Changes & Opportunities at the College

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Owen is leaving us far too soon

Many will have seen the companion announcements from the College and from Covenant Health that Owen Heisler is leaving to take on a senior medical leadership job in Covenant. I wish Owen great success in his new role.

This was not a planned departure; to the contrary, we had planned for Owen to be at the CPSA a long time, and perhaps he’d have succeeded me in my job. (I’ve previously declared in this column that my contract with the College ends June 30, 2017). Owen was a very effective Complaints Director and continued Karen Mazurek’s work in fostering a great team in our Professional Conduct Department. When Michael Caffaro was hired to take on the role of Complaints Director, Owen transitioned to the executive leadership role in Accreditation and Operations (Finance, Human Resources and Information Technology).

We have been in a transitional state for some time, albeit more than we planned. We were all devastated by the illness and death of Bryan Ward in 2012. Within the last 3 years, Janet Wright left to return to clinical practice, and both John Swiniarski and Ken Gardener retired from the College (although both still do some work for us). Susan Ulan assumed the role of Assistant Registrar (AR) for Physician Wellness and, as noted, Michael Caffaro is our new AR for Professional Conduct.

Owen has seized the opportunity to move into a job he feels suits him better. I understand and accept that, but the timing is challenging. With a departure date of December 31st, our senior team, the directors who work with Owen and the front line staff in Accreditation, IT and Operations will all need to step up our game to fill the vacancy until we can recruit a replacement.

The College has gone through similar challenges in the past, most notably when Bryan got sick. We will manage through this too. Every organization has to go through a process of renewal. We could all see this coming: I’ve been the oldest member of the team for some years, and with the exception of Karen and Owen, all the registrars were within 5 years of my age, meaning that we knew we’d undergo significant turnover in a relatively short time.

We have mobilized our team to work out the short term coverage and we’re looking at how we organize ourselves – do we have the right mix of portfolios? Do we have the right mix of expertise? What complement of registrars do we need? Undoubtedly we’ll be hiring to replace Owen; what the job description and skill set we’re seeking look like is yet to be determined.

For someone with an interest in medical regulation there will be an opportunity coming soon. The CPSA is a stellar organization – a great place to work, great people with whom to work, and great opportunity to learn, grow and influence medical practice.

And so with this change I wish all the best to Owen, and look forward to his successor.

Ensuring physicians remain competent

Karen Mazurek and I are just back from an international symposium on what the British term revalidation and we in Canada are terming physician practice improvement (or PPI). I wrote about this framework in the previous issue of The Messenger.

Karen and her team in Continuing Competence have been diligently working to revamp our program to ensure it meets its goal – to ensure physicians stay competent throughout their careers. I’m convinced the PPI framework developed nationally is correct, and I’m also convinced the work happening in Alberta is entirely consistent with this approach and will help us ensure our resources are applied as usefully as possible. I also support the evaluative approach we’re taking to future work – we want to be able to demonstrate that the changes we make have the impact we’re seeking – better patient care. Indeed, I think this is one of the critical elements of success as we move forward.

In the just published Journal of Medical Regulation (volume 101; number 3, 2015), Liz Wenghofer PhD of the Northern Ontario School of Medicine argues that to a large extent healthcare regulation has been an “evidence-free” zone largely informed by anecdotal, traditional and legal considerations, and suggests that by seeking partnerships with researchers we can advance the state of knowledge in medical regulation, in part by allowing researchers access to the information we collect.

In the same issue, Niall Dickson, the CEO of the General Medical Council (UK) writes: Most regulators are awash with data but for the most part it has been impenetrable, and the analysis needed to make sense of it has been expensive and hard to execute…The power of the digital age gives regulators the opportunity…to understand the impact of what they do and, sometimes, the impact of what they are not doing.

I agree.

While Alberta and the CPSA in particular has not been a totally “evidence-free zone” – witness the many peer-reviewed publications about and arising from the PAR program – we recognize we must do more, and that we have a great opportunity to add to the evidence around professional medical regulation.

To diverge briefly to address PAR specifically, we’ve sufficient experience to recognize the value of multi-source feedback (MSF) in assessing certain aspects of medical practice. We also have sufficient experience and physician feedback to recognize the current method of administration of PAR, including the scoring system and the identification of peers for feedback, is not satisfactory. We’ve always known the limitations of MSF in assessing the medical expert role and are looking ways to augment an improved PAR delivery method to ensure we provide useful feedback to our members.

At the College we’ve built some analytical expertise (and use contracted expertise as well to help us turn prescribing data, for example, into useful information). We also have recently engaged research expertise to help us ensure the next phase of our continuing competence program adds to the fund of evidence and knowledge about medical regulation.

To those physicians who’ve already engaged with Karen and her team (Ernie Schuster, Mark Godel, Erin Anderson, Nigel Ashworth, Nicole Kain and Monica Wickland-Weller) I thank you for sharing your needs and desires.

I want to add a couple of ideas for future consideration.

The first is to suggest at some time we (and all health regulators) will need to think seriously about how we move from regulating individual practitioners to groups or teams of healthcare professionals. Should we consider how well an individual physician provides care if, by a suite of measures, the team in which the physician works provides exemplary care?

The second is to consider and quantify the winning conditions for such exemplary practice. We all know of teams, departments, units and communities that are collegial and high-functioning, where the public can reliably expect to receive quality care, and we know of the opposite. What are the differences? How can we identify and quantify them? What can be done to create winning conditions (and how can they be successfully imported into dysfunctional teams/units/departments/communities)?

It’s an exciting time in the world of regulation.

As always, I welcome your thoughts and feedback

Trevor Theman

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