If the Military can do it: Why can’t we? How the Canadian Forces does “it”!

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

3. Canada CLEAR 2008 Annual Conference Anchorage, Alaska

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

5. 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 CLEAR 2008 Annual Conference Anchorage, Alaska

6. 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 CLEAR 2008 Annual Conference Anchorage, Alaska

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

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

9. 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. CLEAR 2008 Annual Conference Anchorage, Alaska

10. 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 CLEAR 2008 Annual Conference Anchorage, Alaska

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

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

13. 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. 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 CLEAR 2008 Annual Conference Anchorage, Alaska

15. 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. CLEAR 2008 Annual Conference Anchorage, Alaska

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

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

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

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

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

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

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

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

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

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

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

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

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

29. 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” CLEAR 2008 Annual Conference Anchorage, Alaska

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

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

32. 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 CLEAR 2008 Annual Conference Anchorage, Alaska

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

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