The Challenges of Health Professional Self-Governance

1. The Challenges of Health Professional Self-Governance Presentation to CAPPE/ACPEP Thursday, April 10, 2008

2. Presentation • The concept of self-governance • What is a “professional?” • Benefits of self-governance • Colleges vis. Associations • Governance vis. management • Challenges to self-governance • Environmental scan • Transition to certification and/or regulation: ten key concepts and opportunities for collaboration

3. What is a “Professional?” • Classical definition • Health professional colleges • Major characteristics: - Regulation in the public interest - Standards of Practice and Code of Conduct - Registration (entry to practice) - Dealing with “unprofessional conduct”

4. Benefits of Self-Governance • Prestige, accountability and recognition • Greater control and influence • Formal commitment to continuing competency • Recognition of “approved educational programs” for entry to the profession • Investigation and discipline • Focusing on the patient/client's best interests • Credibility and profile in health reform arena.

5. Colleges vis. Associations • Earning the right to self-governance • Overlapping “scopes of practice” • “What’s in it for me?” • Separation of regulatory and membership services/advocacy functions.

6. Challenges to Self-Governance • Report from the British Columbia Ombudsman’s Office. • College complaint profiles. • Multiple accountabilities and responsibilities, with modest financial and volunteer resources. • The only appreciable revenue source is registrant fees. • Few recognize that self-governance is a privilege. • Many complainers and few champions.

7. Governance and Management • Governance and management “in the public interest” • A profoundly complex and conflicted business. • Governance is “what” and management is “how.” • The Board, the Executive Director/Registrar, and Board Committees.

8. Environmental Scan • Significant human resource shortages. • Far greater emphasis on patient autonomy, choice and “patient rights.” • Increased immigration and the need for colleges to assess applicants with “substantially equivalent” competencies. • Aging of the population, increase in chronic diseases, and demands upon the health and social services systems.

9. Environmental Scan • Expectations of instant access, service and outcomes. • Greater patient reliance on alternative medicine. • More “informed” (?) consumers. • Electronic Health Records, privacy and confidentiality. • Improvements in the effectiveness and efficiency of health services, in part through technology and robotics.

10. Environmental Scan • Federal Government’s interest in increased competition among health providers (Competition Bureau). • Umbrella Act in each province/territory, with each profession having their own Regulation. • Far more rigorous continuing competency programs.

11. Environmental Scan • Greater use of alternative complaint resolution processes. • Increasing transparency and accountability of health professional college structures and processes: open Board meetings, investigation and discipline, etc. • Increased professionalization and emphasis on credentials, and use of unregulated assistants.

12. Transition to Certification and/or Regulation • Numerous legal, political and other minefields - and a very high threshold, particularly for new groups seeking self-governance. • Transition to being self-governing is more than a “paperwork exercise,” even for established professional associations. • “Precious few volunteers do almost all of the heavy lifting, and take all the …”

13. Transition to Certification and/or Regulation • Value Proposition – communication and consultation with members and stakeholders (national and provincial) • Competency Profile – unique, objective and preferably developed and validated nationally • Standards of Practice (national) • Code of Ethics (national) • Approved educational programs for entry to practice and continuing competence (provincial)

14. Transition to Certification and/or Regulation • Entry to Practice/Registration Standards – provincial, but with national mobility • “Grandparenting” – recognition of existing practitioners (provincial) • Continuing Competency Programs (provincial) • Governance principles and policies (national and provincial) • Management policies and procedures (national and provincial)