BC Issues Recommendations on Updating Health Profession Regulation
23 September 2020
By Sara Pon
The BC provincial government is considering changes to health professional regulation. On August 27, 2020 the Steering Committee on Modernization of Health Professional Regulation [Steering Committee] released their Recommendations to modernize the provincial health regulatory framework [Recommendations]. This blog will list the range of recommended changes and discuss parts of the recommendations aimed at improving patient safety concerns.
These recommendations follow a series of reports and consultations. Following concerns about the College of Dental Surgeons of British Columbia, the government launched an inquiry into the College of Dental Surgeons and the health profession regulatory framework. The Cayton report was released on April 11, 2019, suggesting changes both to the College of Dental Surgeons, as well as changes to the larger legislative framework. In 2003 the Office of the Ombudsperson released a report examining self governance of health professionals in BC. The Steering Committee conducted two rounds of public consultation on the proposed changes. The final recommendations are based on these reports and consultations. The next step would be for the government to introduce a bill amending or replacing the Health Professions Act.
Current Regulation of Health Professionals
In BC the Health Professions Act regulates most health care professionals. Most regulated health professions are self-regulating, governed by a College. A board oversees the actions of the College. For a person to be a member of one of the regulated health professions they must meet certain requirements, have their application for registration be accepted, and maintain good standing with the profession.
A college has several responsibilities and powers:
- Set out what education or training a registrant must have
- Set what qualifications a registrant must have
- Determine professional standards of practice, competence, and conduct
- Accept complaints about registrants, investigate complaints, and make discipline decisions
- Limit who can hold professional titles
- Set minimum standards for education curriculums
Overview of Recommendations
The Steering Committee has made six recommendations to improve the health professional regulatory framework.
- The updated regulatory framework must embed cultural safety and humility.
- College governance must be improved, including changing the composition, appointment, and size of college boards.
- Colleges must be more efficient and effective, accomplished through reducing the number of colleges from 20 to 6.
- Oversight of colleges must be strengthened, accomplished by creating a new oversight body and increasing accountability of colleges.
- The complaints and adjudication process must be updated, including separating the investigation and discipline steps and increasing transparency.
- Colleges must share information between each other and with other agencies to improve patient safety and trust.
Addressing Governance Concerns
Currently, college boards are composed of registrants elected by the profession and members of the public. Members of the public make up between one third and half of the board. The Cayton report and the Ombudsperson report both found that college boards are not acting in the public interest. The registrant members feel accountable to the profession, not the public, because the profession is who elected them. However, boards should be acting in the public interest to protect patients.
The past reports have found other governance concerns. Many college boards are too large, which has led to them being inefficient and not being able to communicate well. Between and within colleges there has been great differences in how board members are compensated. Registrant board members are often paid more than public board members, and some members of the public are volunteering their time.
The Recommendations suggest several changes to ensure boards are acting in the public interest and are performing at a high level.
- Half of board members should be members of the public and the other half should be registrants
- All board members should be appointed through an independent process
- Appointments should be based on competence
- Boards must reflect diversity
- Colleges should create appointment criteria and competence requirements
- All board members should receive training and education
- Boards should be smaller, around 8 to 12 members
- Board members and committee members should be consistently compensated within and between colleges
Increasing Oversight of Colleges
The Cayton report and public consultations have expressed concerns that colleges are not sufficiently protecting the public, lack accountability to people outside the profession or college, are not acting transparently, and there is a lack of information on how colleges are performing.
The Recommendations state that an independent oversight body should be created. The oversight body would have the following roles:
- Collect and analyze performance data on colleges
- Audit colleges
- Investigate the performance of colleges
- Conduct systemic reviews of health profession regulation
- Publish suggested policy and practice for colleges
- Recommend minimum standards of practice, the specific content of which would be developed by colleges
- Create consistent standards for ethics and conduct of registrants
- Review college standards and bylaws and suggest where changes are needed
- Appoint board members
- Assess if new health professions should be regulated
- Assess if existing health professions not governed by the HPA should fall under the HPA, such as social workers and emergency medical assistants
- Provide annual reports to the Ministry of Health
Modernizing the Complaints and Adjudication Process
The Cayton report and public consultations illustrated numerous problems with the complaints and adjudication process. These problems include:
- The lack of separation between investigation and discipline stages, which violate principles of law;
- A lack of transparency;
- A lack of fairness;
- Frequent delays;
- A lack of clinical expertise in investigations;
- Inconsistent outcomes;
- Poor communication with complainants; and
- Unsatisfactory outcomes.
The Recommendations suggest the following changes to the complaints and adjudication process:
- Simplify the complaints and discipline process
- Separate the investigation and adjudication process – colleges would conduct investigations and discipline decisions would be made by an independent process within the oversight body
- Require public notification when the college is taking action on a complaint
- Limit the ability of respondents to negotiate a resolution at the later stages in the process
- Information about agreements between respondents and the college should be made public, except where the matter relates to the health of the respondent
- Consider cultural safety and humility within the complaints and adjudication process
- Allow colleges to comment when a complaint becomes public knowledge
- Require decisions to consider a respondent’s past history
- Remove statutory time limits for investigations, and instead create timelines for each step in the complaints process
- The oversight body should monitor how long the complaints process takes
The Recommendations address complaints of sexual abuse or sexual misconduct. Currently, colleges have discretion on how they deal with complaints of sexual abuse or sexual misconduct and colleges differ on how they address this. The Recommendations suggest the following changes:
- Create more stringent discipline when a respondent is found to have committed sexual abuse or sexual misconduct
- Require colleges to fund counselling for victims
- Collect money from registrants found to have committed sexual abuse or sexual misconduct to fund counselling programs
- Create common standards and policies for preventing, investigating, and disciplining sexual abuse and sexual misconduct
- Train specialized investigators for investigating sexual abuse and sexual misconduct
- Train college officials in trauma-informed practice
- Create consistent definitions of sexual abuse and sexual misconduct for all colleges
For information on how to make a complaint against a health professional, see the specific college’s website.