When Practice Scopes Expand – Challenges & Opportunities for Regulators

1. When Practice Scopes Expand – Challenges & Opportunities for Regulators Jan Robinson, Registrar and CEO College of Physiotherapists of Ontario Dr. Ambrose McLoughlin, Registrar and CEO The Pharmaceutical Society of Ireland September 25, 2010 Nashville, Tennessee

2. When Practice Scopes Expand – Challenges & Opportunities for Regulators Jan Robinson, Registrar & CEO College of Physiotherapists of Ontario September 25, 2010 Nashville, Tennessee

3. Outline • Tell our story • Scope expansion? • A regulator’s “True North” • Evolution

4. changing practice landscape new jobs new roles new titles

5. “new environment normal”

6. legislative model ➔ scope of practice not protected ➔ controlled or reserved acts ➔ delegation (a legal process)

7. clash of realities

8. further …….. no cohesive dialogue occurring • however legislation would be theunderpinning for progress

9. As a regulator we couldn’t leadthe initiative

10. Many ways to provideleadership sowe created a forum for dialogue

11. Resulted in task force (Association led)

12. White paper

13. Political landscapealso relevant • doctor shortage • patient inconvenience • increasing emphasis on interprofessionalcollaboration

14. Tripartite initiative within profession re: government (academia; association; regulator)

15. Request for referralfor scope review

16. Almost but not quite……

17. Minister’s advisory group initiatedthe review

18. Sprint to the finish line • short time frame • focussed on pubic interest objective • use of experts

19. Success!!

20. How??

21. Accomplish by staying laser focussed on key elementsor what is a regulator’s“True North”

22. Are proposed changes neededalready embedded in practice?

23. expansion or adoption ?

24. Are proposed changes evidence informed?

25. Are proposed changes being taught?

26. Wish lists are not acceptable • need all 3 • need a broadcompetency focus

27. Are the changes within full scopealso considered at levelof the individual?

28. Does the regulator demonstrate rigor?

29. Rigor including • standards • transparency on the register • quality assurance measures • sufficient boundaries within professionalmisconduct rules

30. Has the regulator’s role been clear(not blurred by advocacy)?

31. Has it been about competence & public risk?

32. In an interprofessional world of practice – what else?

33. liability insuranceexpectations • communication • education on roles of others

34. Stick with the high road Focus on • competence • evidence • public interest

35. continually evaluate the leadership strategy

36. Evolution….. Forever thus!

37. Speaker Contact Information Jan Robinson Registrar & CEO College of Physiotherapists of Ontario jrobinson@collegept.org

38. Dr. Ambrose McLoughlin, Registrar and CEO The Pharmaceutical Society of Ireland Council on Licensure, Enforcement and Regulation (CLEAR) 2010 Annual Educational Conference Nashville, Tennessee When Practice Scopes Expand- Challenges and Opportunities for Regulators 38

39. Effective Governance • Definition of practice • Definition of CPD 39

40. Key Roles of Health Regulators Improve performance and quality Provide assurance that standards are achieved Provide accountability both for levels of performance and value for money (Sutherland and Leatherman, 2006 and “Building a Culture of Patient Safety”-Report of the Commission on Patient Safety and Quality Assurance, July 2008) 40

41. Key Activities of Regulators Direction Set out expectations and requirements Surveillance Performance and compliance with rules Enforcement and Change Legal and other powers including Investigation (“Building a Culture of Patient Safety”-Report of the Commission on Patient Safety and Quality Assurance, July 2008) 41

42. Principles of Effective Regulation Necessity/Risk Assessment Effectiveness/Targeted Proportionate Transparency and Accountability Consistency/Continuous Improvement Not Light-Touch But Right-Touch Regulation (CHRE June 2010and Department of the Taoiseach (Prime Minister) Regulating Better 2004) 42

43. Standards Best practice/Best models/Protocol based Minimum output consistent with maintenance of expertise, quality and best outcome Performance measurement Pre-defined standards Review of organisational structures and processes Adoption of new systems and technologies Building a culture of patient safety 43

44. The Challenges to Regulators 44

45. Reports on Adverse Events in the EU The Kennedy Report from the Bristol Royal Infirmary Inquiry (UK) Dame Janet Smith’s Reports on Dr. Harold Shipman (UK) Judge Maureen Harding Clark’s Report on Our Lady of Lourdes Hospital Drogheda (Ireland) Report from HIQA on the provision of care to Ms. Rebecca O’Malley in relation to her treatment for symptomatic breast cancer (Ireland) 45

46. Policy Response at EU, Federal, State and Global Level Patient safety and quality authorities and Institutes with involvement of professional bodies Prioritising clinical excellence and clinical risk management Public reporting on sentinel events and incident reporting systems Engaging with employers, service providers, patients, their carers andadvocates 46

47. Practice Scope Expansion Mandatory licensing systems for all service providers Hospitals/Hospital facilities All other health care facilities Service specific licences Intensive care Cancer care Pharmacy care and treatment Review every 3-5 years 47

48. Practice Scope Expansion contd. Intervention by Regulators To improve quality of care To set standards of clinical competence for practice Fostering CPD and practice excellence Assuring the competence of the individual practitioner and the clinical team or network Political/Public and patient reassurance (Sutherland and Leatherman 2006 and “Building a Culture of Patient Safety”-Report of the Commission on Patient Safety and Quality Assurance, July 2008) 48

49. Meeting the challenges Registration and Licensure Certification and Re-Certification Credentialing Privileging (Sutherland and Leatherman 2006 and “Building a Culture of Patient Safety”-Report of the Commission on Patient Safety and Quality Assurance, July 2008) 49

50. The approach in Ireland and the EU 50