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Quality assurance from a lay perspective: Milton Keynes University Hospital Revalidation Committee

How are lay people involved in local revalidation processes?

Since 2014, Milton Keynes University Hospital Trust (MKUHT) has had two lay members on their Revalidation Committee.

The Committee plays a key role in supporting the responsible officer in making recommendations and driving up the quality of appraisal.

Chaired by a lay member, the committee consists of lead appraisers, staff from the responsible officer’s office and a further lay member.

The Committee review the appraisal documentation for every one of the Trust’s doctors. They identify issues for consideration by the responsible officer including gaps in the sufficiency or quality of evidence submitted, and feedback areas of improvement to both doctors and appraisers.

The lay members play a full role in the business of the Committee: reviewing individual appraisal portfolios, preparing recommendations for the responsible officer, and providing ratings and feedback to appraisers.

What are the benefits?

Dr Ian Reckless, Medical Director and RO
Many ROs have staff supporting them in reviewing doctors’ portfolios, flagging grey areas and advising them on quality. Having a Committee with lay representation performing this role provides a robust and objective approach. Revalidation is all about providing assurance to the public so it’s right that I obtain that perspective.
Andrew Kerr, Business Manager, Medical Director’s Office

The committee enables a level of review that might not have been possible if revalidation was the sole responsibility of one person. Our process adds robust quality control and hopefully assurance to our patients.

Both the revalidation process and the committee have brought significant benefits to the Trust, helping to identify individuals that need more support and raising awareness of continuing professional development (CPD) and quality improvement.

The committee assists the responsible officer in fulfilling his statutory responsibilities, but also importantly involves lay input and it provides constructive feedback for appraisers. There is not always agreement on portfolio evidence, due to the differing interpretation of the requirements, but a panel helps balance this.

Graham Anderson, Chair of the Revalidation Committee. Graham is a former Non-Executive Director of the Trust and retired businessman. He is supported by a second lay person who was recruited using a bespoke person specification.

Revalidation is all about patient care and the patient experience. The Lay involvement brings independent challenge, business acumen and impartiality to the process which includes a robust line of questioning on the quality and sufficiency of appraisal evidence. I play a role in achieving consensus when there are conflicting views across the medical members of the Committee on either a particular case or approach.

The quality of appraisal documentation has risen significantly over the life of the Committee. In the early days, we rejected many portfolios because they failed to meet the prescribed standards: examples included the multi-source feedback being limited to one source only or because doctors did not present evidence to cover their work outside the Trust. Both were unacceptable.

Supported by the Committee, I strongly encouraged better and continual appraisal training and instituted a record of appraisers' scoring against narrative criteria for triangulation purposes. Through several other initiatives, there has been a sustained improvement in the quality of both appraisals and appraisers. Again supported by the Committee, I challenged the Committee to review its own performance and this was completed rigorously and satisfactorily earlier this year.

Making it work at your organisation

  • Bring greater independence and robustness to your quality assurance processes by looking for opportunities to involve lay representatives.
  • Design a job description for lay representatives that reflects the right knowledge, skills and experience needed to work constructively alongside medical professionals.
  • Where lay representatives are involved in reviewing documentation for individual doctors, be clear on the arrangements and safeguards in place to protect the doctor’s confidentiality.