see also: [[Complaints]]
See ACEM policies: [Supporting a trainee in difficulty](x-devonthink-item://44C22F0C-4E63-4F7E-9CEF-543B5AE274EF) and [managing remediation and the poorly performing practitioner](x-devonthink-item://93500402-1B58-41F9-B57D-8B5B6D7F42E6)
See: [How to give and receive feedback effectively](https://pmc.ncbi.nlm.nih.gov/articles/PMC5709796/)
## ACEM Remediation of a poorly performing practitioner policy
- Find a mentor (who isn't a supervisor)
- Assign a supervisor
- Appropriate time frame for remediation
- Have a performance management plan:
- Specific aims: courses, upskilling, required and desired outcomes
- Duration of program (usually 3 months minimum)
- Supervision arrangements (degree and nature, timetable for review)
- Present plan in writing
- An assessment to determine if performance management plan has been completed satisfactorily
- report outcomes to appropriate stakeholders
## SPIES
**S**eek information
**P**atient safety / impact on patient care
**I**nitiative
**E**scalate
**S**upport
| Task | Explanation |
| -------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| Seek info | - Clarify info (was this a rumour or witnessed behaviour?)<br>- Any misunderstanding?<br>- Personality issues?<br>- Assess what the problem is, how serious it is |
| Patient Safety | - Analyse the impact on patient safety and take remedial action<br>- May range from keeping an eye on someone to physically removing them |
| Initiative | - Anything I can do myself to resolve the situation? eg ↑ supervision, training<br>- Flexibility in working patterns if it is a temporary personal issue<br>- If pt safety is at risk, may need to *escalate* |
| Escalate | - Involve appropriate senior colleagues (eg director if a colleague; DEMT if a registrar)<br>- Further escalation may be to medical director or department director (if another team), or the chief executive in very significant (and rare) cases |
| Support | - Many colleagues who under-perform have personal issues; find ways to support that person through the difficulties they face (eg [[Alcohol-related disease#ED SBIRT intervention - CAGE\|SBIRT]] if drug/alcohol issue, although this framework could apply in other ways)<br>- Support your team in dealing with the matter<br>- *Take responsibility* for patient care if needed |
## example question responses
> for all of these, **checking on x person's (eg registrar) wellbeing** and **maintain patient safety** should be included if appropriate
*list four processes related to clinical incident notification and management that should occur following event involving bad case for registrar overnight*
- adverse event reporting via hospital system eg RISKMAN
- open disclosure to the family
- notification of ED director, patient safety officer, hospital executive
- review case in department M&M
*registrar has bad incident overnight. list actions to recommend ot night registrar*
- detailed documentation accounting of the events
- debrief and notification of event with senior staff member (ideally ED director)
- registrar notify medical indemnity provider
*4 steps deal with incident with registrar after resuscitating the mistake?*
- debrief staff members involved
- discuss wiht patient/ NOK and open disclosure advserse events
- documentation of events and incident report for adverse pt event
- notification of ED director
*You review the intern’s notes to find brief documentation that is not representative of the verbal history given to their registrar. Feedback from others is that the intern can be dismissive and difficult. How would you manage this junior doctor?*
- Formulate a plan with the JMO supervisor that includes:
- Meeting with the JMO to advise them on the findings of the investigation
- **Check on JMO wellbeing** – offer support - suggest HR, EAP, GP, DPET - check if they need timeoff work, ask for their feedback about what would be helpful for them to improve
- Formulate a performance management plan with specific learning goals for trainee and a clear timeline for review of progress
- Review shift **supervision** – consider taking intern off nights, make sure all seniors they work with are aware of IPAP/learning needs
- Maintain **patient safety** at all times - if evidence for dangerous conduct then step down until further investigation/plan
- Advise that they might want to seek advice from MDO
- Plan for review a set date to check if learning goals being satisfied