria.
  • Attestation criteria: The percentage of clinical staff who must complete training according to the training criteria to receive a refund.

1.2 Is my health service eligible to participate?

Public health maternity services in Victoria (Levels 2 to 6) are eligible to participate in the program.

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1.3 Why should my health service participate?

Improving patient safety is a priority for VMIA, which manages medical indemnity claims arising from adverse events. Many of these are avoidable.

VMIA’s analysis of claims data shows clear evidence that where clinical staff providing care in birth suites undertake training in multidisciplinary maternity emergency scenarios, fetal surveillance and neonatal resuscitation, the number and severity of adverse events are substantially reduced.

From 1 July 2018, if your maternity service provides education and training which meets the training and attestation criteria, a refund of 5% (minimum $15,000) on the obstetrics component of your medical indemnity premium will be paid.

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1.4 What if I choose not to participate?

Participation in the program is optional. If you would like to discuss your decision about whether to participate, VMIA’s Risk Advisers will help you to understand the benefits specific to your organisation.

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1.5 Do clinical staff who provide care in a birth suite need to be trained in all three focus areas?

This depends on their role. The program is designed to ensure that the majority of clinical staff providing care in the birth suite complete training in all three focus areas. However, for the purposes of the attestation criteria, each focus area is assessed individually. This is because certain speciality groups do not need to undertake training in all three focus areas, as one or more may not be relevant to their practice. For example, an anaesthetist or neonatal nurse may intermittently provide birth suite care, however, will not necessarily require training in fetal surveillance.

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1.6 Which clinical birth suite staff need to attend education and training to meet the Incentivising Better Patient Safety attestation criteria for a premium refund?

For some speciality groups, only certain focus areas will be relevant to their practice (see Q1.5 above).

To receive the insurance premium refund, the following clinical staff – whether or not they are employees of the health service – who provide birth suite care will be required to complete education and training in the three focus areas:

  • Midwife
  • Midwife in Charge (NUM or ANUM)
  • Obstetric Resident or equivalent junior doctor
  • Obstetric Registrar
  • Obstetric Fellow
  • GP Obstetrician, and
  • Obstetric Consultant.

For focus area 1 (multidisciplinary maternity emergency training), a multidisciplinary workforce mix will be required for your training program to meet the training criteria. This means other specialist clinicians i.e. anaesthetists and paediatricians, may be required to attend education and training in this area of practice.

Health services and hospitals

2.1 My hospital is part of a broader health service. Can I participate?

Yes. Decisions to participate in the program should be made at a hospital level. Although VMIA collects the total medical indemnity premium at the health service level, the obstetric component is calculated based on the services provided by the individual hospital.

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2.2 My health service incorporates individual hospitals. Can I aggregate my hospitals’ results to be eligible for a refund?

No. Each hospital must individually meet the attestation criteria.

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Clinical staff

3.1 I have a high number of casual and part-time clinical staff. Do they need to be trained?

Yes. If you choose to participate in the program, any clinical staff member from the list of specialities covered in Q1.6 will be counted towards the total pool of staff who may be trained. This includes casual, bank and part-time clinicians.

Casual and part-time clinical staff who have completed an education and training program at another Australian health service or training organisation that meets the training criteria will be counted towards the 80% of clinical staff required to meet the attestation.

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3.2 I use agency midwifery staff to provide care in my birth suite. Do they need to be trained?

Yes. If you choose to participate in the program, any clinical staff member from the list of specialities covered in Q1.6 will be counted towards the total pool of staff who may be trained. This includes agency midwives if they provide care in your birth suite.

Agency midwives who have completed an education and training program at another Australian health service or training organisation that meets the training criteria will be counted towards the 80% of clinical staff required to meet the attestation criteria.

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3.3 My birth suite is staffed by locum or visiting medical officers. Do they need to be trained?

Yes. If you choose to participate in the program, any clinical staff member from the list of specialities covered in Q1.6 will be counted towards the total pool of staff who may be trained. This includes locum or visiting medical officers if they provide care in your birth suite.

Locum or visiting medical officers who have completed an education and training program at another Australian health service or training organisation that meets the training criteria will be counted towards the 80% of clinical staff required to meet the attestation criteria.

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3.4 Are Hospital Medical Officers (HMOs) included in the total pool of staff who need to be trained?

No. HMOs who meet the following criteria will not count towards the total pool of clinical birth suite staff that are required to be trained for the purposes of IBPS.

The HMO:

i. provided birth suite care for <12 weeks; and

ii. was fully supervised by a senior clinician when providing birth suite care; and

iii. made no independent clinical decisions for the birth suite patient and

iv. did not provide care equivalent to an Obstetric Resident.

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3.5 My birth suite clinicians have attended training in the focus areas overseas. Do they need to retrain in Australia?

To be eligible for the refund, the training must have been completed in Australia or New Zealand and meet the training criteria.

Health services cannot count birth suite staff who have completed training overseas (other than in New Zealand) in any of the focus areas towards the 80% of clinical staff required to meet the attestation criteria.

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3.6 My health service has clinicians who provide birth suite care on a very infrequent basis i.e. neonatal code blue teams, Urgent Care Centre (UCC) staff or endocrinologists providing high-risk patient reviews. Do these clinicians need to be trained?

No. Your health service may wish to include these clinicians in maternity education and training programs. However, they will not count towards your total pool of clinical staff required to meet the attestation criteria.

Only the defined group of clinical staff (Q1.6) is required to complete the training in the focus areas to receive a premium refund.

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3.7 I have staff members who completed education and training externally (not at my health service) within the 2018-19 financial year. Do they have to retrain at my health service?

The requirement to provide training at your health service varies depending on the focus area. If clinical staff have completed an education and training program externally, it is the responsibility of the health service to ensure they are satisfied the program meets the training criteria and that appropriate records are kept. Health services may be subject to audit – see Q7.1.

Focus area 1: Multidisciplinary maternity emergency training

Clinicians who provide birth suite care during the 2018-19 financial year must complete a multidisciplinary maternity emergency training program held within their principal hospital of practice.

Only clinicians who provide birth suite care at more than one Australian or New Zealand maternity service in the 2018-19 financial year, i.e. new starters, agency midwives or visiting medical officers, may complete a multidisciplinary maternity emergency training program at another health service, provided that it meets the training criteria.

Clinicians who meet these requirements will count towards the 80% of birth suite staff eligible to meet the attestation criteria.

Focus area 2: Neonatal resuscitation

Clinicians who attend a neonatal resuscitation education and training program that meets the training criteria at another health service or education provider (in Australia or New Zealand) within the 2018-19 financial year, will count towards the 80% of clinical birth suite staff eligible to meet the attestation criteria.

Focus area 3: Fetal surveillance

Clinicians who attend a fetal surveillance education and training program that meets the training criteria at another health service or education provider (in Australia or New Zealand) within the 2018-19 financial year, will count towards the 80% of clinical staff eligible to meet the attestation criteria.

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3.8 What about my clinical staff who provide maternity care in other areas of my hospital i.e. postnatal, antenatal and/or domiciliary services?

Clinical staff who exclusively provide care to patients outside of the birth suite will not count towards the total workforce pool required to meet the attestation criteria.

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3.9 Does it matter if the training that my staff member received externally was at a private hospital?

Clinical staff who attended an education and training program that meets the training criteria at a private hospital in Australia or New Zealand will count towards the 80% of clinical staff eligible to meet the attestation criteria.

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3.10 I held education and training in May and June of 2018. Will these staff need to retrain?

Yes. Clinical staff who provide care in the birth suite will need to be trained in the focus areas within the 2018-19 financial year. The program is designed to provide an incentive to implement an annual program of education and training to keep birth suite clinicians’ skills and knowledge current.

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Suggested training program

4.1 I don’t currently offer the programs listed under ‘suggested training programs’. Can I still participate?

Yes. If your education and training program meets the training criteria, you will be eligible to participate.

For example, many health services in Victoria use online learning platforms to provide newborn resuscitation theory to their clinicians. These health services then train their staff in practical newborn resuscitation skills through internally developed programs. If these education and training programs meet the training criteria, you will be eligible to count attendees at these sessions towards your 80% clinical staff target.

VMIA is responsible for assessing each health service’s compliance with the training criteria. Your VMIA Risk Adviser can help you if you’re unsure whether your education and training program meets the training criteria. Get in touch with them early so you ensure you’re in the best position to secure the 5% premium refund.

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4.2 My health service wishes to use the K2 Perinatal Training Program. Does this meet the training criteria?

The K2 Perinatal Training Program is an online learning platform. If your health service uses this product, face-to-face training in fetal surveillance must be provided to your clinical staff every second year to be eligible for a refund.

For the 2018-19 financial year, all clinical staff providing care in a birth suite who have completed either a face-to-face or online education and training program will count towards the 80% of clinical staff target in the attestation criteria.

Face-to-face training may be delivered in a way that suits your health service’s needs and is not prescribed by the program. VMIA may request evidence of the specific components of your training program.

Your Practitioner level equivalency must be determined in accordance with your hospital’s policy on fetal surveillance.

4.3 My health service wishes to use the Maternity and Newborn Emergencies program. This contains a neonatal resuscitation component. Can my clinical staff who participate in this program be counted towards the 80% neonatal resuscitation criterion?

Yes. The Maternity and Newborn Emergencies (MANE) program meets the training criteria for focus area 3 (neonatal resuscitation). Completion of this program will be counted towards the 80% of clinical staff required to meet the attestation criteria.

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4.4 PROMPT sessions have both facilitators and participants. If a clinician facilitates a PROMPT day (but did not attend as a participant), do they count as having completed a multidisciplinary maternity emergency training session for the purposes of IBPS?

PROMPT facilitators who facilitate a PROMPT session will count as having completed a multidisciplinary maternity emergency training program for the purposes of IBPS. 

PROMPT facilitators must stay for the full duration of the PROMPT session. PROMPT facilitators who attend components of a PROMPT session - i.e. provide the theoretical component but are unable to stay for scenario-based (drill) training - will not count as having completed a multidisciplinary maternity emergency training program for the purposes of IBPS.

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4.5 Face-to-face FSEP sessions are comprised of both facilitators and participants. If a clinician facilitates an FSEP session (but did not attend as a participant), do they count as having completed a fetal surveillance education and training program for the purposes of IBPS?

To achieve Focus Area 2, birth suite clinicians must complete either a face-to-face or online fetal surveillance education and training program during the 2018/19 financial year. Additionally, they must have attained the equivalent to a Practitioner Level 2 (or greater) score of achievement after 1 July 2017. 

To attain a Practitioner Level, clinicians must complete and sit the assessment component of a face-to-face fetal surveillance education and training program. This means that birth suite clinicians who facilitate FSEP will need to complete and sit the assessment component of an FSEP day that is not facilitated by themselves to attain a Practitioner Level for the purposes of IBPS. 

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4.6 Multidisciplinary maternity emergency training programs, i.e. PROMPT, must be multidisciplinary for the purposes of IBPS. If a hospital only has a small number of medical staff in their community, can a facilitator who is a doctor (i.e. Discipline 2, 3, or 4) make the training session multidisciplinary, even when all participants are midwives and nurses (i.e. Discipline 1)? 

Only Maternity Capability Level 2 and Level 3 hospitals may deem multidisciplinary maternity emergency training sessions as multidisciplinary if facilitators are from Disciplines 2, 3, or 4 (medical staff) and the participant group is exclusively from Discipline 1 (midwifery and nursing staff). 

Multidisciplinary maternity emergency training session facilitators must stay for the full duration of the training session. Multidisciplinary maternity emergency training facilitators from Disciplines 2, 3 or 4 who attend components of a training session - i.e. provide the theoretical component but are unable to stay for scenario-based (drill) training -  will not allow the session to be deemed multidisciplinary for the purposes of IBPS.

Maternity Capability Level 4, Level 5 and Level 6 hospitals may not count their multidisciplinary maternity emergency training sessions as multidisciplinary if they have a medical facilitator from Disciplines 2, 3 or 4 and only midwifery/nursing participants from Discipline 1. These hospitals must have a multidisciplinary participant group.

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4.7 Do clinical staff need to be trained in face-to-face and online fetal surveillance?

Yes. Clinical staff must complete a face-to-face program at least every second year to be counted towards the 80% of clinical staff required to meet the attestation criteria. This can be supplemented with an online program every other year.

For users of the Royal Australian and New Zealand College of Obstetricians and Gynaecologist’s (RANZCOG) fetal surveillance Education Program (FSEP), it is important to note that a Practitioner level will only be awarded through the face-to-face program.

4.8 Where can I get more information on the education and training programs?

We have suggested a number of education and training programs that meet the training criteria. These lists are not exhaustive.

Your VMIA Risk Adviser can provide you with more information on maternity education and training and support if needed.

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Attestation

5.1 How do I attest that I have achieved the Incentivising Better Patient Safety eligibility criteria for the 2018-19 financial year?

Your CEO will complete the attestation form stating your hospital has achieved compliance with the attestation criteria. The forms will be released closer to the end of the 2018-19 financial year.

For hospitals which are part of a broader health service, CEO’s may need to complete more than one attestation form. Only hospitals that achieve all the attestation criteria will be refunded.

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The refund

6.1 How much money will I receive?

If you achieve compliance with the attestation criteria in each of the three focus areas, you will receive a refund of 5% of the obstetrics component of your medical indemnity premium. For smaller health services who may not pay a large obstetrics premium, VMIA will issue a minimum refund of $15,000.

6.2 When will I receive the money?

VMIA will issue the refund payment in June each year. The first refunds will be paid in June 2019.

6.3 As part of a broader health service, If I achieve compliance with the Incentivising Better Patient Safety program, where does the refund go?

VMIA calculates the obstetric component of medical indemnity premium at the hospital level and collects the total medical indemnity premium at the health service level. This means all refunds will be paid at health service level.

It is up to the health service to determine how the refund is disbursed, and VMIA does not stipulate how it can be used.

We do, however, encourage health services’ management teams to continue their focus on continuous improvement, staff training and education that will improve patient safety.

6.4 Is my medical indemnity premium affected by this program?

No. The program will not impact your 2018-19 premium, however, by implementing continuous improvement initiatives such as, Incentivising Better Patient Safety, there is significant potential to reduce claims (and therefore premiums) by preventing harm and improving care over the long term.

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Audit

7.1 Will VMIA audit my health service?

VMIA at all times reserves the right to conduct retrospective audits on a portion of participating health services for attestation verification purposes. The health services to be audited will be chosen at random.

It is the responsibility of health services to ensure appropriate education and training records are kept, including assurance of external programs attended by your clinical staff. Your VMIA Risk Adviser can provide you with more information and support if needed.

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Development of the Incentivising Better Patient Safety program

8.1 How was the attestation criteria developed?

The attestation criteria were created by VMIA in partnership with the Victorian maternity sector, following a review of our claims data and the factors that typically cause adverse events in the birthing suite.

Some of the key factors contributing to poor outcomes in maternity care are repeated failures in:

  • Recognising fetal deterioration through appropriate fetal heart rate monitoring (cardiotocography or ‘CTG’) during labour and birth
  • Systems, communication and teamwork among health professionals, leading to errors and delays in decision making
  • Appropriate escalation to deliver the baby within a safe period after deterioration is identified.

Evidence demonstrates that when the majority of birth suite clinicians are trained in programs that reduce the risk of these events, it leads to safer outcomes for women and babies.

We’ve consulted with a wide range of subject matter experts and representatives from metropolitan and rural maternity services, as well as the Department of Health and Human Services, Safer Care Victoria, consumers, government, peak bodies, professional colleges, unions, obstetricians and midwives to understand what the maternity sector needs.

8.2 Why is this program only available for maternity services? Are there plans to roll out this initiative beyond maternity services?

Following the roll-out of maternity education and training programs in Victorian hospitals, such as the Practical Obstetric Multi-Professional Training (PROMPT) program, claims have decreased by 64% since 2003.

VMIA will be evaluating the program and may extend it beyond the maternity sector and into other specialty areas if measurable health improvements and a reduction in claims is achieved.

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Support

9.1 What support is available to help me?

VMIA wants to reward Victorian maternity services for improving safety and outcomes. Your VMIA Risk Adviser can offer tailored support to ensure you implement a program that meets the overarching training and attestation criteria. This may include co-developing systems and processes, action plans, meeting with your staff or talking to your Board.