The Advisory Group for Regulatory Excellence

In a recent blog post, we explained that in the coming year Ontario’s health regulatory Colleges will be making more information about health care professionals available to the public and that this shift is driven in large part by a request from the Minister of Health and Long-Term Care for increased transparency made back in October 2014.

Prior to the Minister’s request, however, several Colleges had already begun to engage in a discussion with the public and the professions about measures to increase transparency.  Specifically, the regulatory Colleges of six health professions, including dentistry, medicine, nursing, optometry, pharmacy and physiotherapy, teamed up in 2012 to form a working group on transparency – the Advisory of Group from Regulatory Excellence (“AGRE”) – whose task was to examine information-sharing practices and to make recommendations on how regulators can make more information about members and College processes available to the public.

The members of AGRE worked together to develop the following set of Transparency Principles to guide future discussions about making more information about health care professionals available to the public:

1. The mandate of regulators is public protection and safety. The public needs access to appropriate information in order to trust that this system of self-regulation works effectively.

2. Providing more information to the public has benefits, including improved patient choice and increased accountability for regulators.

3. Any information provided should enhance the public’s ability to make decisions or hold the regulator accountable. This information needs to be relevant, credible and accurate.

4. In order for information to be helpful to the public, it must:

   1. be timely, easy to find and understand.

   2. include context and explanation.

   3. Certain regulatory processes intended to improve competence may lead to better outcomes for the public if they happen confidentially.

   4. Transparency discussions should balance the principles of public protection and accountability, with fairness and privacy.

   5. The greater the potential risk to the public, the more important transparency becomes.

   6. Information available from Colleges about members and processes should be similar.

In addition, the AGRE developed a multi-phase transparency initiative for the implementation of amendments to the Colleges’ information-sharing practices and changes to what information about health care professionals is posted on the Colleges’ public registers. The initiative is divided into Phase 1 and Phase 2, each with distinct recommendations. The specific information about College members which AGRE recommends Regulators make public in Phase 1 of the initiative includes:

• The date of a referral to Discipline Committee

• The status of a Discipline Committee hearing (e.g. stayed, recessed)

• The full Notice of Hearing

• Criminal findings of guilt (if relevant to suitability to practice)

• Bail conditions (if relevant to suitability to practice)

• Notice of non-members practicing illegally

AGRE recommends in Phase 2 of the initiative that Colleges consider making the following information public about their members:

• Names of former members (including fact and date of a member’s death, if known)

• Health facility privileges

• Criminal charges (if relevant to suitability to practice)

• Licenses held in other jurisdictions

• Discipline findings in other jurisdictions

• A notation that the Discipline Committee has made no finding

• Acknowledgements and undertakings

• Oral Cautions/Cautions-in-person issued by the College’s Inquiries, Complaints and Reports Committee (“ICRC”)

• Specified Continuing Education or Remediation Programs (“SCERPs”) ordered by the ICRC

The work of AGRE has been shared with the Councils of all of Ontario’s health regulatory Colleges and with the Federation of Health Regulatory College of Ontario. In its correspondence to the Regulators in October, the Ministry of Health commended the work of AGRE and encouraged all Regulators to build on AGRE’s work by using its decision-making framework when implementing transparency measures in the future.

The Councils of all six AGRE members, as well as most other College Councils, have adopted the AGRE Transparency Principles. In addition, the majority of the Colleges have indicated that they plan to discuss, publicly consult on, and eventually implement, the recommendations of AGRE’s transparency initiative. Some of the Colleges have already drafted and approved by-law amendments for public consultation that reflect the Phase 1 recommendations regarding the member-specific information that should be included in the public register.