Regulation of Midwives – getting the recipe right for effective regulation South Pacific Nursing and Midwifery Forum Honiara 3 November 2016 Judith McAra-Couper Chair Sharron Cole CEO/Registrar Midwifery Council of New Zealand

Role of Midwifery Council Sets and guards standards in midwifery clinical and cultural competence and conduct Makes sure midwives meet and maintain professional standards of education, conduct and performance so that they deliver high quality healthcare throughout their careers Holds midwives to account if they fall short Knows the safety of mothers and babies comes first

Key midwifery facts About 3100 midwives with practising certificates, of whom c 380 also hold a nursing practising certificate c 1550 work in hospitals c 1100 are caseloading in LMC practice About 61,000 birth p.a. Average age 47.7

Midwifery Council of NZ Established December 2003 In following years , developed and set scope of practice, pre-registration education standards, clinical competencies, code of conduct, statement on cultural competence Developed policies and set up processes around registration, competence, fitness to practice and conduct Board 80% operational because of limited human and financial resources

Reasons for 2014 Governance Review The Council was mindful that in a very operational Council, there can be: A bias to short term thinking Excessive emphasis on detail Inclination to rehash and redo staff work at the expense of Board work Always reacting rather than being proactive Ill defined authority and accountability Confusion over roles

Visualising governance

What is “Board Work”? Strategic role - to develop and review the vision, mission and the strategic plan and assist the Registrar to communicate these to the profession and other stakeholders Generative role – to act as a source of leadership for the organisation and assist the Registrar to identify and solve problems and build on opportunities through strategic/forward thinking Fiduciary role - to approve the business plan and budget, monitor organisational and financial performance, monitor risks and protect the Board’s assets

Changes in governance practice Council meetings structured to be more strategic More information and analysis to ensure Council is better able to identify and assess level of risk and have in place “right touch” regulatory practices Clarify Council and secretariat roles to ensure both governance and operations are “fit for purpose” and that regulation is effective and consistent Strengthen and broaden relationship with stakeholders – “Changing Perceptions” Strengthen secretariat capacity to support a strategic Council – more strategic analysis, policy papers and blue skies provocations/challenges

Streamlining Competency Complaints Process Design and trial a new approach to competency and complaints processes Free up Council members’ preparation and discussion to enable them to focus on more strategic issues The Council members to be engaged only in making final, critical decisions using a new process that is much refined, streamlined and does not involve Council members at each part of the process

New process for Competency Complaints Sorting and assessing the complaint using a small cohort of experienced s36 assessors Using a template that includes summary evidence and identifies: high, medium and low risk on each case specific criteria for each ranking appropriate recommended actions The Council will in general only consider in depth, the medium and high risk cases

New process for Competency Complaints Summary templates of cases made available to Board members a week before meeting and have the opportunity to ask any detailed questions At the Council meeting, members discuss the case using the template report and advice from the Secretariat, and make final decisions. Material on specific cases available in one file, so that all the relevant documentation is accessible Cover sheet templates will be used in analysis and identification of trends and risks  right touch regulation

Review of progress Board now has more time for strategic thinking Council more integrated as less time on clinical matters Better at applying public safety lens Less defensive, more open to critical questions More analysis on information  trend in formal competence reviews. May be due to  notifications but perhaps Council more cautious as not involved in clinical assessment