Collaborative Leadership for Safety and Quality - Ray Joubert - Saskatchewan College of Pharmacist

Collaborative Leadership for Safety and Quality (721 KB ppt)

I thought I would comment on this from the perspective of governance.

The fundamental question is whether or not there is a need for a governance structure to assure the quality of collaborative practices.

While the literature supports the patient safety benefits of collaboration and team work, things can still go wrong. Human factors, systems flaws and environmental pressures can still exist to compromise patient safety. Therefore, it is important that we continue to promote and support quality assurance processes.

While teamwork improves quality, should quality assurance processes exist to eliminate risk, or assure and enhance the quality of services, or both? Who accepts responsibility for setting these goals and ensuring that they are achieved?

In our current system, heath care professionals, employers and professional regulatory bodies share responsibility for quality assurance. Individual professionals have ethical obligations to assure quality. Employers have a responsibility to ensure that their employees render services that are valuable to their clientele, whereby quality is the main determinant of value. Employers also reduce risks to mitigate liability. Through their mandate, professional regulatory bodies are responsible for ensuring that the public is protected against unskilled and substandard practices. However, my understanding of the health care system and the literature indicates that there are no coordinated efforts to establish the goals for quality assurance and accepting joint responsibility to ensure that these goals are achieved. Therefore, we might conclude the some form of governance structure is needed to accept responsibility for coordinating our quality efforts.

While we can argue that this is the role of government, challenges arise when a substantial portion of health care is delivered outside of the publicly funded system. Also, the term "quality" is only used once in the preamble in the context of access to care, and does not appear in the text of the Canada Health Act. While will find this term used in related interpretations and reports, it is not used in the context of responsibility for governance and goal setting over the entire health care system.

Can employers accept this responsibility for governance? This can work if collaborative practices and teamwork occur under common employers. However, the reality is that team members can come from different employers and no mechanism exists to coordinate their efforts.

Similarly, can the professional regulatory bodies accept this responsibility?

At this point in time, shared responsibility, or any other role, for governance of quality assurance of collaborative practices is not within our mandates. As I understand the principles of administrative law that govern how we function, we cannot assume responsibility for roles that are not specifically authorized under our governing legislation. Therefore, we would need this legislative authority before proceeding. In the meantime, this does not prevent us for engaging in less formal or official initiatives such as this conference, or in dialogue such as participating in the Integrated Primary Health Care Working Group where we examine how professional organizations can promote enhanced interdisciplinary collaboration.

Before even considering this responsibility however, I believe it is incumbent upon the regulatory bodies to ask and answer the fundamental question of the need for a governance structure to accept responsibility for assuring the quality of collaborative practices. Should we conclude that a need exists, we should ten commit ourselves to answering a variety of challenging questions, such as:

What role does each organization play in promoting responsibility for governance?

What are the options, and the advantages and disadvantages of each?

What evidence supports the optimal governance of collaborative practices and teams and is this evidence relevant to our context?

Is this a role for self-governing or professionally led regulatory bodies, and if so, how can such culturally diverse organizations collaborate. For esampole how would we deal with the potential sense of loss of professional autonomy?

Should this be our role, what would be the legislative framework?, and finally,

How do we effectively engage the public, as it is their interests that are at stake?

R. J. (Ray) Joubert, Registrar
Saskatchewan College of Pharmacists

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Collaborative Leadership for Safety and Quality - Ray Joubert - Saskatchewan College of Pharmacist