Clinical Expert Panel

What is an investigation?

An investigation or review is defined as a process of gathering information to determine the facts about a matter from which the decision maker is then able to resolve a course of appropriate action (see below).

How are investigations or reviews undertaken?

Each review is different, and the team make-up varies with the type of review and the concerns raised. Teams established under specific NSW Health Policy Directives (eg MCCC) would be constituted in line with the relevant policy directive.

For the review of a service, the team is led by a senior manager or clinician who has previous governance, review or investigation experience. A few clinicians, with relevant expert knowledge, are included in the team. If appropriate, other experts such as human resources or industrial relations may be included in the team. Teams usually comprise 3-6 members.

There may be occasions where the Clinical Expert will be the sole practitioner undertaking a review. They will undertake the review and report using the same principles as larger reviews.

Who commissions the investigations or reviews?

Reviews are generally commissioned by Local Health Districts/Specialty Health Networks (LHD/SHN) or other bodies, which specify the scope and purpose of the review, normally as Terms of Reference. The review report is provided to the Chief Executive of the commissioning body. Clinical Experts must adhere to the scope of the review as specified.

What is the role of the review/investigation team?

The role of the review team is to ascertain the facts about a serious incident and provide a report with the findings and recommendations, which will be delivered to a decision maker (Chief Executive or senior manager). It is the role of the decision maker to determine what action, if any, should be undertaken resulting from the reviews.

What is my role in the reviews?

As a member of the investigation or review team, the Clinical Expert will provide expert advice on the standard of care compared to relevant best practice, review medical records and other documents, interview ‘witnesses’, review other evidence, assist the team in developing and recording findings and recommendations.

An experienced Clinical Expert may be requested to lead the investigation team. Clinical Experts are expected to practice at a high standard and bring those high standards into the reviews they undertake.

What do I do if I uncover reportable behaviour during the review?

There may be occasions when, during an investigation, a Clinical Expert uncovers reportable behaviour, such as that required by the registration board or professional association, child protection, domestic violence, corruption or criminal conduct. The clinician has a professional obligation to undertake the relevant reporting. They must report the behaviour to the Chief Executive of the commissioning body. The commissioning body or CEC will assist the clinician where required. If the review team uncovers what they believe to be serious systemic issues (a continuing risk of harm to the patient or serious or imminent risk of harm to other patients, carers, family or staff) they must immediately escalate the risk in writing to the Chief Executive.

What if I have an actual or perceived conflict of interest?

All reviews must be conducted in an impartial and objective manner, bearing in mind the setting in which the service functions. The investigator must not have, and must not be perceived to have, any conflict of interests in relation to the matter or the people, the conduct or the policies and procedures the subject of investigation. Conflicts of interest must be declared to the commissioning body as soon as they arise.

Can I be held personally subject to any action?

Section 133B of the Health Services Act 1997 provides that persons acting under the directions of the board of a statutory organisation may not be personally subject to any action, liability, claim or demand if action was undertaken in good faith. However, this does not protect a person from being called to give evidence unless the review was a privileged serious adverse event review.

Can I discuss cases with my colleagues?

Clinical Experts are required to keep any information obtained or records created during reviews confidential and not disclose the information to other parties, as specified in the NSW Health Code of Conduct. This is over and above privacy afforded to patients and clients of services under Commonwealth and State privacy legislation. Note that members of privileged serious adverse event teams have specific legal penalties for breaching confidentiality.

Why do I need to be trained?

Reviews need to be conducted independently and with procedural fairness so that the findings and recommendations are robust and fair to the subject(s) of the review, any affected patients and families and the health service. Training is required to ensure Clinical Experts can undertake high quality reviews and there is consistency across Clinical Experts.

What can I expect when I undertake a review or investigation?

It is expected that you will:

• Be part of a team working together to determine the facts about a matter and providing helpful recommendations
• Have a clear scope of the review (Terms of Reference)
• Have a location for the team to meet and discuss the review
• Have access to relevant evidence (eg personnel for interviews, medical records, rosters, operating theatre lists, emails, correspondence etc)
• Have staff available to assist with setting up interviews, access to medical records, accessing documents etc.

What are the benefits of being a Clinical Expert?

The main benefits are:

• Using your clinical expertise in new and unique ways
• Helping health services to improve the quality of care to patients and families
• Providing comfort to patients and families that their concerns are being addressed by persons with appropriate independence, expertise and care
• Being stimulated and challenged by tackling issues and concerns that are difficult and demanding
• Being involved with a team working towards and fair and robust outcome
• Help meet AHPRA CPD requirements for clinical audit and outcome review.

Where can I obtain further information?

Email: CEC-PatientSafety@health.nsw.gov.au

How do I apply to be a panel member?

Application form

What are the qualifications of Clinical Experts?

Clinical Experts would:

• be recognised as experts in their specialty or sub-specialty
• be registered health professional with the relevant registration board through Australian Health Professionals Registration Agency (AHPRA) or membership of an appropriate Australian professional association
• have no restrictions on practice, no serious complaints or pending litigation
• be experienced in or demonstrated understanding of the NSW public health system
• be able to demonstrate currency of expertise if retired.

What training does the clinician have in conducting a review/investigation?

Training will be provided to the Expert Panel members by the CEC to ensure they can undertake high quality reviews and have consistency across Clinical Experts.

What are the benefits to the LHD/SHN of having Clinical Experts?

Clinical Experts can be a useful resource for LHD/SHNs because they have:

• Fresh independent eyes and thinking
• Been extended through experiencing stimulating and challenging issues that may be difficult and demanding to resolve
• Helped health services to improve the quality of care to patients and families
• Understood the trauma to patients/families, staff and the organisation when a serious adverse event occurs
• Improved teamwork through working in a different kind of team
• Provide a trained resource for internal reviews.

What can I expect of the of Clinical Experts?

• Availability to undertake the NSW Clinical Expert Training and a brief orientation process
• Availability for interviews and reviewing medical records
• Availability after the review for finalising the report
• Comply with timeframes specified by the team leader or commissioning body
• Availability to brief the commissioning body on the findings and recommendations in the review report.

What costs are involved?

It is expected that Clinical Experts will be compensated/remunerated for their participation in reviews. The form of the compensation/remuneration will depend on the 'employment' situation of the clinician at the time of their engagement in the review and will be negotiated with the commissioning body.

How do I engage a clinician from the panel and where can I obtain further information?

Application form and CEC-PatientSafety@health.nsw.gov.au

• Terms of Reference Template
• Investigation or Review Plan Template
• Investigation or Review Process Checklist
• Report Template