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

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

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

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”

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

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

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

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

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”

Controlled Acts

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

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

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

Professional Regulation

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

Terminology College= Members= Restricted Title= 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”

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”

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

Problems with The Dental Hygiene Act

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

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

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

The End