World Health Professions
Regulation Conference 2014

Crowne Plaza Hotel, Geneva, Switzerland

 
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Abstracts

David Benton - Contrasting regulatory models to promote best practices in
regulatory governance and performance

Hazel Bradley - Shared competencies between different health professions in an emerging health system

Jonh Chave - European responses to challenges facing health professional regulation

Niall Dickson - Reform of health professional regulation in the United Kingdom

Gilles Dussault - Challenges facing health professional regulation

Rhona Flin - Safe in their hands? Non-technical skills and competence assessment

André Gariépy - Competence-based approaches and professional regulation: a balancing act

Margaret Mungherera - Key challenges and experiences of health practitioner regulation in Africa, evolving scopes of practice and inter-professional collaboration

Ayala Parag - Regulatory Models: The Israel Experience

Annabel Seebohm - The impact of standardisation initiatives in Europe and global lessons for health professional regulation

Una Reid - Experience of approaches to measuring and regulating safety and quality of practice – challenges and successes

Chris Robertson - Reflections on the first three years of national regulation in Australia and future directions


 

DAVID BENTON

Contrasting regulatory models to promote best practices in regulatory governance and performance

This paper will provide a high level synopsis of various part of a research study that was undertaken to examine an international comparative analysis of nurse regulatory models. The full study addressed:

  • current trends and issues in regulation and how they can be viewed from an opens systems perspective;
  • the principles underpinning nurse regulation and contrasted these with those used in other sectors such as finance and government;
  • the development of a set of performance measures and sought to illicit which of a range of models were best suited to producing high performance across the measures; and
  • the structure of legislation and to what extent this varied based upon a set of features such as the legal tradition of the jurisdiction, the model of regulation being used, the gross national income category of the jurisdiction and the region of the world.

This paper will highlight that differences in legislative structure do exist. Many of the terms used within legislative acts are poorly defined and vary in their definition from one jurisdiction to the next.

In terms of measuring the performance of regulatory bodies there are four major domains - legislation advocacy and responsiveness - organisational and internal governance - external governance and public accountability - and responsibilities and functions.

That whilst there is an opinion that a stand-alone delegated self-regulatory model delivers best results and that the small amount of existing research evidence available does tend to support this there is a need for more quantitative studies.

HAZEL BRADLEY

Shared competencies between different health professions in an emerging health system

South Africa is an emerging economy which has undergone significant changes since the first democratic elections in 1994. The government health system, serving 85% of the population, has reformed from a fragmented, hospi-centric service to a primary health care approach based on the district health system. This reform involved the establishment of health districts and the appointment of a new level of health managers, mostly health professionals, working at district level. Recent initiatives have re-focussed energies on primary health care and improving universal health coverage in a manner that would have significant implications for the government and the private health sectors.

In South Africa, the education and practice of human resources for health are highly regulated by professional councils and adapting to changing health system requirements and an increasing disease burden is a priority. However, in line with other countries, ensuring a sufficient and equitable distribution of health workers throughout the country remains a challenge.

I used a participatory action research approach to explore the emergence of district pharmacists, members of the district management team, in Cape Town, by considering their roles and related competencies. Partnering with a broad stakeholder group comprising pharmacists and managers was considered critical to developing shared learning and understanding that would translate into action and change in the organisations. My research identified five competency clusters for district pharmacists, each with several competencies:

  • professional pharmacy practice
  • health systems and public health
  • management
  • leadership
  • personal, interpersonal and cognitive.

Whilst professional pharmacy practice competencies were valued, overall generic management and leadership competencies, both technical and “softer” relational competencies, were considered critical by managers and pharmacists. Other health systems research carried out in South Africa over the past few years identified similar competencies for managers working at senior and middle management levels and points to the need for health professionals to develop generic competencies in management and leadership. In response, several initiatives have been launched in the country to facilitate the development of these competencies.

JOHN CHAVE

European responses to challenges facing health professional regulation

My presentation will focus on recent developments in relation to professional regulation in Europe, in particular professional regulation and the European internal market. It will cover the approach of the European Commission to regulation, including initiatives to challenge the level of professional regulation, and the recent Directive on the Recognition of Professional Qualifications (including the European Professional Card, alert mechanisms, and language testing).

Finally the presentation will set out a vision of how professional regulation can be reconciled with the need to increase access to health services, but also to ensure that appropriate levels of quality are maintained.

Niall Dickson

NIALL DICKSON

Reform of health professional regulation in the United Kingdom

Professional regulation in the UK has undergone something of a revolution over the last 10-15 years. The General Medical Council (GMC) has changed substantially over this period:

  • it has moved from self-regulation to an independent model of regulation, free of government intervention and directly accountable to parliament
  • the size of its council has significantly reduced from 104 to just 12 members (half medical, half lay)
  • from being dominated by the medical profession, the GMC now works in partnership with patients and doctors. Patient safety is its core focus
  • the GMC’s adjudication function was separated from the rest of the organisation into the Medical Practitioners Tribunal Service
  • revalidation for all doctors was introduced in 2012 and has now been operating for over a year.

These changes have been the result of a number of external factors, not least the health care scandals that have arisen over the years such as the Bristol Heart inquiry. As a result of the Francis Report, following the independent inquiry into Mid Staffordshire hospital, the issues of accountability and trust are once again at the forefront of health care regulation in the UK.

The time is right for reform and the Law Commission Bill in the UK is the vehicle for many of the legislative and regulatory improvements the GMC is calling for. The Bill seeks to bring together the disparate pieces of legislation that currently underpin the activities of the nine separate professional health care regulators in the UK into one overarching and simplified Act. If the Bill is passed, health professional regulation in the UK could look very different in the future.

The UK is not the only jurisdiction considering reform. From a brief survey of a number of international regulators (including New Zealand, Australia, Hong Kong, Singapore, Dubai, USA and Abu Dhabi) it is clear that, despite their differing health care models and contrasting political and cultural environments, the appetite for regulatory reform is strong.

 

GILLES DUSSAULT

Challenges facing health professional regulation

There are many pressures on health professions at the moment, and they have to decide how to react to them. Among these pressures are the calls to adapt the education and training of professionals as needs and demands of populations change. There are also demands to become more efficient and to keep up with organizational and technology advances. The increased mobility of professionals and of consumers of services also means that there is a growing need for regulation to address issues of harmonization of qualifications, and of legal responsibility. Above all, there will an increasing pressure to provide equitable access to services to all people: this implies the education, employment and retention of sufficient numbers of professionals of the kind which correspond to the needs of populations; that these professionals are accessible to all who need their services and that their work meets professional quality standards and expectations of users.

Professional organizations can just wait and see how the environment will evolve and react in a piecemeal manner, they can try to resist the changes, or they can take the lead and respond before having new regulations imposed on them. I will argue that health professional organizations would do better to take the lead in building effective regulatory systems, as an essential means of gaining and maintaining the trust of patients, which is the foundation of professional development.

Rhona Flin

RHONA FLIN

Safe in their hands? Non-technical skills and competence assessment

Many safety-critical tasks are characterised by teams of workers dealing with significant risks, time pressure and increasingly complex technology. In these domains, practitioners need both technical and non-technical skills. The term non-technical skills comes from European aviation and they can be defined as ‘the cognitive, social and personal resource skills that complement technical skills, and contribute to safe and efficient task performance’. They are not new or mysterious skills but are essentially what the best practitioners do in order to achieve consistently high performance: the skills include situation awareness, decision making, team work and leadership. There are now methods for training and rating the non-technical skills of surgeons (NOTSS) and anaesthetists (ANTS), with applications being developed for other clinical specialists. In this presentation, I will briefly outline the non-technical skills approach and explain how this is now part of competence assessment for a number of occupations, such as airline pilots. I will then consider the practical and professional issues of assessing non-technical, as well as technical skills, for the health professions. Experience

ANDRÉ GARIÉPY

Competence-based approaches and professional regulation: a balancing act

This presentation will talk about the current context in the regulatory world and the potential pitfalls of the competencebased approaches. It will project the perspective of a government oversight entity, specialized in the recognition of professional competence by regulatory bodies.

Health professions are regulated for public safety and the quality of services. The regulation schemes would set entryto- practice requirements. In light of potentially competing interests, a balancing act has to occur, generally under the supervision and authority of governments and legislatures.

Governments have become more involved in the public interest debate with regards to regulated professions and their entry-to-practice requirements. They have committed to more liberalisation of trade in services, translated in more mobility and better qualification recognition for foreign trained professionals.

New policies and oversight mechanisms are being put in place to insure that requirements are relevant and necessary for protecting the public, that they are reasonable and applied in a fair way. In some cases, self-governance has been removed from the regulatory scheme.

The development of competence-based approaches has brought a new and valuable understanding of the knowledge and skills needed to practise a profession. These approaches provide for an apparent precision, transparency, comprehensiveness, and coherence. They could allow for a reasonable comparison of competency profiles internationally.

Despite their positive features, the competence-based approaches have not eased the delicate balancing act of defining a profession and setting the bar for entry-to-practice requirements, all in the public interest. On some aspects, they have created new areas of concerns around the justification and the fairness of the requirements and the assessment process based on them.

MARGARET MUNGHERERA

Key challenges and experiences of health practitioner regulation in Africa, evolving scopes of practice and inter-professional collaboration

Key challenges for regulation of health professionals in Africa include the perception of governments about professional autonomy, clinical independence and self regulation of the health professions. Strategies to address these challenges include establishing an enabling legal framework, creating structures that ensure efficient decentralised functions supported by sufficient resources, and continued efforts to ensure all health professionals have an in-depth understanding of their ethical obligations and their rights to professional autonomy and clinical independence.

Evolving scopes of practice of health professionals and interprofessional collaboration in African countries also create regulatory challenges. Strengthening health systems is one means to achieve Universal Health Care and efforts to improve health human resources in African countries are increasingly targeted at the primary health care level. This presentation will explore some of the features of this context including provision of effective health care across diversity of primary health care problems and in situations of armed conflict.

Migration within the African continent and especially across borders creates a huge challenge for regulation but this can be addressed, at least in part, by regional collaboration. This presentation will provide an example of a regional interprofessional collaborative initiative.

Many other regulatory related challenges need to be addressed to ensure a sustainable and effective health system in Africa such as:

  • the selection of students into health training schools
  • curriculum issues especially around the teaching of clinical ethics
  • ensuring health professionals remain competent through access to CPD - especially for health professionals in remote and rural areas.

Ayala Parag

AYALA PARAG

Regulatory Models: The Israel Experience

History and Background:

Up until 2003 in Israel, only foreign graduates of professional education programs not recognized by the Ministry of Health were required to write a theoretical and practical government exam. From 2003 onward, all foreign graduates who studied in recognized graduate programs (Bachelor of Physical Therapy) were allowed to write the government exam. However, graduates of Israeli universities were not required to write the government exam, since the education process was deemed adequate. As part of the professional recognition process prior to being able to practise, the Ministry of Health provided all physiotherapists who met the government requirements, either by virtue of studying in an Israeli university or by passing the government exam, with a Certificate of Recognition of Professional Standing. In July 2005, following a High Court Appeal, the Ministry was barred from providing the Certificate of Recognition of Professional Standing to both graduates of Israeli universities and foreign graduates. The period between July 2005 and July 2008 was devoid of regulation.

In July 2008, the Health Professions Act was passed. The Act provided a level playing field for all physical therapists. Under the Act, both graduates of Israeli universities and foreign graduates must all pass a professional government licensing exam. Essentially the Act provides “protection of title” and defines conditions for recognition of physical therapy graduates. These are outlined below. Physical therapy graduates who are recognized under the Act must pass a government exam in order to receive a professional certificate from the Ministry of Health. This certificate allows them to practice as physical therapists and to be employed as such.

Regulation in context - needs of Israeli Society and the future:

The number of physical therapists per capita in Israel is similar to that of other western countries – approximately 0.5 per 1000 people. There is a sense that the number of graduates per year greatly exceeds Israel’s needs. Certainly, at present there is a dearth of available jobs for physical therapists in the public sector. The demand for services is expected to grow with the aging of the population. In addition, the public healthcare system, will be forced to change in order to meet future challenges in service provision and remain sustainable, provide good quality of services and achieve good health outcomes for an aging population. However, these changes will not necessarily impact on the challenge in the regulation context. These challenges will remain, and include limitations created by the Act such as only Israeli citizens or those of permanent resident status are permitted to write the government exam and there is no recognition of foreign graduates without a Bachelor of Physical Therapy degree or graduates of programs that do not meet the educational level specified in the Act (minimum level of Bachelor of Physical Therapy). It is illegal to practice as a physical therapist in Israel without the professional certificate from the Ministry of Health. Unless Israel encounters an unexpected and sudden rise in the demand for services, it is questionable whether the Israeli government will be driven to make changes in legislation to accommodate foreign graduates.

ANNABEL SEEBOHM

The impact of standardisation initiatives in Europe and global lessons for health professional regulation

Current initiatives by the European Union affect health professional regulation in several ways. The scene will be set by explaining the European Union mandates in health care and the internal market in order to understand the European Union competencies according to the Treaty of Lisbon. Thereafter, the European Union action shall respect the responsibilities of Member States for the definition of their health policy and for the organization and delivery of health services and health care. The exercise of the health professions, along with all the rules and regulations, which apply to their activities affects the organization of health services and health care and is therefore Member States` responsibility. Nevertheless, specific examples show that health professional regulation is and will be highly influenced by European Union initiatives. The focus of the presentation will be on current standardisation initiatives by the European Committee of Standardisation (CEN) in the area of health services and its impact on health professional regulation. A brief excursion on the role of international trade agreements will hint at a potential international dimension of such initiatives.

UNA REID

Experience of approaches to measuring and regulating safety and quality of practice – challenges and successes

The government-sanctioned self-regulatory frameworks or Councils under the Ministry of Health, mandated with regulating the health professions in the interest of public protection in Jamaica, with reference to the wider Caribbean is introduced.

All Councils share a similar focus, regulatory process, governance and management structures.

Pathways to the registers differ and include Council examination; educational institution examination; and educational institution examination and internship endorsed by the Council. Applicants must satisfy the Councils they are competent and safe to practise in their respective scopes of practice.

The indicators for measuring and regulating the safety and quality of practice are: a) accreditation of the responsible educational institutions; b) accreditation of programmes; c) a registration examination; and d) mandating competence assurance through continuing professional education and certification.

The educational accreditation agencies are the Regulatory Councils, the University Council of Jamaica and the Caribbean Accreditation Authority for Medicine and Other Health Professions.

Successes:

1. Regulation of all health professions;

2. Introduction of a single regional mechanism for registration and monitoring of the practice of all categories of health personnel; one result is the merging of competencies for some health professions across the region;

3. National and regional education accreditation bodies;

4. Accreditation of parent education institutions and programmes;

5. Mutual Recognition Agreement for physicians and nurses;

6. Competency-based curricula;

7. Mandatory competence assurance programme for periodic professional re/certification.

Challenges:

1. Keeping legislation and regulation current in context with changing health profession education preparation;

2. Resourcing Councils to effect their responsibility efficiently and effectively;

3. Selecting Council members to show a balance between the regulated and the public, and competency of members;

4. Greater inter-councils collaboration allowing for proactive risk management, given their shared focus of public protection;

5. Fitness to practice and management of risks - disciplinary management process, availability of evidence to support complaints;

6. Dynamic accreditation system that:

  • provides evidence of the relevance of curricula output to health services requirements, professional practice, and professional development
  • provides evidence of the impact of scopes of practice, continuing professional education for recertification on health outcomes
  • monitors the regulated for compliance with the mandatory competence assurance process.

7. A managed accreditation system for health care facilities to assure the quality of professional services to the public;

8. Licensing of foreign qualified graduates.

Chris Robertson

CHRIS ROBERTSON

Reflections on the first three years of national regulation in Australia and future directions

The agreement signed by the Prime Minister and First Minsters of the day in 2008 provided the architecture for a unique and novel model of health practitioner regulation that has now seen three full years of operation and has been the subject of multiple external and internal reviews.

After a rapid transition to the start of the new scheme in July 2010, the early teething issues for management of registration functions were relatively quickly resolved. Recent parliamentary reviews have found that the early challenges are behind us and that while there is further refinement that can be achieved we have a good bill of health in this area and the changes likely to result from the upcoming independent review led by our Ministerial Council may be evolutionary rather than revolutionary.

What has been learned by AHPRA and the 14 National Boards as well as from reviewers, advocates and critics of this significant regulatory change and what are the likely modifications we might anticipate will be made to the model in future years?

There are a number of key themes emerging from reviews and our experience to date of implementation of the new scheme. It is helpful to consider these along the lines of the core functional areas of practitioner registration, notifications management and accreditation of education.

The effective management of notifications about the health performance and conduct of registered health practitioners has been much more of a challenge to reestablish following transition and the relationship between national and state jurisdictions continues to be contested. This is an area where change will continue to be demanded and possibly achieved in the future refinements to the national scheme.

 

VENUE:
Crowne Plaza Hotel
Avenue Louis-Casaï 75-77
1216 Cointrin
Geneva, Switzerland

DATES:
17 & 18 May 2014

CONTACT:
whprc2014@seatoskymeetings.com
     
 

The World Health Professions Regulation Conference is hosted by the World Health Professions Alliance

 

 
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