1. CLEAR 2008 Annual Conference Anchorage, Alaska If the Military can do it: Why can’t we? How the Canadian Forces does “it”! Presented by: LCol Susan Groves Canadian Forces Health Services Pharmacy Senior Practice Leader On behalf of BGen H. Jaeger, Surgeon-General Canadian Forces CLEAR, Sept 2008

2. CLEAR 2008 Annual Conference Anchorage, Alaska Outline Overview of the Canadian Forces (CF) Overview of the CF Health Services Professional-Technical Chain/ Chain of Command Challenges

3. CLEAR 2008 Annual Conference Anchorage, Alaska Canada

4. CLEAR 2008 Annual Conference Anchorage, Alaska The Canada Health Act

5. CLEAR 2008 Annual Conference Anchorage, Alaska Canada Health Act Canada's federal legislation for publicly funded health care insurance. Primary objective is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers Provincial/territorial responsibility – Constitution Act 1867 Excludes members of the Canadian Forces

6. CLEAR 2008 Annual Conference Anchorage, Alaska The Canadian Forces Our People: 62,000 Regular Force members 25,000 Reserve Force members Three “environments”: Land, Sea, Air Drawn from and located across Canada and around the world

7. CLEAR 2008 Annual Conference Anchorage, Alaska Visible from sea to sea to sea A presence in each province and territory, and practically every major community

8. CLEAR 2008 Annual Conference Anchorage, Alaska A Worldwide Presence NORAD NATO UN

9. CLEAR 2008 Annual Conference Anchorage, Alaska Overall Goals of CF Health Group Improve or maintain health and mental well-being in CF members. –prevent disease and injury –diagnose or treat injury, illness, or disability Sustain or restore function, enabling the member to serve effectively in the CF.

10. CLEAR 2008 Annual Conference Anchorage, Alaska Range of Services CF Health Services is comprised of two branches –Medical –Dental Provides a full range of services internally and purchases some specialty services

11. CLEAR 2008 Annual Conference Anchorage, Alaska The CF has representation from virtually all regulated health professions including but not limited to: Physicians Dentists Pharmacists Nurses Social Workers Physiotherapists Dieticians X-ray techs Lab techs Dental hygienist Dental assistant Physician Assistants

12. CLEAR 2008 Annual Conference Anchorage, Alaska So how does the CF ensure that health services are provided by competent practitioners?

13. CLEAR 2008 Annual Conference Anchorage, Alaska Health Services Professional-Technical Chain QR&O Art 3.33 No officer who is not a Medical Officer shall exercise command over a Medical Officer in respect of his treatment of a patient

14. CLEAR 2008 Annual Conference Anchorage, Alaska Health Services Professional- Technical Chain of Command Health Professionals within the CF have two Chains of command (CoC) CoC defines who each individual reports to and who reports to them. It deals with all the various aspects of military life including military discipline The Prof-Tech chain is separate from the chain of command and deals with all the various prof-tech issues – licensure, education, training, equipment, scope of practice and professional discipline

15. CLEAR 2008 Annual Conference Anchorage, Alaska Clinical Practice Leaders Each of the various health professional disciplines has a Clinical Practice Leader. This person acts as the technical authority for that discipline and can also function in the role of regulator.

16. CLEAR 2008 Annual Conference Anchorage, Alaska Practice Leader Responsibilities Ongoing licensure Maintenance of Clinical Skills Adherence to policy Education and training Liaison with the provincial bodies Scope of Practice

17. CLEAR 2008 Annual Conference Anchorage, Alaska Challenges faced Licensure in multiple jurisdictions Varying Scopes of Practice Combination of Canadian Forces, Public Servants and Contracted Employees

18. CLEAR 2008 Annual Conference Anchorage, Alaska Policy Extensive, well-developed policies allow the CF to manage the challenges.

19. CLEAR 2008 Annual Conference Anchorage, Alaska Policy Documents High-level direction with broad organizational application For example the release of medical/dental documents would be covered in a policy

20. CLEAR 2008 Annual Conference Anchorage, Alaska Direction Documents Usually flow from a Policy and include CF Health Services Group: Instructions Orders Directives Standards

21. CLEAR 2008 Annual Conference Anchorage, Alaska Instructions Based on a higher-level policy Defines a course of action to be taken Empowers a subordinate to take a specific action

22. CLEAR 2008 Annual Conference Anchorage, Alaska Orders Convey compulsory direction

23. CLEAR 2008 Annual Conference Anchorage, Alaska Directives Provide interim direction Usually prof-tech in nature Valid for a fixed period of time

24. CLEAR 2008 Annual Conference Anchorage, Alaska Standards Define the level of performance or service to be achieved

25. CLEAR 2008 Annual Conference Anchorage, Alaska Standard Operating Procedures This is less formal direction and includes: Standard Operation Procedures (SOPs) Advisories Guidelines

26. CLEAR 2008 Annual Conference Anchorage, Alaska SOPs Established procedure to be carried out to perform a given task/function

27. CLEAR 2008 Annual Conference Anchorage, Alaska Advisories Information communicating an opinion/guidance about what could or should be done in a particular situation. For example an out break of Flu

28. CLEAR 2008 Annual Conference Anchorage, Alaska Guidelines Direction which is not mandatory to follow but should be followed.

29. CLEAR 2008 Annual Conference Anchorage, Alaska Crown Liability and Proceedings Act Public Servants, including military members, are covered under this act for any action on their part in performance of their duties. - In other words this is our “malpractice insurance”

30. CLEAR 2008 Annual Conference Anchorage, Alaska Investigations The CF has numerous levels of investigation: National Investigation Services Military Police Board of Inquiry Summary Investigation Professional-Technical Investigation

31. CLEAR 2008 Annual Conference Anchorage, Alaska Sanctions The CF can and does sanction members: Limit Scope of Practice Order Retraining Report to College

32. CLEAR 2008 Annual Conference Anchorage, Alaska Civilian-Military Co-operation CF does not do it alone. There is interaction between the various Practice Leaders and the Provincial Regulatory Bodies Practice Leaders can and do sit on National Regulatory Associations

33. CLEAR 2008 Annual Conference Anchorage, Alaska Questions? Thank you!

34. CLEAR 2008 Annual Conference Anchorage, Alaska Speaker Contact Information LCol Susan Groves Canadian Forces Health Services Group Headquarters Groves.sv@forces.gc.ca