1. 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

2. 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

3. 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

4. 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

5. 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

6. Visualising governance

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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