Setting Practice Standards for Cardiology Technology whose responsibility

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Setting Practice Standards for Cardiology
Technologywhose responsibility?
Presentation to ASRCT Calgary, May 5 2007

• Dr David Cane
• Catalysis Consulting

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What I will cover

• The various players in setting health-care
  professional standards
• who is who and who does what
• How this applies in Cardiology Technology
• Recent developments at the level of CSCT
• Competency Profile
• The possibility of licensure for Cardiology
  Technologists in Alberta

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The system we work in
Health care and education are provincial
responsibilities in Canada
Different approaches in each province
Confusion 101!
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The Language of Standards
Regulation
Licensure
Certification
Accreditation
Registration
Confusion 102!
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Some Definitions

• Registration
• Means to be on someones official list or
  register
• Regulation
• To regulate means to control or direct (can be
  applied to the membership of any organization)
• Mostly used to mean Statutory Regulation (control
  by or on behalf of government)
• Licensure
• Means the same as Statutory Regulation
• A license is the mechanism of statutory
  regulation
• Certification
• Means to certify or attest to someones
  qualifications
• Usually a voluntary function provided by a
  professional association
• Accreditation
• Means to approve a function, not a person

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Who is responsible forQuality of Practice?

• A variety of levels of control
• Government
• Ultimate, highest-level control with legal teeth
• Employer
• Always accountable for actions of employees
• Professional Association
• Can set standards for membership
• Individual Technologist
• Carries personal responsibility for their actions
• Consumer
• Can vote with their feet

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Statutory Regulation

• Statutory Regulation is the control of the
  profession by government
• Governments do this to protect the public
• Regulation can be by title protection and / or by
  controlled (restricted) activities
• Governments may
• Regulate directly
• Establish a unique regulatory body (college)
• Delegate to an existing professional organization

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• Regulator sets an entry-to-practice standard
• Standards may involve
• Education
• Examination
• Character and criminal record checks etc
• Individuals who meet the standard are licensed
  to practice
• Regulator usually also monitors discipline and
  currency

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Certification

• Certification is a process through which an
  organization independently verifies (certifies)
  a persons qualifications
• Certification is a voluntary function
• A service offered to individuals (for the benefit
  of employers the public)
• The Certification Organization establishes a
  standard and certifies those who reach it
• Usually through an examination process
• May or may not involve discipline / currency
• Regulators sometimes incorporate certification
  into the regulatory standard
• Employers sometimes choose to hire employees with
  certification

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Accreditation

• Accreditation is approval of an organization by
  an external agency
• May apply to
• An educational program
• A clinical facility
• The Accreditation Agency sets a standard and
  accredits organizations that meet it
• Accreditation is a voluntary function
• Completion of an accredited educational program
  may be incorporated into requirements for
  licensure or for certification

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What about the role ofProfessional Association?

• A professional association is a membership
  society that promotes and advocates for the
  profession, and supports its members
• Membership is voluntary
• Association typically provides member services
  such as
• Conferences
• Journals
• Professional development opportunities
• Insurance

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Role Summary
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How does this apply to Cardiology Technology?

• Professional Associations
• CSCT, ASRCT and other provincial organizations
• Certification Organization
• CSCT
• Accreditation Agency
• Canadian Medical Association Conjoint
  Accreditation
• Statutory Regulators
• Only province with regulation is New Brunswick
• Regulatory Body is NBSCT

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What about a common national standard?

• In many professions standards differ
  significantly across Canada
• Unification can be difficult
• Provincial approaches vary
• Established authorities may not be flexible
• Voluntary processes may be involved
• Federal-provincial Agreement on Internal Trade
• Only affects professions with statutory
  regulation
• Professions may take the initiative
• As has happened in Cardiology Technology

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The KeyA National Occupational Competency
Profile(NOCP)

• An entry-to-practice standard that is accepted by
  all the players
• The glue that holds a national approach in
  place

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The CSCT NOCP

• Defines the requirements for CSCT Certification
• Defines the learning outcomes required of
  CMA-accredited educational programs
• Is required as a condition of licensure by NBSCT
• Is widely recognized by employers as the key to
  consistent, quality service

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Unification of Standards
NOCP
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What is a NOCP?

• An array of job tasks that an entry-to-practice
  technologist must be able to perform proficiently
• A listing of knowledge, skills and attributes
  that a technologist brings to the job
• A product of learning
• Not a curriculum
• Not a series of protocols

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Important Points about the NOCP

• A standard, not a guideline
• A minimum standard
• Defines entry-to-practice requirements
• A compromise between leading edge and reality
• Must be sensitive to differences in practice
  between provinces
• Must recognize that schools face some limitations

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What Makes a GoodCompetency Profile?

• Clear and unambiguous
• No examples or etceteras
• Brief
• Avoid repeats and redundancy recognize that
  competencies are integrated
• User-friendly
• Easy to read, use and maintain
• Set a distinct standard
• Identify externally observable, measurable
  characteristics
• Occupational focus
• Specify how knowledge, skills attributes are
  used on the job
• Provides defensibility
• Balanced relative to the Scope of Practice
• Cover all job aspects at a similar level of
  detail

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Structure of the New CSCT NOCP

• Area 1 Cardiac Procedures
• 58 competencies in 6 sections
• Area 2 Patient Care
• 51 competencies in 10 sections
• Area 3Professional Standards
• 42 competencies in 9 sections
• Area 4 Foundational Knowledge
• 30 competencies in 5 sections
• Appendix listing cardiac pathologies
• 181 competencies in total

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Most Significant Changes

• Removal of specialty level comps
• Addition of new entry-level comps in pacemaker
  device therapy
• Introduction of Performance Environments for
  assessment of competence

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Licensure in Alberta?

• Statutory regulation in AB health professions is
  controlled by the Health Professions Act
• Regulatory bodies under the Act are called
  Colleges
• Currently there are 28
• Each governs a profession or cluster of related
  professions

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Inclusion of new professions

• Application can be made to the Minister
• Minister (if receptive) will direct the Advisory
  Board to investigate
• Scope of practice
• Risk of harm
• Nature of regulation recommended
• Costs / benefits
• Decision made by legislature
• Could result in a new College or expansion of an
  existing College

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What does a College look like?

• Governing body Council
• Elected from membership plus government
  appointees
• Staffing
• CEO and significant permanent staff
• Functions
• Dictated in significant detail by government
• Initial licensure (incl out-of province
  international applicants)
• Continuing competency (standards of practice,
  currency)
• Complaints discipline
• May include prof association functions (but
  these are of lower priority)
• Finances
• Must be self-sufficient based on registration fees

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Pros and Cons of Licensure

• Pros
• Increased professional profile
• More influence with government
• Perhaps some (limited) funding opportunities
• Cons
• Significant government intervention in the
  profession
• Tension between professional and public interest
  (can be difficult to sustain member services)
• Some mandatory functions (eg complaints
  discipline) are complex and expensive

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Thank You!