Quality Assurance by Practice Visit

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Should the Royal Australian and New Zealand College of Psychiatrists attempt to assess the office practice of psychiatrists and, if so, how should it be done ? This is one of the matters under consideration by the RANZCP Quality Assurance Committee, and a matter about which the College will be required to make a decision. Assessment may be undertaken with a view to maintaining high standards of practice, for quality assurance, or with a view to weeding out obviously substandard practice. The intention will effect the approach taken, as relatively brief examination may detect grossly deficient practice whereas detecting relatively weak areas in a generally good standard practice will require more careful assessment. Detection of deliberate bad practice may require intense scrutiny and is outside the scope of this paper. Hospital practice is already subject to hospital accreditation inspections. Inspection and examination of records and physical facilities and interviews of personnel are standard methods of assessment for institutions, but have less commonly been applied to office practice, yet substandard performance is significantly more frequent in office cases than in hospital cases, 13.3% versus 3.9% in the study of Sanazaro and Worth 1’1. Assessment of psychiatric office practice is particularly important as a high proportion of psychiatrists’ work, in some cases all of it, is carried out in this setting. Burvill [‘I found 52.2% of Australian psychiatrists’ time was spent with private patients, and Olfson and associates l31 reported 54.6% of psychiatrists worked in private office practice or private outpatient settings. Presumably, most of the private practice time of the Australian psychiatrists is private office practice, so assessment of office practice is important in the overall assessment of psychiatrists’ practice.