The Regulated Health Professions Act

1. The Regulated Health Professions Act R.H.P.A.

2. Professional Status Body of scientific knowledge & Ongoing research Autonomy & self-regulation Recognized authority with sanctions Profession Professional standards & code of ethics Advanced educational preparation Strong service orientation

3. Professional Regulation • Purpose: • Aimed at advancing the public interest by: • Protecting from unqualified/incompetent health care providers • Developing mechanisms to encourage highest quality care • Permitting freedom of choice of health care providers • Promoting flexibility and efficiency in health service provision

4. Regulation Review • Dental Hygiene was regulated under the Health Disciplines Act (1974) • The Royal College of Dental Surgeons (RCDS) was the regulatory body • In November 1982 the Ontario government announced the creation of: • “The Health Professions Legislation Review”

5. Review of Regulation • Why? • Public wanted a more open and accountable system • Government wanted a more efficient, flexible system • Unregulated Professions wanted recognition, autonomy and self-regulation

6. Regulation • More than 75 health care professions requested self-regulation • On April 3, 1986 The Minister of Health announced that 24 professions, including dental hygiene, would be granted self-regulation • The Regulated Health Professions Act [RHPA] was passed in November, 1991 • Core regulations were completed and the Act was Proclaimed December 31, 1993

7. Self-Regulation • Criteria for Selection • Profession must have a body of knowledge to form the basis for Standards of practice • Professional services must pose a substantial risk of harm to patients • Profession must be able to regulate itself in that: • Leaders put public good above self-interest • Members comply with and can bear cost of self-regulation • There is a recognized training program in canada

8. RHPA Innovations • Public representation on councils of governing bodies increased from 25% to 42-49% • Discipline hearings are open to the public • Reasons for decisions on complaints must be given to compainant and professional • Quality Assurance programs are mandatory to test knowledge and continued competence of members of the profession

9. The RHPA • The RHPA omnibus or umbrella Act sets out the general framework for regulation • The Controlled Acts concept: • Under RHPA specialized activities carrying a significant risk of harm are contolled or restricted to specific, qualified practitioners • All other health care services will be unrestricted or in the “public domain”

10. Controlled Acts

11. Controlled acts • There are 13 controlled acts . • 1. Surgery [includes dental surgery] • 2. Putting a hand , finger or instrument beyond a certain point in any opening of the body • 3. Setting bone fractures • 4. Moving joints of the spine • 5. Delivering babies

12. Controlled Acts (continued) • 6. Using dangerous forms of energy • 7. Giving a substance by inhalation or injection • 8. Prescribing or dispensing prescription drugs • 9. Fitting contact lenses or eyeglasses • 10. Fitting hearing aids

13. Controlled Acts (continued) • 11. Fitting/dispensing a dental prosthesis or orthodontic or periodontal appliance or device • 12. Allergy challenge testing • 13. Communicating a diagnosis identifying a disease or disorder as the cause of symptons

14. Professional Regulation

15. Bill 47 “The Dental Hygiene Act” • Long Name= • An Act respecting the regulation of the Profession of Dental hygiene (1991) • Contains specific regulations

16. Terminology • College= • The College of Dental Hygienists of Ontario • The regulatory body for the profession • Members= • Dental hygienists who are registered with the College and hold a certificate of competence • This certificate must be renewed annually • Restricted Title= • No one other than a “member” of the College shall use the title “dental hygienist”

17. The Dental Hygiene Act • FEATURES: • A general statement describing “Scope of Practice” • The practice of dental hygiene is the assessment of teeth and adjacent tissues and treatment by preventive and therapeutic means and, on the order of a member of the Royal College of Dental Surgeons of Ontario, the provision of restorative and orthodontic procedures and services”

18. Dental Hygiene Act • Authorized controlled acts: • Scaling teeth and root planing including curetting surrounding tissue • Orthodontic and restorative procedures

19. Problems with The Dental Hygiene Act

20. The Order Issue • Under The Dental Hygiene Act (1991) a dentist must issue an order before a dental hygienist can provide periodontal therapy • Because this restricts these services to the dental office it limits availability of care for underserviced populations-seniors, those residing in isolated areas or collective living centres, the poor or unemployed

21. Self -initiation • The extensive education of dental hygienist in client assessment and record keeping ensures that they have the necessary skills and knowledge to self-initiate [to decide for themselves] to provide periodontal therapy

22. Problems • Refusing to acknowledge this demeans the professionalism of dental hygienists • It was not the intent of the RHPA that one profession should regulate another

23. The End