Clinical expert panel

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.

Each review is different, and the team membership varies with the type of review and the concerns raised. Teams established under specific NSW Health policy directives 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.

Reviews are generally commissioned by local health districts and specialty health networks 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.

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.

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.

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 the Clinical Excellence Commission will assist the clinical expert 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.

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

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.

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.

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.

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 (for example, personnel for interviews, medical records, rosters, operating theatre lists, emails, correspondence)
• have staff available to assist with setting up interviews, access to medical records, or accessing documents.

The main benefits are:

• using your clinical expertise in new ways
• helping health services improve the quality of care for patients and families
• giving patients and families confidence that people with the right independence, expertise and care are addressing their concerns
• being challenged by difficult, demanding issues
• working as part of a team towards a fair and robust outcome
• helping meet Australian Health Practitioner Regulation Agency continuing professional development requirements for clinical audit and outcome review.

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 Practitioner Regulation Agency 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.

We provide training to the expert panel members to to ensure they can undertake high-quality reviews and have consistency across 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.

• Availability to undertake 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.

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.