In Nova Scotia, as in other Canadian provinces, regulated health professions are self-regulating. As a result, provider regulation is divided between 22 autonomous regulators in Nova Scotia and by a similar number in other provinces. Longstanding concerns about the implications for the system’s capacity to deliver cost-effective integrated care have been accentuated in recent years by the policy emphasis on collaborative interprofessional practice models. In 2012, Nova Scotia adopted the Regulated Health Professions Network Act to better align self-regulation with collaborative interprofessional practice.
The primary impetus for the Act came from the regulators. They designed and promoted the Act to enable the implementation of a model of regulation they called “collaborative self-regulation”.
One objective is to improve regulation by enhancing its capacity to protect the public as it increasingly receives care from interprofessional teams. Collaboration is also intended to better allow the regulatory system to address systemic weakness stemming from distribution of Nova Scotia’s limited regulatory resources across many autonomous regulatory bodies, some of which are very small.
Another objective is to make regulation more enabling and encouraging of collaborative interprofessional practice. The Act is based on the idea that regulatory structures and processes can become enablers and encouragers of collaboration in practice if regulation models collaborative behavior and actively seeks opportunities to support collaboration among those who are regulated.
The Act leaves the how and when and extent of collaboration to regulators. This reflects core design principles: that self-regulation generally works well in Nova Scotia and that collaboration is a voluntary process that works when it is conducted as a voluntary process. The Act does however make each regulator a member of the Regulated Health Professions Network, which is mandated to make collaboration happen among its members. A mandatory five-year review of the Act implies that more interventionist legislation might be found necessary if the review is negative.
The expected outcome is a combination of the strengths of self-regulation (the grounding of regulation in the responsibility of each profession to protect the public interest) and the benefits of collaboration in a system that will increasingly deliver care through interprofessional teams. For example, where a patient complains about care received from providers from multiple professions, each regulator will retain its decision-making autonomy for its own members. Regulators will however be able to collaborate to conduct a single shared investigation instead of the separate investigations each would otherwise be required to conduct.
The Act happened because regulators did the necessary work (with modest government financial support) and unanimously endorsed the finished product. Alignment with the priority the Nova Scotia government gave to collaboration in its general health care agenda and with emphasis on interprofessional care in broader Canadian health care reform also mattered. The lack of significant opposition from unions and professional associations, stemming from the protection the Act gives to the regulatory autonomy of each profession, was another important factor. Yet it should be noted that one major union used the legislative process to question the need for regulatory bodies for occupations largely employed in institutions funded and regulated by government.
The implementation of the Act is just starting so evaluation is not yet possible. The Network is however making an evaluative framework a top priority.
For an analysis of this reform, see: https://escarpmentpress.org/hro-ors/article/view/1183