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2021-22 End of Year Summary

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Background

The British Columbia Public Advisory Network (BC-PAN) is a joint public engagement initiative created by health care regulators in British Columbia. The BC-PAN encourages meaningful engagement in health care regulation by holding three meetings a year, led by an external facilitator, and providing the public with the opportunity to share their perspectives with regulatory colleges on relevant regulatory topics.

The BC-PAN currently consists of 10 regulatory partners, 15 public advisors, a facilitator, and a public engagement coordinator. Regulatory colleges use the BC-PAN’s feedback to:

  • Revise standards and policies
  • Validate strategic decisions
  • Conduct research and additional engagement
  • Share input with stakeholders

Achievements

During the 2021-22 year, the BC-PAN:

  • Gave a presentation about the BC-PAN at the Canadian Network of Agencies and Regulation (CNAR).
  • Created an informational video about the BC-PAN.
  • Launched a new website

Learnings and Impacts

Supporting the public outside of the complaints process

Not all unsatisfactory interactions with a health care provider are appropriate for the formal complaints process. Colleges learned how they can better address the public’s questions about their interactions with health care providers so that the public can make informed decisions about their care. BC-PAN members were asked to consider what the patient’s needs might be and how colleges can respond to those needs, within their mandate and capacity.

Key learnings
  • Before there is a concern about the care received, the public should be notified of a practitioner’s registration with health regulators so that they are aware that there are opportunities to follow up about their care.
  • Public-focused information should be available for those who may have general questions about their care.
  • When interacting with a college, the service should be responsive, accessible, respectful, and let the patient know about their options for next steps.
College Impacts

College of Opticians

  • Created a new sitemap that is more intuitive and streamlined through pages.
  • Included information about what to do “pre-complaint” instead of directing straight to complaints.
  • Brainstorming and fleshing out “example complaints” and examples of what does not constitute as a complaint.
  • Considering common resolutions to complaints and posting them on the site.
  • Added more resources such as legal and mental health to their resource list.
  • Including more information about the types of contact methods to file a complaint (Zoom, FaceTime, Text, Call, Email).
  • Including information about feedback throughout the process and the ability to have a support person present.

College of Traditional Chinese Medicine and Acupuncturists

  • Updated public registry to include a direct link to any public notifications.
  • Revised language used in initial letter template to complainants.
  • Provided brief email updates when moving to the next the complaint process or to inform them of delay.

College of Physicians and Surgeons

  • Input has validated the importance of having a call center and patient navigator.

College of Occupational Therapists

  • Added an email link on website to support the ability to submit questions.

Health care providers selling products

When health care providers engage in the sale or endorsement of products or treatments, it may constitute a conflict of interest, where the health care provider’s own interests’ conflict with the duty to act in the best interest of the patient. At the same time, some members of the public may desire access to these additional services or products. Understanding what the public may find questionable, unethical or confusing when health providers endorse or sell products or treatments will be helpful for the colleges in regulating conduct.

Key learnings
  • Because of the power imbalance between a patient and a health care provider, health regulators should provide a clear line and enforce strong boundaries regarding the topic.
  • Guidelines should ensure that the patient’s interests are prioritized above the health care provider’s benefits.
College Impacts

College of Dietitians  

  • BC-PAN input about not being deceived and being able to trust registrants has been added to updated marketing policy documentation.
  • Interprofessional communication is emphasized in website Q&As.
  • Updating professional boundaries resource to address dual relationships clearly and provide behavioural strategies to registrants.

Enhancing communication and informed consent

To support patients to be empowered partners in their health care, they need to understand the services and treatments being offered to them. Informed consent is the process where a health care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention. Exploring what informed consent means to the public, how the process should look at all stages of care, and why it is important can help regulators understand public expectations how the consent process should work.

Key learnings
  • Informed consent should be clear and understandable to the public; use language and a method of delivery that makes sense to the patient. Avoid jargon and acronyms.
  • The informed consent process should not be rushed. Colleges can create resources directed at the public that health care providers can refer patients to so patients can do their own research, ask questions, and come to their own conclusions.
  • It is helpful to ask the patient to relay back the information the health care provider gives to evaluate if they fully understand.
  • Information provided in the informed consent discussion should include best- and worst-case scenarios of the treatment, alternatives, costs, evidence of outcomes, potential impacts on other aspects of life, and the complexity of the procedure.
College Impacts

College of Physical Therapists and College of Occupational Therapists

  • Published a newsletter article with the BC-PAN’s discussion highlights to raise awareness of public perspectives and expectations.
  • Reviewed complaints communications to support plain language.

College of Physicians and Surgeons

  • The BC-PAN input has helped to inform the decision to draft a new practice standard on informed consent.

Dual relationships

Dual relationships occur when a health care professional treats family members, close personal friendships, commercial relationships or others with whom they have a non-professional relationship. Dual relationships are often unavoidable in small communities such as rural and remote locations or communities of shared identity. Some of the key considerations are the welfare of the person being given health care, effectiveness of service or treatment, avoidance of harm and exploitation, conflict of interest, and the impairment of clinical judgment.

Key learnings
  • College codes of ethics should include a definition on what good judgement is regarding dual relationships.
  • Colleges can encourage the use of telemedicine to better support patients in accessing health care providers outside of their communities.
  • Colleges should specify how health care providers should disclose dual relationships to patients so that the patient is aware of its implications and actions to follow up. In social circumstances, it should be up to the patient on whether they would like to disclose the relationship.
  • Colleges should engage people using different platforms to inform them of their expectations on dual relationships. Social media may be used in urban centers, but radio and community bulletins may be more effective in rural. 
College Impacts

College of Traditional Chinese Medicine and Acupuncturists

  • Consent and dual relationships input have been shared with the Patient Relations Committee to inform program development.

College of Physicians and Surgeons

  • Input from the BC-PAN helped to inform recent revisions made to the Treatment of Self, Family Members and Others Close to You practice standard and accompanying public resource.

College of Occupational Therapists

  • Used the BC-PAN’s information to help inform resource for registrants on starting and closing practice.

Public resources

Regulatory colleges create many types of resources for the public to provide them with information related to health care regulation. To ensure that the resources created for the public are accessible and effective, college partners are seeking the BC-PAN’s feedback on current resources being developed as well as to review resources that are already available to the public. The BC-PAN’s meeting started with an overview of college partners’ actions taken following previous BC-PAN meetings, then transitioned to a review of resources developed by the colleges to explain their mandates. Lastly, the public advisors provided guidance to college partners on ways to make public information resources more effective and relevant to the public.

Key learnings
  • Advisors value consistency across colleges in their resources – especially complaints process resources as colleges’ processes are similar.
  • Providing simple or detailed information is not an either/or – it is a spectrum. Advisors prefer receiving high level information then accessing details through hyperlinks.
  • Including transcripts and timestamps in videos helps to make resources accessible to many communities.
  • Colleges should work on creating Indigenous specific resources to explain benefits, coverage, and efforts to ensure cultural safety.
  • Place resources in points of care and at the street level that includes colleges’ contact information; it is unlikely that the public will go to colleges’ websites for information.
  • Review the mobile capability of resources to ensure it is accessible. People with lower incomes cannot afford both a computer and a cellphone and are most likely viewing resources through mobile.
  • Be mindful of biases and perceptions of diversity in graphics. Colleges can source local artists to develop their graphics to show a connection to communities. 
  • When educating the public about the roles of lesser known health care providers, it is important to include information on how to access the health care provider. Addressing questions like if a referral is needed and finding a health care provider based on location would be helpful.