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Getting back on track: a systematic review of the outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns
  1. Jan-Willem Weenink1,2,
  2. Rudolf B Kool1,
  3. Ronald H Bartels3,
  4. Gert P Westert1
  1. 1 Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
  2. 2 Institute of Health Policy & Management, Erasmus University, Rotterdam, Netherlands
  3. 3 Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands
  1. Correspondence to Jan-Willem Weenink, IQ healthcare, Radboudumc, Geert Grootplein 21, Nijmegen 6500 HB, Netherlands; janwillemweenink{at}


Objective To provide an overview of the evidence regarding outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns, and to explore if outcomes differ for specific concerns and professions.

Methods A search in four databases (Medline, Embase, PsycINFO and CINAHL) was conducted from 1 January 1990 to 7 May 2017. Studies reporting on outcomes of nationwide and state-wide programmes aimed at remediation and rehabilitating healthcare professionals with performance concerns (ie, dentists, midwives, nurses, pharmacists, physicians, physiotherapists, psychologists and psychotherapists) were included.

Results We included a total of 38 studies. More than half of the studies included programmes in the USA (57.9%), and a majority of studies focused on outcomes for physicians (78.9%) and on outcomes for substance use disorders (SUDs, 63.2%). Programme completion rates for SUDs were positive and approximately 80%–90% of participants were employed after treatment. Studies that reported on remediation outcomes for dyscompetence, almost all from Canada (7/8), showed varying results. One study compared outcomes for performance concerns in the same programme (ie, SUD and other mental and behavioural problems) and showed comparably successful results. No study specifically compared outcomes between professions.

Conclusion The literature is dominated by outcomes for physicians in North American programmes, with positive outcomes for SUD and varying outcomes for dyscompetence. Based on our findings we cannot make valid comparisons in outcomes between professions and specific performance concerns, and we call for other programmes to report on outcomes for different professions and concerns. Because of the positive outcomes of physician health programmes, other countries should consider introducing similar programmes to support healthcare professionals getting back on track.

  • human factors
  • governance
  • health policy

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  • Contributors J-WW designed the study, was responsible for data collection and data analysis, and wrote the paper. RBK supervised the design of the study, was responsible for data collection and data analysis, and contributed to the paper. RHB and GPW supervised the design of the study and contributed to interpretation of data analysis and the paper. All authors have read and approved the final version of the manuscript, and had full access to all of the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. J-WW is guarantor of the study, and affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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