Conceptualising the quality experience for independent medical examinations: A narrative review

Background

An independent medical examination is a unique healthcare assessment conducted by an expert health professional with the aim of providing impartial advice to key stakeholders in workers’ compensation schemes regarding a worker's injury or illness. A range of dedicated guidelines provide for best practice at local and national levels, but concerns exist regarding the quality of these encounters for all involved.

Methods

A narrative review was conducted to explore quality principles underpinning practices and reporting of independent medical examinations. Quality was defined by dimensions outlined by the World Health Organization (effectiveness, safety, people-centredness, timeliness, equity, integration of care, efficiency). Academic (databases: Medline, CINAHL, Embase) and grey literature (advanced Google search) published in English was searched with no date limits. Results were synthesised according to the components of independent medical examinations (independent medical examiner approval and selection, independent medical examinations, reporting) and then mapped to quality dimensions.

Results

The quality dimensions of effectiveness, safety, person-centredness, timeliness, equity, and efficiency were partly addressed in existing independent medical examination practices, most commonly within the examination itself. However, there were prominent gaps in person-centredness and integration of care across all stages of the examination and reporting process. Opportunities for strengthening quality practices included: inviting community members with lived experience of workplace injury to serve on boards responsible for appointing independent medical examiners; explicitly encouraging questions and perspectives from injured works during examinations; holistic reporting that accurately captures injured workers’ experiences; consultations with usual treating teams prior to report finalisation and submission; and providing verbal summaries and/or reports directly to injured workers.

Conclusion

Although some quality principles were evident in existing independent medical examination practices described in the literature, unlike the acute and community healthcare sectors, the notion of quality was not universally applied in this context. To promote evidence-based practice, foster positive cultural shifts, and enhance experiences of injured workers and independent medical examiners, formally embedding a comprehensive quality experience in independent medical examination programs is recommended.