The Challenges of Health Professional Self-Governance

1
The Challenges of Health Professional
Self-Governance

• Presentation to
• CAPPE/ACPEP
• Thursday, April 10, 2008

2
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

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What is a Professional?

• Classical definition
• Health professional colleges
• Major characteristics
• - Regulation in the public interest
• - Standards of Practice and Code of Conduct
• - Registration (entry to practice)
• - Dealing with unprofessional conduct

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Benefits of Self-Governance

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

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Colleges vis. Associations

• Earning the right to self-governance
• Overlapping scopes of practice
• Whats in it for me?
• Separation of regulatory and membership
  services/advocacy functions.

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Challenges to Self-Governance

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

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Governance and Management

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

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Environmental Scan

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

9
Environmental Scan

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

10
Environmental Scan

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

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Environmental Scan

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

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Transition to Certification and/or Regulation

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

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Transition to Certification and/or Regulation

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

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Transition to Certification and/or Regulation

• Entry to Practice/Registration Standards
  provincial, but with national mobility
• Grandparenting recognition of existing
  practitioners (provincial)
• Continuing Competency Programs (provincial)
• Governance principles and policies (national and
  provincial)
• Management policies and procedures (national and
  provincial)