THE COMMON ELEMENTS OF A PATIENT RELATIONS PROGRAM

GOALS OF A PATIENT RELATIONS PROGRAM: 

The goals of the College's Patient Relations Program are: 

• to help the health professionals regulated by the College enhance relations with their patients or clients, and by extension, the public;  
• to help the public achieve greater understanding of the range and quality of the professional services offered by members of the College; 
• to help patients or clients be fully informed of their rights in dealing with members of the profession and the College, including that they will be treated in an ethical, competent, sensitive and respectful manner; 
• to help the public have a greater knowledge of the role of the regulatory College and how to participate in College processes and/or programs.  

I  GOVERNANCE  

In serving the public interest, Colleges have a responsibility to establish policies, plans and initiatives for their Patient Relations Programs, and to ensure that a culture of awareness and respect for the professional-patient relationship permeates the organization. Each College should have a strategic plan for its program, designed to achieve particular time-targeted objectives, reflecting a focus on patient relations. These responsibilities reflect the leadership role of the College Council, as well as the accountability of the entire College for the vitality of the patient relations program. The Council also determines resources to meet realistic goals. 

1.       Alignment of Patient Relations Programs with College Objectives 

The patient relations program should be an integral part of each College's strategic plan. It should include objectives, priorities, resource allocation, evaluation and accountability mechanisms. 

2.       Mechanisms for internal accountability 

The College Council has accountability mechanisms to ensure coordination, timely implementation and achievement of results for patient relations activities throughout College operations, Committees and programs. 

3.       Mechanisms for external accountability 

The College Council utilizes external accountability mechanisms, (such as annual reports, College publications, reports to the Minister and to HPRAC, and its website) for transparency of relevant College processes, decisions and performance results relating to alternate resolution, complaints, discipline and any other matters that may affect public confidence in the College's ongoing performance. 

II INFORMATION FOR THE PUBLIC

Colleges should strategically identify and utilize the best tactics to provide the public with relevant information that will assist patients, clients and their families to understand the profession and the role of the College. Information programs should be aimed at educating the public and providing the tools so they can be better informed.   

4.       Profile of the College 

The College undertakes activities to enhance public awareness of the College as the self-regulatory body for the profession, its roles and functions. General information available to the public might include:

• The College role, and its public interest mandate;
• How the College is accountable;
• How to contact the College - address, telephone, website;
• The Register;
• The inquiries, complaints and reports processes;
• The discipline process;
• How to obtain information;
• College regulations, by-laws, rules, guidelines and policies;
• The statutory Committees of the College, clear terms of reference for each, and evidence of an annual report;
• How the College relates to other health professional Colleges, and to facilities and institutions.

 5.       Profile of the Profession 

The College prepares an overview description of the profession, including what its responsibilities are, and what it does, and makes it available to the public. Such a statement might include:

• History of the profession and/or its regulation;
• Numbers of people registered in the profession in Ontario, by region if possible;
• Scopes of practice, as permitted by law;
• Academic qualifications of the professionals;
• Descriptions of practices, specialties or classes of registrants within the profession;
• Areas of interest or clinical expertise available;
• How to access services of a member of the profession: pathway information (e.g. direct, referral, requisition, order);
• Practice settings, and the intersection of members of the profession with facilities and institutions;
• Liability issues;
• How professional services are funded; overview of billing practices and relationship to professional standards;
• The profession's code of ethics;
• How members of the profession interact with other health professionals and unregulated health providers, and how their respective responsibilities are delineated.

 6.       Regulatory Requirements of the Profession  

The College has in place, and makes available to the public, documentation about technical and regulatory requirements of the profession, and how they contribute to and enhance public protection, which could include:

• The profession-specific statute;
• Qualifications for entry to practice and registration requirements;
• Quality assurance programs, educational upgrading;
• Continuing competence requirements;
• Standards of practice;
• Warnings against individuals who practice illegally, and information about how to deal with them;
• Definition of professional misconduct, including sexual abuse. 

7.       Handling of Concerns or Complaints About Professionals

Colleges provide information so that patients and clients are aware that they have the right to make a complaint about a professional, the process for making a complaint, and how complaints are resolved.  At a minimum, such documentation should include all information that is required by the Regulated Health Professions Act, but may also include other matters:

• How to obtain information;
• How to make a formal complaint;
• Representation allowed for complainant and member;
• What information is required;
• How and with whom the information provided will be shared;
• What will follow the recording of the complaint;
• What information is available to the complainant, and at what stages;
• Opportunities and College rules for alternative dispute resolution;
• Timelines for resolution of the complaint;
• How a College investigates a complaint;
• To whom an investigative report is available, and what opportunities there are for comment;
• How third party complaints are handled;
• What alternatives may be used in the resolution of a complaint - e.g. remediation, mentoring, counseling, referral to discipline, etc.;
• Right of appeal to HPARB, and the appeal process;
• Civil remedies;
• The role of complaints in quality improvement;
• Samples of types of common complaints, and how they might be resolved.

 8.           Fitness to Practise

Colleges provide information to the public about how they address physical and mental health issues of health care practitioners that could impact on the quality of care they provide. Such information could include:

• Overview of steps the College takes to protect the public;
• Mandatory reporting on incapacity;
• Health assessment of reported practitioner;
• Hearings to determine level of functioning and appropriate treatment.

 9.       Sexual Abuse Prevention, Complaints about Sexual Abuse and Funding for Therapy

The public should be aware of the measures the College has in place to prevent and deal with sexual abuse of patients. Colleges need to respond with particular sensitivity to patient complaints about sexual abuse by a professional, and ensure that the patient or client understands that funding for therapy, in addition to the complaints process, is available to them.  Full information about the complaints process is provided, along with specific information about rights to therapeutic services and the College's role in preventing sexual abuse, including:    

• The guidelines for the conduct of members of the College with their patients or clients, including the steps the College takes to ensure that members of the profession and the College staff are trained in preventing and dealing with sexual abuse of patients;
• What constitutes sexual abuse of a patient;
• How sexual abuse may be reported by a health professional of a facility;
• How a patient can make a complaint about sexual abuse;
• The eligibility criteria for funding for therapy;
• How an application is made for funding for therapy;
• When funding for therapy will be available;
• Who selects the therapist or counsellor;
• Qualifications of a therapist or counsellor;
• How long therapy can be provided;
• How the therapist is paid;
• Confidentiality provisions impacting the complainant, reporter and witnesses.

10.   Mandatory Reporting

To underline the College's public interest mandate, the public is made aware that members of a profession are required to report to the College if they have been found guilty of an offence, or if there has been a finding of professional negligence or malpractice.  The public is also made aware that facilities are required to report to the College on matters relating to a member, including sexual abuse, incompetence or incapacity.  Information would normally include:

• How reports are filed;
• Timelines for reports;
• Content of reports;
• Naming of the patient, and consent provisions for the naming of  the patient in sexual abuse matters;
• How the College responds to reports by members or facilities.

11.    The Discipline Process 

Colleges make available to the public comprehensive information about the nature of disciplinary activities, and how public protection is improved through the discipline process.  Information would normally reflect the RHPA-mandated process, including:

• How a matter becomes a case for disciplinary consideration;
• Investigations leading to a hearing;
• The nature of the tribunal;
• Who comprises the discipline panel, prosecution, defence;
• The public nature of the discipline hearings;
• Identity of parties in a discipline hearing;
• Burden of proof;
• Role of complainant;
• Witnesses, how selected and expertise/experience required;
• How a decision is reached;
• Different kinds of penalties;
• Right of member to appeal;
• Notations on register.

12.   Register of Professionals

As required by Sec. 23 of the Code, the College provides information to the public about members of the profession in a clear and accessible way. The register must contain the following:

• Each member's name, business address and business telephone number, and if applicable, the name of every health profession corporation of which the member is a shareholder;
• The name, business address and business telephone number of every health profession corporation;
• The names of the shareholders of each health profession corporation who are members of the College;
• Each member's class of registration and specialist status;
• The terms, conditions and limitations that are in effect on each certificate of registration;
• A notation of every matter that has been referred by the Inquiries, Complaints and Reports Committee to the Discipline Committee that has not been finally resolved, until the matter has been resolved;
• The result, including a synopsis of the decision, of every disciplinary and incapacity proceeding, unless a panel of the committee makes no finding;
• A notation of every finding of professional negligence or malpractice made against the member unless the finding is reversed on appeal;
• A notation of every revocation or suspension of a certificate of registration or of a certificate of authorization;
• Information that a panel of the Registration, Discipline or Fitness to Practise Committee specifies;
• A notation that a finding of the Discipline Committee is under appeal, until the appeal is disposed of;
• A notation of the resignation and agreement when a member has resigned and agreed never to practise again in Ontario;
• Information specified in the College by-laws.

Colleges may choose to present additional information that may be helpful to the public.  In some professions, the College should reflect on whether the information could be considered to provide a competitive advantage for certain members of the profession, how frequently the information would require updating, and how the College would validate self-reported information.  Reference to the professional association might be considered in cases where pertinent information was more readily available from that source. The decision to include or exclude the non-obligatory information resides with the Colleges. Such additional information could include matters such as:

• How to find a competent professional;
• Regional search capacity;
• If a professional has hospital privileges, and in what facilities;
• If professional is accepting new patients;
• If professional is part of a primary care inter-disciplinary team;
• Academic qualifications, education and training;
• Language proficiency;
• Specialty status or clinical focus;
• Business hours;
• Practice setting (e.g. home, clinic, hospital, long-term care home etc.);
• If home visits are part of the practice;
• Accessibility of place of business;
• Other information unique to the profession.

            III   Information for Members

The College should have in place policies that identify and utilize the best tactics to provide members of the profession with relevant information that will assist them to be aware of and respect the rights of patients and clients, and to know their obligations as a professional. Information programs should be aimed at educating members and providing the tools so they can be better informed. 

13.   Definition of a Professional

The College makes a statement about its concept of what being a professional means, and the culture of professionalism that influences the work of its members. An example is that of the Australian Council of Professions:

A disciplined group of individuals who adhere to high ethical standards and uphold themselves to, and are accepted by, the public as possessing special knowledge and skills in a widely recognised, organised body of learning derived from education and training at a high level, and who are prepared to exercise this knowledge and these skills in the interest of others. 

14.   Regulatory Requirements of the Profession

The College has in place accessible documentation about regulatory requirements of the profession, and how they contribute to and enhance public protection, which may include the items in section 6 above.

15.   Handling of Complaints

Members know that patients have the right to make a complaint about a professional, what the process is for making and responding to the complaint, and how complaints are resolved.  Information would normally include:

• How a formal complaint is made;
• Representation allowed for complainant and member;
• Response required by the member, and the time-line for the response;
• Information required;
• How and with whom the information provided will be shared;
• What will follow the recording of the complaint;
• Information available to the complainant, and at what stages;
• Opportunities and College rules for alternative dispute resolution;
• The role of complaints in quality improvement;
• Timelines for resolution of the complaint;
• The complaint investigation;
• College practice assessments;
• Availability of investigation report;
• Right of member to respond to investigation report;
• Options that may be used in the resolution of a complaint - e.g. remediation, mentoring, undertakings etc.;
• Right of appeal to HPARB, and the appeal process.

16.   Fitness to Practise

Colleges inform members about the importance of reporting and addressing physical and mental health issues affecting health care practitioners that could impact on the quality of care provided to patients. Information may include:

• Overview of steps the College takes to protect the public, and the integrity of the health care team;
• Mandatory reporting on incapacity;
• Health assessment of reported practitioner;
• Hearing to determine level of functioning and appropriate treatment;
• How to access services to deal with physical or mental health problems.

17.   Professional Conduct and Misconduct

Members of the profession should be aware of what constitutes professional conduct and misconduct. Information would normally include matters such as:

• Standards of the profession;
• Accuracy of information to patients and clients about services, opportunities to participate in service delivery, service limitations, and how to access services;
• Legislation and regulations related to client decision-making and informed consent are applied;
• Confidentiality of health information is protected;  how information is shared with other health professionals and with insurers;
• Appropriate client assessment is carried out safely, with adequate resources, and using acceptable methods and tools;
• Coordination of care; referral practices; maintenance of records; how patient is informed;
• Commercial arrangements for conducting a practice:
  • Billing practices are clearly presented, including insurance matters;
  • Recalling patients: standard or courtesy;
  • Advertising and promotional activity;  
• Matters particular to the profession.

18.   Sexual Abuse Complaints and Funding for Therapy

Members of the profession are fully informed about the boundaries that must exist between members and patients, and understand that the law promotes zero tolerance for sexual abuse. Members should know their obligations regarding funding for patient therapy for sexual abuse. 

• Preventing boundary violations;
• What constitutes professional misconduct of a sexual nature;
• How an application is made for funding for therapeutic services;
• Obligations of the member to reimburse costs of funding for therapy, and the authority for the practice.

 HPRAC considers these items to be obligatory. 

19.   Register of Professionals