Frequently asked questions

  1. Eligibility
  2. Health services and hospitals
  3. Clinical staff
  4. Suggested training programs
  5. Attestation
  6. The refund
  7. Audit
  8. Development of the Incentivising Better Patient Safety program
  9. Support

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 eligible Victorian public 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.

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1.2 Is my health service eligible for the 2019-2020 Incentivising Better Patient Safety program?

Victorian public health services that offer a planned birthing service (Maternity Capability Levels 2 to 6) are eligible to participate in the program.

1.3 Is the 2019-2020 Incentivising Better Patient Safety program valuable for my health service?

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 management, fetal surveillance and neonatal resuscitation, the number and severity of adverse events are substantially reduced.

From 1 July 2019, if your health service provides education and training which meets the training and attestation criteria, a refund of 5% (minimum $20,000) on the obstetrics component of your medical indemnity premium will be paid.

1.4 Do all clinical staff who provide care in a birth suite need to be trained in the 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, only clinicians defined as clinical staff need to be trained.

This is because certain speciality groups who provide birth suite care 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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1.5 Which clinical 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 Q1.4).

To receive the insurance premium refund, only 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)
  • Junior medical officer*
  • Obstetric registrar
  • Obstetric fellow
  • GP obstetrician, and
  • Obstetric consultant.

*Please note that junior medical officers who provide birth suite care for <13 weeks, do not make independent medical decisions about birth suite patients and are fully supervised when practicing in a birth suite are excluded from the total pool of clinical staff who should be trained for the purposes of this program.

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.

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Health services and hospitals

2.1 My hospital is part of a broader health service. Am I eligible?

Yes. 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. This means that all Victorian public hospitals who offer a planned birthing service (maternity capability levels 2 – 6) are eligible whether or not they are part of a broader health service.

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.

Clinical staff

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

Yes. Any clinical staff member from the list of specialities covered in Q1.5 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 or New Zealand health service or training organisation that meets the training criteria will be counted towards the 80% of clinical staff required to meet the attestation.

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

Yes. Any clinical staff member from the list of specialities covered in Q1.5 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 or New Zealand 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.

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

Yes. Any clinical staff member from the list of specialities covered in Q1.5 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 or New Zealand 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 obstetric residents, resident medical officers (RMOs) and hospital medical officers (HMOs) included in the total pool of staff who need to be trained?

For the purposes of the Incentivising Better Patient Safety program, obstetric residents, RMOs and HMOs are all classified as junior medical officers. If your hospital has junior medical officers that meet the following criteria, they will not count towards the total pool of clinical staff working in your birth suite that are required to be trained for the purposes of this program. Any other junior medical officer will be captured in your total clinical staff workforce pool and should be trained.

The junior medical officer who:

i) provided birth suite care for <13 weeks;

ii) did not make independent medical decisions about birth suite patients and

iii) was fully supervised when practicing in the birth suite

will be excluded from the total pool of clinical staff who should be trained for the purposes of this program.

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3.5 I have junior medical officers who will provide less than 13 weeks of care in my birth suite, but they will be making independent medical decisions about birth suite patients. Are they included in the total pool of staff who need to be trained?

Yes. If junior medical officers are making independent medical decisions about birth suite patients, they must be captured in your total clinical staff workforce pool and should be trained.

3.6 I have junior medical officers who provide less than 13 weeks (65 days) of care in my birth suite, but over an extended period of time across the 2019-2020 financial year. Are they included in the total pool of staff who need to be trained?

No. If junior medical officers work in your birth suite for less than 13 weeks (65 days) in total, they don’t make independent medical decisions about birth suite patients and are fully supervised when practicing in the birth suite, they will be excluded from the total pool of clinical staff who should be trained for the purposes of this program.

3.7 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, focus area 1 and focus area 3 training must have been completed in Australia or New Zealand and meet the training criteria.

For focus area 2, the RANZCOG Fetal Surveillance Education Program is offered across the Asia Pacific region and occasionally in Europe. Attendance at a RANZCOG Fetal Surveillance Education Program outside of Australia and New Zealand will be accepted.

3.8 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 (Q1.5) is required to complete the training in the focus areas to receive a premium refund.

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3.9 I have staff members who completed education and training externally (not at my health service) within the 2019-2020 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

Clinical staff who provide birth suite care during the 2019-2020 financial year must complete a multidisciplinary maternity emergency training program held within their principal hospital of practice.

Only clinical staff who provide birth suite care at more than one Australian or New Zealand health service in the 2019-2020 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.

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

Focus area 2: Fetal surveillance

Clinical staff 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 2019-2020 financial year, will count towards the 80% of clinical staff eligible to meet the attestation criteria.

Please note that the RANZCOG Fetal Surveillance Education Program is offered across the Asia Pacific region and occasionally in Europe. Attendance and achievement of an appropriate Practitioner Level at a RANZCOG Fetal Surveillance Education Program outside of Australia and New Zealand will be accepted.

Focus area 3: Neonatal resuscitation

Clinical staff 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 2019-2020 financial year, will count towards the 80% of clinical birth suite staff eligible to meet the attestation criteria.

Clinical staff who attend a neonatal resuscitation education and training program that does not include an assessment of an individual participants practical competency in providing high quality, effective neonatal ‘first response’ resuscitation, must undertake this component at their principle hospital of practice within the 2019-2020 financial year.

Only clinical staff who provide birth suite care at more than one Australian or New Zealand health service in the 2019-2020 financial year, i.e. new starters, casual/bank/agency midwives or visiting medical officers, may complete their practical competency assessment at another health service. Please ensure evidence of all practical competency assessments are maintained.

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3.10 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.

3.11 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.

3.12 I held education and training in May and June of 2019. Will these staff need to retrain in the 2019-2020 financial year?

Yes. Clinical staff who provide care in the birth suite will need to be trained in the focus areas within the 2019-2020 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.

Clinical staff who completed a face-to-face focus area 2 (fetal surveillance) education program and were awarded a Practitioner Level 2 or 3 score of achievement after 1 July 2018, may complete an online fetal surveillance program in the 2019-2020 financial year.

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Suggested training programs

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

Yes. If you have a locally developed education and training program that meets the training criteria, you will be eligible for the 2019-2020 Incentivising Better Patient Safety program.

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 and attestation 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.

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

The K2 Perinatal Training Program is an online learning platform. Completion of a K2 Perinatal Training Program assessment meets the online component of focus area 2 (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% for focus area 3 (neonatal resuscitation)?

The Maternity and Newborn Emergencies (MANE) program does not offer an assessment of individual participant practical competency in providing high quality, effective neonatal ‘first response’ resuscitation. However, attendance at MANE will meet all other components of the focus area 3 (neonatal resuscitation) criterion.

For clinical staff who attend MANE, an additional assessment of individual participant practical competency will need to be undertaken by the health service for clinical staff to be counted towards the 80% 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 this program?

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

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 learning opportunity but are unable to stay for skills and drill stations or simulated maternity emergency scenarios, will not count as having completed a multidisciplinary maternity emergency training program for the purposes of this program.

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4.5 Face-to-face FSEP sessions have both facilitators and participants. If a clinician facilitates a face-to-face 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 this program?

To achieve focus area 2, clinical staff must complete either a face-to-face or online fetal surveillance education and training program during the 2019-2020 financial year. Additionally, they must have attained the equivalent to a practitioner level 2 (or greater) score of achievement after 1 July 2018.

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 clinical staff 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 this program.

4.6 Multidisciplinary maternity emergency training programs, i.e. PROMPT, must be multidisciplinary for the purposes of this program. 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 Victorian public health services of maternity capability level 2 and level 3 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 learning opportunity but are unable to stay for skills and drill stations or simulated maternity emergency scenarios) will not allow the session to be deemed multidisciplinary for the purposes of this program.

Victorian public health services of maternity capability level 4, 5 and 6 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 in the 2019-2020 financial year?

No. 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. Please note that the RANZCOG Fetal Surveillance Education Program will only award a practitioner level 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 2019-2020 financial year?

Your CEO will complete an attestation form stating your hospital has achieved the Incentivising Better Patient Safety program’s attestation criteria. These forms will be released closer to the end of the 2019-2020 financial year.

For hospitals who are part of a broader health service, CEO’s will 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 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 $20,000.

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6.2 When will I receive the money?

VMIA will issue the refund payment in June each year.

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 2019-2020 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.

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 such as the PRactical Obstetric Multi-Professional Training (PROMPT) program in Victorian hospitals, medical indemnity 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 of Management.

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