Published: December 2019
Introduction
The Council of the College of Veterinarians of Ontario has consistently chosen to be deliberate about assuring its effectiveness as a profession-based regulator in the province and beyond. This aim is not easy, and the journey has and does require a thoughtful, reflective approach of improvement.
In 2012, the Council adopted a new and well supported framework for regulatory decision making titled “Right Touch Regulation”. The decision to adopt “right touch” placed the College on the path of setting policy only when it is systematically linked to a public (animal) interest problem and an identifiable risk. The use of ‘right touch’ thinking broadened Council understanding of risk and the practice of veterinary medicine. And, in fact, in 2016 a formalized risk focus was introduced to our work in all areas - operations, governance, practice policy, and individual member adjudicated decisions.
In 2017, Council published its public position on regulatory effectiveness, and clearly articulated that its role is to understand the current and emerging risks to animals and the public in the practice of veterinary medicine and to consider solutions, collaboratively or singularly, that aim to reduce any potential harm.
Notably, within the focus on effectiveness, an additional aim is to measure the outcomes of Council initiatives, and demonstrate to the public that the College actually makes a positive difference in the role to which it is entrusted. This outcomes-focused regulation framework is intended to build on Council’s regulatory effectiveness journey and sets a structure on how we evaluate our decisions, our impact and our opportunities in order to continuously improve the delivery of our mandate.
Definitions
Outcome: The result or effect of an action or decision taken by Council or a statutory committee.
Impact: A measurable effect or influence on the competence or behaviour of the intended target population.
Evaluation: The process of judging or calculating the impact of an action, or a decision taken by Council or a statutory committee.
Current Context
The external pressure for regulatory accountability has been increasing over the last twenty-five years; for profession-based regulators, this discussion has become increasingly express in the last five to ten. The resonating question is how does the public know that a regulatory body - co-accountable to the public for its mandate through government - is doing its job effectively? How does the public know that the policies put in place actually have the intended outcome? How does the public gain assurance that measures of discipline actually make a difference? How does the public build its confidence in a profession-based regulator, or how does a profession-based regulator best demonstrate its trustworthiness?
Recent cases and reports across a variety of professions and jurisdictions in Canada clearly speak to the need for a more focused approach on measuring outcomes and impact. This is not an easy goal.
In Ontario, since the mid 2000’s a handful of regulators began to consider what measures or key performance indicators may be useful for a Council to track and understand, but also what data might lead to greater transparency on what is or is not working so well in our regulatory models.
This College has actually been an early contributor to performance measurement and the regulatory effectiveness discourse. However, it is a journey.
With the basic structure and purpose of profession-based regulation widely under scrutiny, both domestically and abroad, regulatory leadership for the future depends on what initiatives can be taken to better demonstrate trustworthiness – our competence, our honesty and our reliability. Measuring and reporting on the things that matter most to public protection and to the delivery of safe, quality veterinary care is imperative.
Striving to Make Progress
Beyond a traditional approach to outputs and processes – the more usual key performance indicators - this framework aims to ensure that the Council utilizes an approach that demonstrates we are focused on the right things and making a real difference. To do so demands integrated and systematic attention to a culture of evaluation and reporting.
The College has made several significant strides related to outcomes in the last few years. Our internal use of our data has dramatically increased, and is the underpinning of our policy documents to Council. Our approach to analytics increasingly flags risks requiring Council attention and regulatory solutions. Our undertakings and discipline orders now measure behavioral and competence improvements related to required remedial activities by veterinarians. Our programs, namely facility accreditation, and our review of medical records, have seen substantial changes based on identified areas of risk. And our public reporting is increasingly transparent with regard to our consultations and our annual report, with a deliberate sharing of diverse opinions and of areas of challenge.
In order to fully achieve Council’s desired goal of an organization demonstrating its impact on public protection, further strides are needed.
Achieving Outcomes Focused Regulation
Building on the strength of its approach to risk-based regulation, the College is introducing a structured and phased framework to assist in achieving a systematic evaluation of the impact its decisions have at both its statutory and adjudicative levels. Further, we wish to ensure that any topic for which the Council determines a need for regulatory influence (zone of concern), achieves a meaningful level of understanding within both veterinary and stakeholder communities.
This approach has 6 phases:
Phase 1 Problem and Risk Identification
Phase 2 Level of Mitigation
Phase 3 Impact Strategy
Phase 4 Implementation
Phase 5 Analysis and Recommendation
Phase 6 Public Reporting
These phases are further detailed in Appendix A, and pictorially described in Appendix B, available in the PDF.
In introducing Outcomes Focused Regulation across the organization, Council recognizes the need for the training and support of both Councillors and staff to inculcate a culture dedicated to impact and opportunity. In particular, gaining expertise on developing relevant and reliable impact strategies will be key to this framework’s success.
Summary
The College is keen to advance its work on outcomes and impacts in relation to its mandated governance of veterinary medicine in the province of Ontario. It commissions this framework to its Executive Committee, its senior staff and its Committees to promote and support this goal and its success.
References and Influencers
Coglianese, C., Measuring Regulatory Performance, OECD, 2012
College of Veterinarians of Ontario, Risk Management Framework, 2017
Lewis, S. Health Policy Consultant, Saskatchewan
McMaster Health Forum, Modernizing the Oversight of the Health Workforce in Ontario, McMaster University, August 2017
Michie, S. et al, Implementation Science, 2011
Organisation for Economic Co-operation and Development (OECD), Risk and Regulatory Policy: Improving the Governance of Risk, 2010
Professional Standards Authority, Right Touch Regulation Revisited, October 2015
Professional Standards Authority, Regulation Rethought, October 2016
Sparrow, M.K., What is a Risk Based Regulator? Presentation, Toronto, ON, April 2016
Sparrow, M.K., The Character of Harms: Operational Challenges in Control, April 2008
Steinecke Maciura LeBlanc, Grey Areas: Applying Risk Based Regulation, September 2017
Thaler, R.H. & Sunstein, C.R., Nudge: Improving Decisions, Penguin Books, 2008
Ubel, P.A. & Rosenthan, M.B., Continuum of Strategies for Influencing Behavior, New England Journal of Medicine, 2019
College publications contain practice parameters and standards which should be considered by all Ontario veterinarians in the care of their patients and in the practice of the profession. College publications are developed in consultation with the profession and describe current professional expectations. It is important to note that these College publications may be used by the College or other bodies in determining whether appropriate standards of practice and professional responsibilities have been maintained. The College encourages you to refer to the website (www.cvo.org) to ensure you are referring to the most recent version of any document.