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Pascoe Management Consulting Inc.
9907 – 182 Street, Edmonton Alberta T5T 3J3
Telephone 780-990-2825; Facsimile 780-489-8215
Electronic Mail
October26, 2008
Dedicated to Lorraine with our prayers during treatment for breast cancer.
1. What is a "Professional?"
The classical definition reflects an individual who has successfully completed extensive academic study and work experience, and belongs to a self-governing body, most often provincially regulated and with one or more protected titles and initials.
Health professional regulatory colleges in Canada:
(i) "regulate in the public interest"
(ii) demonstrate entry to practice standards (e.g., academic credentials, work experience)
(iii) enforce Standards of Practice and Code of Ethics
(iv) obligate their registrants to participate in continuing competency (most often a certain number of hours of direct practice, teaching and/or supervision, and continuing education), and
(v) deal with the registrants who have engaged in an apparent "unprofessional conduct" through an investigative and potentially disciplinary process.
2. What are the Benefits of Self Governance?
Prestige, accountability and recognition.
Greater control and influence.
Formal commitment to continuing competency.
Recognition of "approved educational programs" for the purpose of entry to the profession.
Accountability for investigation and discipline.
Focusing on the patient/client/consumer's best interests.
Credibility and profile in the health reform arena.
3. What are the Differences between Colleges and Associations?
Regulatory colleges' mandates are to "protect the public interest," whereas membership associations are free to represent and advocate for members' interests, including on compensation and related issues.
Regulatory colleges and membership associations are self-governing. Regulatory colleges are established under provincial legislation, whereas membership associations are most often established as corporate entities under societies acts.
Most regulated health professions have separate bodies for regulatory college vis-à-vis membership services functions.
4. What are the Challenges to Self-Governance?
Readers are encouraged to review the British Columbia Ombudsman Office's May 2003 report entitled "Acting in the Public Interest? Self-Governance in the Health Professions: The Ombudsman's Perspective." It is located at:
Regulatory colleges have multiple accountabilities and responsibilities, with modest financial and volunteer resources. Most often they are only appreciable revenue source is registrant fees.
Few registrants, even those in regulatory colleges with lengthy histories, fully appreciate that self-governance is a distinct privilege.
5. How are Regulatory Colleges Governed and Managed?
Regulation "in the public interest" is a profoundly complex and often conflicted proposition. Even with a comprehensive policy framework, it obligates considerable sensitivity and balancing of often competing interests.
Governance is the "what" and management is the "how."
Regulatory colleges are governed by Boards of Directors and reporting committees, and managed by a Registrar/Chief Executive Officer/Executive Director.
6. What Factors are Important from an Environment Scanning Perspective?
Significant human resources shortages across the country, particularly in rural and remote areas.
Far greater emphasis on patient autonomy, choice and "patient/client/consumer rights."
Increasing immigration and the need for regulatory colleges to assess applicants with "substantially equivalent competencies."
The aging of the population and health human workforce, increased incidence of chronic diseases, and greater demands upon the health and social services systems.
Expectations of instant access, service and uniformly positive outcomes.
Greater patient/client/consumer reliance on alternative medicine and therapies.
Patient/client/consumers that may or may not be more "informed."
Electronic Health Records, privacy, access and confidentiality.
Vast improvements in the effectiveness and efficiency of health services, in large part through technology.
The Federal Government's (particularly Competition Bureau) interest in increased competition among health providers.
Skepticism on many individuals' part that the investigative and disciplinary processes are transparent, unbiased and fair.
Significant emphasis on inter-provincial mobility through the Agreement on Internal Trade.
Far more rigorous continuing competency programs.
Greater use of alternative complaint resolution processes.
Increased transparency and accountability of health professional college structures and processes, including Board meetings open to the public.
Increased professionalism and emphasis on credentials, and the use of unregulated assistants.
7. How do Membership Associations Transition to Certification and/or Regulation?
There are numerous legal, political and other minefields, and a very high threshold, particularly for newly emerging groups seeking self-governance.
The workload is onerous from the perspectives of documentation, consultation, negotiation, understanding the legislative process, maintaining volunteer interest and commitment over protracted periods of time, etc.
The "value proposition" is often subjective and intangible. This places significant challenges with respect to communication and consultations with members and stakeholders at the provincial/territorial and national levels.
Groups contemplating certification and/or regulation often benefit from nationally developed occupational competency profiles that are objective and externally validated.
Standards of Practice and Code of Ethics should be arrived at through consensus among the provinces/territories and national association.
Entry to practice/registration standards are most often provincial, yet should reflect a national approach without inter-provincial barriers.
"Grandparenting," that is recognition of existing practitioners when a profession becomes regulated is always problematic, however less so when there is an approved occupational competency profile.
While there may be provincial differences, there should be reasonable comparability among provinces and territories in their approach to continuing competence.
Regulatory colleges require bylaws, governance policies, and management/operational policies and procedures.
Please encourage your colleagues who might benefit from clarification of these concepts to contact me directly at 780-990-2825 in Edmonton.
Sincerely,
Jon Pascoe
Pascoe Management Consulting Inc.