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

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

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

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

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

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

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

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

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

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

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

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

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

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