CARNA is making public a 48-page external review of its complaints and discipline processes and outcomes.
The review was conducted over the summer and contains 14 recommendations for action and improvement, with a strong focus on increased transparency, website enhancements and internal process improvements. We will continue to report here on the status of our action plan to implement the recommendations.
CARNA engaged Harry Cayton – an internationally recognized expert in professional regulation and governance and former chief executive of the U.K.’s Professional Standards Authority – to ensure its actions and outcomes meet current international regulatory best practices and standards. CARNA is committed to improving its processes through transparency and accountability in an ever-changing, health-care landscape.
We welcome your feedback.
Improve the information available for potential complainants, particularly patients and families, by:
Revise the professional conduct website content to better define the professional conduct process and update the complaint forms by June 2020.
Identify languages, in addition to English, to support better accessibility by September 2020.
Develop process and forms for additional languages by September 2021.
Consider its wider role in patient safety and be active in identifying potential risks that should be addressed by other bodies in the health system. It should communicate its concerns to them.
Work with the Health Quality Council of Alberta to incorporate a process of sharing emerging concerns with health-system stakeholders by March 2020.
|When a complaint has been received and assessed as warranting investigation, it should be shared with the registrant and their perspective obtained before a decision to investigate is made.|
Complete a redesign of its processes and workflow and implement these changes by May 2020.
|Develop a consistent approach to risk throughout the complaints and discipline process. It should be explicitly applied and recorded at each decision point to ensure that risks of harm are accurately assessed and that conditions on practice are appropriately chosen and applied.|
Development of a risk assessment and direction tool by February 2020.
Pilot of the risk assessment and direction tool by March 2020.
Evaluate and adjust risk and direction tool by April 2020.
|When a decision is made to investigate a complaint, reasons should be recorded more clearly in the database and an indication of which practice standards might have been breached given.|
A standard review process for quality assurance of all complaint decisions will be defined by May 2020.
|Improve the selection, induction and training for Complaints Review Committee (CRC) and Hearing Tribunal (HT) members. Training should take place on an annual basis, and be an annual appraisal of each member’s performance. Chairs should be appointed and trained separately. The Health Professions Act does not require chairs to be registrants; this is something CARNA has chosen to do and should be discontinued. Chairs should be appointed on the basis of their competence, not their profession.|
Implement an enhanced orientation and continuous development program for CRC and HT panel members by December 2019.
|Complete and implement its code of conduct for HT members and for lay persons supporting nurses in proceedings. It should respond differently when a nurse has legal representation to when they have not. This is important in negotiating consent agreements and in any contested hearings. HT members should understand the difference and act accordingly.|
Clarified professional conduct expectations for unrepresented registrants with the United Nurses of Alberta by December 2019.
|CARNA has many appropriate policies and procedures relating to complaints and discipline, but it does not have a consistent approach to quality assuring their implementation, nor does it measure their outcome. It should implement a quality assurance program for all decision points in the complaints and discipline process, and it should track and measure the outcome to all sanctions applied to registrants and amend its approach if necessary.|
Develop and implement a performance management plan that incorporates a quality assurance process with performance measures along with tools to collect, analyze and report on the measures by May 2020.
|HTs considering consent agreements should pay attention to any allegations that might have been made against a nurse but which have been withdrawn as part of the consent agreement process, so they can independently assess if the consent agreement adequately addresses the nurse’s failings and the risks to public protection.|
Independent legal counsel to the HT will advise, and ongoing training will be provided to, HT members on their role in considering consent agreements by January 2020.
|Implement the powers available to it in the new bylaws as soon as possible and should appoint new members to the HT panel list to ensure its independence and freedom from bias. It should publish all conditions on practice and the names of the registrants to whom those conditions apply. HT decisions should be published and accessible on the public register on the website. This should include all consent agreements except those relating to incapacity. CARNA should commit to an open and transparent culture in everything it does.|
Implement the publishing of HT notices and decisions with the names of the registrants by Nov. 15, 2019.
Appoint additional HT members and enhance the orientation and training of all panel members by November 2019.
|Overhaul its process for ensuring registrants’ compliance with conditions on practice. It should dispense with compliance meetings of the HTs and create an active process for monitoring compliance, including following up with employers and mentors. Action should be taken against registrants who, without exceptional reason, do not meet the terms of their agreements with CARNA within the time agreed. Monitoring of complaint resolution agreements should be included.|
End compliance hearings in favour of active compliance monitoring by the Professional Conduct department by December 2019 for new requests for orders.
|Monitor the outcome and effectiveness of consent agreements and complaint resolution agreements. It should take action to remove from practice, temporarily or otherwise, registrants who do not meet the terms of their agreement and those who have further complaints despite previous ‘remediation’.|
Establish and implement a compliance process for orders and sanctions that is consistently followed by March 2020.
Develop a quality assurance process for reviewing recidivism decisions by September 2020.
|Ensure the governance review that it is commissioning considers if being a nurses’ association adversely influences the independence of its regulatory functions and its absolute commitment to patient safety and protecting the public interest.|
Review regulatory governance models and review the current governance structure with assistance from an independent governance consultant with experience in strengthening governance practices. Recommendations for governance reform to be presented to Provincial Council by September 2020.
|Refresh, update and bring together policies on data security, records retention and information governance. Ensure that all staff and committee members are trained in data security and that information governance policies are consistently applied. As improvements to its information technologies come into effect, it should digitise remote working, eliminate or minimise the use of paper and move towards a clear desk policy.|
Updated data governance and data security practices to be implemented by March 2021.