PROTECTING THE PUBLIC THROUGH MODERNIZED HEALTH REGULATION

Through the lens of B.C.’s new regulatory college leaders

The Registrar

Modernizing licensing and professional regulation has been at the forefront of the health sector in recent years. Regulators are continually adopting new practices to update operations, streamline registration processes and enhance public safety, all to better fulfill their public protection mandate.

British Columbia has long led the modernization of regulation in Canada, with many regulatory colleges revising their practices. On June 28, 2024, two new colleges were es- tablished by amalgamating several legacy regulatory colleges, with the goal of strengthening transparency and accountability within health profession regulation.

The Registrar Magazine spoke with the leaders of these two new colleges: Registrar & CEO of the College of Health and Care Professionals of B.C. (CHCPBC), Dianne Millette, and Registrar & CEO of the College of Complementary Health Professionals of B.C. (CCHPBC), Carin Plischke. Both respected leaders with decades of experi- ence in the sector discussed how the new colleges were created, and what the public can expect in this new era of modern health regulation.

Years in the making

The idea of amalgamating multiple health regulators in B.C. into two separate colleges was part of an exhaustive process years in the making. In 2018, B.C.’s Ministry of Health (MOH) began a multi-year initiative to modernize regulatory frameworks ensuring health profes- sions were regulated more consistently. In March 2019, an inquiry into the College of Dental Surgeons of British Columbia was spearheaded by the Ministry. Harry Cayton was directed to do the investigation by the minister, eventually leading to amalgamation being legislated.

“Voluntary amalgamations weren’t new, such as when the College of Registered Nurses of British Columbia amalgamated with two other nursing professions a year prior, before inevitably amalgamating with the midwifery profession,” Millette says. “Our colleges’ particular amalgamation, however, were mandatory.”

Plischke, the former registrar, CEO, and previous board member of the now-defunct College of Occupational Therapists of B.C., recalls that the pre-planning phase of amalgamation was meticulous. “Going to numerous events and hearing about the vision for modernizing health regulation, pre-COVID-19, was inspiring,” she says.

In August 2020, the MOH-led Steering

Committee on Modernization of Health

Professional Regulation issued recommendations to update the province’s health professions regulatory framework. Significant findings from the Cayton report and public consultations highlighted the need for health profession regulators to:

• Commit to cultural safety and humility

• Improve governance

• Improve efficiency by reducing the number of regulatory colleges from 20 to six

• Strengthen oversight

• Simplify complaints and discipline processes

• Share information to improve patient safety and public trust

As a result, in April 2023, the Deputy Minister sent a letter to the boards of each legacy regulatory bodies announcing that two colleges —one overseeing seven professions and the other four— were to be established in June 2024. Alan Seckel was appointed by the ministry as the amalgamation lead to support boards during the transition. In September 2023, Seckel appointed Joanie Bouchard, former registrar of the College of Dietitians of British Columbia, as chief transition officer. Bouchard worked with a project consultant team and some staff from the amalgamating colleges to develop project charters and assist with various aspects of the transition.

In 2024, months of hard work came to fruition with the names of both colleges confirmed and Dianne and Carin appointed registrars and CEOs in February. Boards for both colleges were appointed in March, with consultations on required bylaws running from April until early

June before the CHCPBC and CCHPBC were legally amalgamated and formally opened on June 28.

Millette explains that her passion in the new position stems from a deep interest in licensing and professional regulation. With over 20 years of experience in regulatory roles in both Canada and the U.S., she saw leading the CHCPBC as a rare opportunity. “I really saw this as a once-in-a-lifetime opportunity” she says. “To lead an organization like this was an unprecedented opportunity, being committed to public service and safety as long as I have.”

Plischke echoes a similar sentiment, explaining that her enthusiasm for role stems from the opportunity to collaborate more directly with other health regulators. “We typically don’t work in isolation within this sector,” Plischke notes. “The delivery of safe health services from licensees presents a unique opportunity to show how team-based care can be done through consistent, enhanced collaboration.”

Prioritizing the public

When it comes to governance, both Millette and Plischke emphasize the importance of having a balanced split of members of the public and regulated professionals on the boards of both colleges.

“Our college’s board involves fifty per cent public members, with the other fifty per cent coming from legacy colleges,” Millette says. “Public service will be the main objective of our board and committees, instead of representation, as profession-specific expertise is embedded in our staff and committees.”

Plischke says that fifty per cent public representation on the board allows regulators to create new methods of fulfilling their public protection mandate. “As we continue building out our operations and outreach, our goal is to eventually have a governing board of directors, along with fulfilling our commitments to cultural safety, humility and anti-racism,” Plischke says.

Measuring public impact

A key area of focus for Millette and Plischke is cultural safety, humility, and anti-racism, where each college prioritizes eliminating racism from policies, while actively working to create conditions that promote greater inclusion, equality and justice.

“We’ve established an office for social accountability, which embeds diversity, equity, inclusion (DEI), decolonization and justice principles into our work,” Millette says. “Our relationships with Indigenous Elders and Knowledge Keepers ensure board activities remain aligned with Truth and Reconciliation efforts already established by legacy regulators pre-amalgamation, such as territorial acknowledgements and approving guidelines for working with Indigenous Elders.”

Both Millette and Plischke sit on the Executive Committee of B.C. Health Regulators, which brings together B.C.’s health regulatory colleges to collaborate on improving regulation and regulatory practice across their organizations. Plischke highlights that this collaboration is crucial, so that mechanisms can be shared that will help to eliminate racism and discriminatory behaviours from the health care system to improve pa- tient care and ultimately achieve public safety.

Millette explains that collecting registrant data will be crucial for CHCPBC moving forward. Drawing on her experience supporting the development of Ontario’s College Performance Measurement Framework (CPMF), she notes that CHCPBC is collaborating with the Canadian Institute for Health Information to identify what’s appropriate and ethical to collect, and how data will be integrated into regulatory standards and processes.

“We’re aiming to become more informed about our registrant population as a start, so that we can ensure that we’re both inclusive of those working across these various health professions and able to measure impact down the line,” she says. “Once we get through the initial phase of harmonizing our processes, the next step will be to really assess the measurements of those outcomes,” she adds.

The vision ahead

CHCPBC is an amalgamation of seven legacy colleges and regulates nine professions, with one legacy college regulating three distinct professions. Millette notes that this raises several important questions that CHCPBC is eager to address.

“First, how does the regulator hear from the various publics that are being served? It’s fine to have public representation on our board, but to hear from the broader public, it’s important to learn from our international colleagues who’ve overseen multi-disciplinary jurisdictions for a long time. The other important task ahead is to find a way of responding to compliments, instead of just concerns. We have a lot to learn from people who just want to share an experience, good or bad, as this is crucial for modernization efforts.”

Ultimately, Plischke’s vision as registrar & CEO is to have a multi-disciplinary, team-based health care regulator that supports a mandate of ensuring health professionals practise in a way that is safe for the public. “It’s really about decreasing confusion for the public and being efficient in the little, but important things,” she says. “For example, how do we get consent to provide services? As a modern regulator, I’m excited about CCHPBC demonstrating leadership in this area, which inevitably encourages public safety.”

With new legislation - the Health Professions and Occupations Actset to come into force in 2025, both Millette and Plischke are thrilled to continue supporting licensees in transitioning to the requirements of this new Act. Plischke emphasizes the evolving importance of demonstrating how well multi-disciplinary regulators can work under one framework with measurable outcomes, a perspective Millette shares.

“There’s a lot of work to be done. However, the future is bright and, in time, we will demonstrate to the public what is possible with modern health regulation,” Millette concludes.