Last November, as part of our annual strategic planning session, I and the other members of CCO Council and staff participated in a workshop devoted to how to best measure and ultimately improve the effectiveness of Council and its committees. It was a fascinating and valuable workshop that provided some concrete steps and learnings drawn from other regulators.
Council effectiveness can be characterized in many ways, from evaluating the effectiveness of meetings, adherence to project plans and milestones, maintaining and achieving statistical benchmarks for the college’s business (things like registrations, complaints processed, timely disposition of discipline referrals, ongoing quality assurance initiatives, etc.) as well as solid financial stewardship.
Undertaking a formal program to evaluate our effectiveness, as identified by the Ontario College Performance Measurement Framework (CPMF), is relatively new for the CCO, although we have certainly been tracking performance measures for some time. Like any new initiative, it’s important that we start simply and then begin to build upon the momentum we create. I am sure it will be a meaningful journey for all of us.
One of the areas that reflects on Council’s effectiveness is how we communicate to members and the public, especially with respect to changes to by-laws, standards of practice and guidelines. CCO has a solid record of circulating this information, and also of putting planned changes out for consultation and transparently incorporating feedback which ensures public interest protection remains front and centre. And we will continue to reinforce this. Some of the changes we discussed in our workshop included sending more frequent newsletters to share updates on various Council initiatives and priorities, even those that may be works-in-progress.
One current initiative is a plan to refresh CCO’s website so it is the best it can be for all CCO stakeholders, and to ensure both the public and members alike can find the accurate and comprehensive information about the college that they need. CCO received several qualified responses to its recently issued request for proposal to undertake this website rejuvenation. I am excited on behalf of the College to see where this will lead.
Congratulations to Returning Council Members
As of the close of nominations on February 16, 2024, three CCO Council members standing for re-election were acclaimed. Congratulations to returning CCO Council Members Dr. Angelo Santin (District 1- Northern), Dr. Julia Viscomi (District 4: Central) and Dr. Dennis Mizel (District 5: Central West).
It has been my pleasure to work alongside these three colleagues over this past year, and I look forward to their continued contributions in the future.
As a reminder, internal elections to compose CCO committees will be held on April 17, 2024. A warm thank you to all candidates and Council members for their passion and professionalism in ensuring the regulation of chiropractic in Ontario.
Sincerely,
Dr. Sarah Green
President
CCO Newsletter – March 1, 2024
CCO Council Approves Guideline G-015: Virtual Care and Amendments to Guideline G-014: Delegation, Assignment and Referral of Care and Standard of Practice S-006: Ordering, Taking and Interpreting Radiographs
CCO Council approved a number of new and amended standards of practice and guidelines on November 23, 2023 that came into effect on February 23, 2024. CCO thanks all stakeholders, including members, for providing feedback to the various distributions.
New Guideline G-015: Virtual Care
CCO Council approved new Guideline G-015: Virtual Care, following distribution for feedback in June 2023. Guideline G-015: Virtual Care replaces the temporary guidance on telecare provided during the COVID-19 pandemic.
Please review Guideline G-015: Virtual Care for protocols on providing care to patients in virtual settings, including registration and professional liability requirements, limitations of virtual care, expectations with respect to clinical competency, privacy and confidentiality and patient interactions, record keeping and business practices, and jurisdictional considerations.
Amendments to Guideline G-014: Delegation, Assignment and Referral of Care
CCO Council approved amendments to Guideline G-014: Delegation, Assignment and Referral of Care, following distribution for feedback in June 2023. Amendments are reflected in underline and cross-out on page 3 of the marked up version of the Guideline.
This guideline was reviewed as a result of a number of complaints to CCO where care was assigned to an assistant as part of a chiropractic treatment plan; however, there were miscommunications and misunderstandings by the patient of the nature of the assigned care. As well, patients were not given an opportunity to communicate or ask questions of their chiropractor, upon request.
Communication with patients is an essential component of the doctor/patient relationship. It is imperative that the nature of care and the right of the patient to communicate and ask questions of their chiropractor is properly and clearly communicated to the patient, especially when elements of care are to be assigned to another individual.
Amendments emphasize the importance of proper and clear communication and consent whenever treatment, as part of a chiropractic plan of care, is to be assigned to another individual. This includes a discussion of the roles and responsibilities of the individual providing the assigned care, the direction and supervision provided by the member, and the right of the patient to communicate with and ask any question of the member at any time during the performance of the assigned care.
Further, the member who has assigned the care must ensure that either the member or another member of CCO is available (which may include availability remotely/virtually) to provide any direction or supervision, communicate with the patient upon request and answer any questions from the patient. Any individual providing assigned care must inform the patient of these rights and facilitate any request for communication between the patient and the member.
Please review the marked up and clean version of amended Guideline G-014: Delegation, Assignment and Referral of Care for further details.
Minor Amendments to Standard of Practice S-006: Ordering, Taking and Interpreting Radiographs
CCO Council approved minor amendments to Standard of Practice S-006: Ordering, Taking and Interpreting Radiographs. Amendments are underlined and/or crossed out in the marked up version of the Standard of Practice.
Amendments reflect the application of consistent language from the record keeping standard of practice and the common practice at many Ontario health regulatory colleges, to collect demographic information as necessary to identify, assessment and treat patients. As well, amendments emphasize the importance of collecting information of the pregnancy status of the patient as a contraindication, prior to any ordering or taking of a radiograph.
Annual Gathering of CCO Peer Assessors – January 20, 2024
At the training day, Peer Assessors “workshopped” topics including proposed 5 hours of hands-on continuing education at least once every three CE cycles (or six years) and a proposed webinar on advertising, websites and social media.
The annual Peer and Practice Assessment meeting and workshop for CCO Peer Assessors was held January 20, 2024, at CCO’s offices in Toronto. The session, presided over by CCO President Dr. Sarah Green, was led by Dr. Katherine Tibor, Director of Professional Practice, and attended by 29 Peer Assessors alongside members of CCO’s Quality Assurance Committee chaired by Dr. Paul Groulx, as well as CCO staff including CCO Registrar Jo-Ann Willson and Deputy Registrar Joel Friedman.
The day-long session followed a packed, objective-driven agenda and featured a mix of presentations, discussion and small group break-out sessions. Participants reviewed updated standards of practice, policies, and guidelines; current trends in regulation; the role of the Peer Assessor and Peer Assessor feedback; and the appropriate use of advertising, websites and social media.
Dr. Groulx thanked Peer Assessors for their tireless efforts throughout 2023 to promote continuing competency among CCO membership, and to uphold the duties and objectives of the College in the service of the public interest. Dr. Tibor reminded all participants of the guiding principle of the peer assessment program: that it is not a punitive undertaking, but rather provides members with the opportunity for learning and support. “It is about developing humane approaches that maintain the strongest focus on risk and patient safety, while also considering practitioner well-being” she said.
One particular area of focus for small-group discussion was the practice of spinal adjustment or manipulation, in relation to Continuing Education (CE) and Peer and Practice Assessments (PPAs). Mr. Joel Friedman noted that draft amendments to Standard of Practice S-003: Professional Portfolio had been circulated for feedback in September 2023, and were currently under review. The draft amendments to Standard of Practice S-003 propose that “every member complete a minimum of a 5-hour structured CE activity, that is a hands-on spinal adjustment or manipulation activity and includes training in the competency of manual spinal adjustment or manipulation skills, at least once every three CE cycles (or six years)”. These draft amendments are currently under review, and any final approval of amendments is required to be made by CCO Council.
The groups explored key aspects of assessing competence in spinal adjustment, and discussed the availability of additional workshops or training opportunities for members, the required expertise of the assessor, as well as whether there were key learnings from other jurisdictions and regulated health professions that include a physical technique as a component.
A surprise highlight for all participants was the screening of a video celebrating the ninth year of service of six Peer Assessors: Drs. Pierre Ramlall, Victoria Clarke, Brian Dower, David Hominuk, Janine Taylor and Marlene Turner, who were duly acknowledged for their ongoing contribution to the self-regulation of chiropractic in Ontario.
At the close of the session, Dr. Tibor invited the Peer Assessors to sign the Code of Conduct and Undertaking to Maintain Confidentiality for Peer Assessors. It was a fitting end to a fulsome, educational and enjoyable gathering of peers.
Peer and Practice Assessment Workshop – January 20, 2024
CCO Council Approves By-law Amendments – November 23, 2023 and February 23, 2024
Like many other health regulatory colleges, CCO Council has conducted a by-law review resulting in the approval of several amendments. Draft by-law amendments were circulated for feedback to stakeholders, including members, on September 19, 2023, and were carefully considered by Council along with all feedback received at the November 23, 2023 and February 23, 2024 Council meetings. CCO thanks all stakeholders including members who provided feedback, which is made available as part of the public Council packages. CCO Council also had the benefit of legal advice throughout the by-law review process.
CCO Council approved a number of amendments to by-laws relating to ensuring gender neutral language, correcting minor inconsistencies, improving clarity, and updating the fees by-law to reflect fees for the emergency class of registration and Specified Continuing Education or Remediation Programs (SCERPs) at the November 23, 2023 Council meeting. CCO Council approved further amendments to by-laws related to eligibility for election to Council, allowing the President to vote on motions before Council, and prescribing the Nominating Committee as a non-statutory committee of CCO, which includes the President as a committee member. Due to a number of considerations, including persuasive feedback about the relatively small size of the chiropractic profession in Ontario, CCO Council has maintained the cooling off period for affiliations with other chiropractic associations and educational institutions at three years for eligibility for election to Council.
CCO by-law amendments are subject to the approval of Council minutes at the subsequent Council meeting and are posted on the CCO website upon approval of the minutes.
CCO Regulatory Excellence Workshop Takes to the Road!
After a brief hiatus, CCO is once again hitting the road to offer the Regulatory Excellence Workshop (REW) (formerly known as the Record Keeping Workshop) in select Ontario communities. Currently, there are two scheduled in-person workshops. The first will be held at the Hunt Club in Ottawa Saturday, May 4, 2024, from 8:30am – 1pm. The second will be in Kitchener-Waterloo (venue TBD) on Wednesday, September 4, 2024, from 5:30pm-9pm. Please continue to visit the CCO website as information becomes available.
This is a great opportunity for members to meet directly with CCO representatives including council members, staff and peer assessors, ask pertinent questions and to socialize with their peers. Past attendees have shared how beneficial they found the in-person session. Stay tuned for further details.
As a reminder, all members registered in the General (i.e., Active) class of registration are required to attend the REW once every 3 CE cycles (or 6 years). New members are required to complete the workshop following their writing of the Legislation and Ethics examination, or within their first year of registration with CCO. The workshop is free and available for all applicants and members of CCO.
Please note, the REW continues to be offered online, with the next virtual workshop planned for June 3, 2024, 8:30 am – 1:00 pm. Please email Rose Bustria at rbustria@cco.on.ca if you are interested in scheduling a workshop in your district or if you plan to attend the virtual REW or either of the scheduled in-person REW’s.
CCO Council – February 23, 2024