Developing an integrated appraisal and revalidation process for Sri Lankan doctors : an expedited, low-cost process using a prototype
Medical revalidation is considered as one of the better ways which can improve quality of health care and improving patient safety and satisfaction. Many developed countries in the world have either implemented or in the process of implementing medical revalidation systems. However, the development of revalidation process is very complicated process and requires lengthy periods and involves huge cost to the health systems. This study looked at a novel way of developing a revalidation process using the concept of prototyping. Prototyping provides low cost and quicker process of developing health system tools to achieve key objectives. This study has taken pragmatic stance to develop a process that can be implemented in the real world, especially in developing countries with western medical system. The study was conducted to develop medical revalidation process in Sri Lankan health sector as an example. The study has adopted 3 stage research with the mixed methodological approach. At the first stage, an extensive narrative literature review was conducted, and understanding from the literature review and personal experience of the researcher was used to develop a porotype of revalidation for Sri Lanka. At the second and third stage, the porotype was tested using explorative sequential design consisting of the qualitative stage and quantitative stage sequentially. Focused group discussions and in-depth interviews were conducted among stakeholders. Cultural Historic Activity Theory (CHAT) is used to discuss the contradiction while framework analysis was used to identify themes and qualitative data analysis. The outcome of the qualitative stage was used to develop a and to modify the prototype. The structured questionnaire was used as the tool for the quantitative stage. On analysis, it was found that Sri Lankan doctors are ready for revalidation based only on CPD activities with support for the later inclusion of other tools such as appraisal, MSF, and complaints investigation. Revalidation allowance was reported as a way of counteracting resistance and increasing the attractiveness of the revalidation process. It was recommended to adopt stepped wedge cluster randomised approach to implement the revalidation process as it provides an opportunity for system development. Additionally, it provides a reliable way of assessing the effectiveness of the new program. The research has provided a novel way of developing health system tools especially important for developing countries as it provides low cost quicker approach.
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