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BACKGROUNDER
As you may recall, the College has been without a quality assurance (QA) regulation for a number of years. Council did approve and forward to government a proposed regulation but it was never passed.
Then, when the Health Professions Regulatory Advisory Council (HPRAC) released the New Directions report in April 2006 with its review of the Regulated Health Professions Act (RHPA), it became clear that this proposed regulation was now quite out-of-date. It was also not consistent with HPRAC's recommendations for amendments to the RHPA. In fact, in June 2007, new requirements for quality assurance were created with the amendments to the RHPA passed as part of the Health System Improvements Act. So, at the College's request, government withdrew the regulation.
Under these RHPA amendments, QA programs must include continuing education or professional development designed to promote continuing competence and practice improvement. Also, any QA program must include the following components: self-assessment, and peer and practice assessments, and monitoring of members' participation and compliance.
The challenge was to develop a new QA regulation and program that met the government's current expectation for health-care regulatory colleges to take on a proactive role in monitoring the performance of their members. We wanted to do this by moving beyond the old traditional QA programs that involved things like office visits, while providing members with a way to demonstrate continuing competency.
Our starting point was the comments made by HPRAC in its New Directions report that college members "must have confidence that when changes are identified as necessary in their own practice…that there is no link to the discipline process. Rather the link is to enhanced competence, continuing improvement and outcome evaluation." The College's new QA program had to meet all these requirements, plus incorporate the nurturing, non-punitive philosophy of the College.
Our new QA program needed:
- to take into account that the overwhelming majority of dentists in Ontario are competent practitioners who continually upgrade their knowledge and skills;
- to meet the demands of changing practice environments and patient needs
- to ensure members can and do demonstrate their continued competence.
We wanted to use this window of opportunity to look at new and imaginative ways to support members in their practice. That is why the College contacted the Donald R. Wilson Centre for Research in Education at the University of Toronto for assistance.
The Wilson Centre is an international leader in health professional education research. It has a core staff of eight PHD researchers, five full-time administrative staff, 150 clinical faculty members, and over a dozen fellows and visiting professors from around the world. The Centre has formal links with the Ontario Institute for Studies in Education and the University of Toronto's Institute for Medical Sciences. It is now one of the top three educational research centres in the world.
Staff from the Wilson Centre are on board and are working closely with the College's QA Committee in the development of our new QA program.
Now, with this proposed QA regulation, we have reached the first major landmark in the development of our new and improved QA program.
Q. What's the best way to sum up the philosophy behind the new QA program?
The QA program is founded on the belief that each member of the College is a competent dentist who is motivated to continuously maintain and improve his or her level of competence.
Q: What are some of the main features of the new quality assurance program referred to in the proposed regulation?
Practice Enhancement Tool: This is a computer-based self-assessment program that will allow members to evaluate and assess their practice, knowledge, skill and judgment based on peer-derived standards. This tool will be developed by Wilson Centre staff, in conjunction with the College's QA Committee. There will be a thorough review process to ensure it meets our needs.
Practice Enhancement Consultants: As part of our nurturing, supportive philosophy towards members, there will be consultants available to assist members at any time to interpret or discuss the results of their self-assessment. The consultant can assist members in identifying appropriate continuing education or professional development activities to help them address any deficiencies or weaknesses.
Annual Declaration: Each year members are entrusted with the responsibility of completing a section on their registration renewal form to self-declare whether or not they are in compliance with the QA program requirements.
Q: Where are the concrete details about the QA program?
The regulation has been carefully drafted by legal counsel with expertise in the development of government health-care regulations. Because of the nature of this format, it does not contain all the nuts and bolts of the QA program. That is yet to come as the next step.
Q: What is the approval process for this regulation?
Council approved the regulation, in principle, at its June 2008 meeting. The regulation is currently in circulation to all members and external stakeholders for their review and input for the required 60-day period. The final draft will go back to Council at its November meeting for consideration and approval. Then, it is sent off to government where a whole different review process takes place. This will involve close examination by legal counsel at the Ministry of Health and Long-Term Care and others. It may even come back to the College for some fine tuning before finally going to Cabinet for approval. Optimistically, this whole process could well take over a year or more.
Q: Where does this proposed regulation fit into the process of developing the new QA program?
Now that Council has approved the regulation in principle, the QA Committee, with the help of staff from the Wilson Centre, will move forward to create the self-assessment program (Practice Enhancement Tool) that forms the core of the new QA program. Since this requires a significant investment of time and money, we did not want to move forward until the proposed regulation was at least approved in principle by Council.
During this process, the QA Committee will be seeking advice from the universities, the National Dental Examining Board and the Royal College of Dentists of Canada.
Q: Can a self-assessment program (Practice Enhancement Tool) be designed to address the needs of both general dentists and specialists?
Yes indeed. The Wilson Centre staff have assured us that it is more than doable. It is important to note that the self-assessment program (Practice Enhancement Tool) will be designed so that the assessment will only be of the areas of practice that the individual dentist is involved in.
Click here for the RCDSO Proposed Draft Quality Assurance Regulation.