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Quality Assurance

The Regulated Health Professions Act, 1991 (RHPA) requires all regulatory health Colleges to have a Quality Assurance (QA) Program. The goal of the QA Program is to protect the public by working in partnership with optometrists to support and provide them with tools and feedback to improve their ongoing competence. The Quality Assurance Committee is responsible for administering the program.

Under the Regulated Health Professions Act, 1991, all Colleges must:

• develop, establish and maintain programs and standards of practise to assure the quality of practice of the profession; and
• develop, establish and maintain standards of knowledge and skill and programs to promote continuing evaluation, competence and improvement among the members.

In addition, the QA Program for all Colleges must include the following components:

1. continuing education or professional development designed to:
   1. promote continuing competency and continuing quality improvement among the members
   2. address changes in practice environment; and
   3. incorporate standards of practise, advances in technology, changes made to entry to practice competencies and other relevant issues in the discretion of the Council;
2. self, peer and practise assessment;
3. a mechanism for the College to monitor registrants' participation in, and compliance with, the quality programs.

The expectation is that optometrists in Ontario are competent professionals who continually upgrade their knowledge and skills to meet the demands of changing practise environments and patients’ needs. The Quality Assurance Program is intended to be supportive and helpful to members, it is not punitive in nature.

The College’s Quality Assurance Program is made up of the following six components:

• A mandatory Continuing Education component
• An Assessment component to evaluate a member’s clinical ability
• An Evaluation component to assist a member in correcting any deficiencies in the member’s practise or clinical ability
• A Remedial component to assist a member in correcting any deficiencies in the member’s practise or clinical ability
• A component to assist in appraising the practise or evaluating the clinical ability of an applicant for registration when referred by the Registration Committee or the Registrar
• A component to obtain information from members to assist the Committee in carrying out the program’s objects

Continuing Education

Members are required to participate in the Continuing Education component in order to ensure their continuing competence and quality improvement, to address changes in practise environments, and to ensure members of the profession remain current with changes in technology, scope and standards of practise, and other relevant issues.

The philosophy behind the Continuing Education component is one of lifelong learning and every member of the College has the responsibility to formulate a personal plan for regular continuing education. Continuing education criteria and the number of continuing education hours members are required to obtain in every three-year period are detailed in the College’s Continuing Education Policy. A random auditing process following the end of every three-year Continuing Education Cycle helps ensure that members are meeting the requirements.

Practise Assessment

A Quality Assurance (QA) Practise Assessment consists of a review of an optometrist’s patient records by a “peer”. That is, it is conducted by a QA Assessor who is an optometrist and who has been trained by the College. The Practise Assessment promotes accountability and helps members enhance their patient care and management. The Practise Assessment is an excellent way to provide a positive learning experience that is directly related to each optometrist’s practise.

Members usually come before the Quality Assurance Committee for a Practise Assessment because they have been identified through an annual random selection process, or they have been referred by the Registrar for not meeting the conditions for maintaining their Certificate of Registration.

Members who are randomly selected are given 60 days to submit 25 clinical records for first time patients. They are also provided with:

• the Quality Assurance Practise Assessment Questionnaire (to provide the QAC and its Assessors with detailed information about the nature of the optometrist’s practise);
• the Short Record Assessment (SRA) form;
• the Complete Record Assessment (CRA) form; and
• a copy of the QA Regulation which outlines the rights of both the College and the member.

Once the member submits his/her files to the College, they are copied and returned to the member. A QA Assessor then conducts a review of the submitted records using the Short Record Assessment and prepares a report. The Quality Assurance Committee reviews the report and the member is advised of the results of the Committee’s deliberation. The QA Regulation limits the number and nature of dispositions available to the Committee to:

• finding that the member is maintaining the standards of practise,
• making recommendations for improvement,
• requiring the member to undergo remediation in the form of continuing education or coaching;
• directing the Registrar to impose terms, conditions and/or limitations on the member’s Certificate of Registration for a specified time; or
• referring allegations of professional misconduct or incompetence/incapacity to the Inquiries Complaints and Reports Committee.

If the Quality Assurance Committee has concerns about the result of the Short Record Assessment, they will notify the member that the assessment process is not yet complete and a review will be conducted using the Complete Record Assessment form. This will be done by a different Quality Assurance Assessor using the same patient records. The results of the Complete Record Assessment will form the basis of the Quality Assurance Committee’s disposition.

The Practice Assessment process for members who have been referred by the Registrar is very similar to the process for members who are identified through random sampling. However, the referred member does not select the patient records that are reviewed during the assessment. He or she is notified two weeks prior that a representative from the College will attend the practise to select the files. In addition, a Complete Record Assessment (not a Short Record Assessment) is conducted by a QA Assessor and a report is prepared for the Quality Assurance Committee. A Case Manager reviews the information and prepares a report which is reviewed by the Quality Assurance Committee and sent to the member for their comment prior to any disposition by the Committee.

Practise Evaluation

A Practice Evaluation is designed to assess a member’s clinical ability. It may be used in cases when a member who is required to complete a Practise Assessment is unable to provide the College with the required patient files. A Practise Evaluation is also used by the Quality Assurance Committee to determine whether deficiencies identified during the course of a Practise Assessment are a result of the member’s lack of knowledge, skill or judgment, or from the member’s lack of application of the knowledge, skill or judgment.

A Practise Evaluation may consist of any of the following:

• requiring the member to answer, orally or in writing, questions that relate to practising optometry;
• requiring the member to answer, orally or in writing, questions that arise from a review of real or simulated patient charts;
• requiring the member to examine persons or clinical simulations exhibiting problems that relate to practising optometry; and
• requiring the member to demonstrate the application of optometric techniques.

Remediation and Coaching

Remediation and coaching are designed to assist members who have been identified as having deficiencies in their clinical ability.

When a Practise Evaluation is complete, the QA Committee works with the optometrist to develop a remedial program tailored to address his or her deficiencies. The remedial program must outline learning objectives, success indicators and expected outcomes. The QA Committee may provide or recommend materials or resources for the remedial activities.

All costs associated with the remedial program are the responsibility of the member. The QA Committee must approve the timeframe and the remedial activities to be undertaken. They may require the member to work with a coach during all or part of the remedial program.

In cases where coaching is recommended, the member is provided with the names of two coaches from which to choose. All coaches are optometrists trained by the College. The member and their coach work together to develop a program using a remediation program template.

Once the program is completed, the member is given a reasonable opportunity to incorporate what she/he has learned into their practice. After that time, a practice re-assessment is conducted using the Complete Record Assessment tool.

On re-assessment, the Committee usually finds that no further action is warranted. If, however, there are still deficiencies identified in the re-assessment, the Committee may direct the member to undergo a Practise Evaluation and/or direct the Registrar to impose terms, conditions or limitations on a member’s certificate of registration.

Registration Assessment or Evaluation

An applicant for registration may be referred to the Quality Assurance Committee for a Practice Assessment or Practise Evaluation if it has been more than three years since he or she successfully completed the Canadian Standard Assessment in Optometry examination. The process is the same as for a member referred by the Registrar for a Practice Assessment for not meeting the conditions for maintaining the Certificate of Registration.

The Committee conducts a practice assessment if the applicant is practising in another jurisdiction at the time of the request for registration in Ontario or a practise evaluation if the applicant has not provided at least 750 hours of direct patient care in the 36 months before applying for registration. If the applicant is practising in another jurisdiction at the time of the assessment, the CRA will be used to assess the clinical records. All costs in this regard are the responsibility of the member.

If the applicant is found to have deficiencies, the QA Committee may make recommendations for improvement in order for the applicant to meet the standards of practice set in Ontario.

Information for Quality Assurance Purposes

The legislation gives the Quality Assurance Committee the authority to require members to provide information to the College for quality assurance purposes.

Members are responsible for providing accurate information within thirty (30) days after receiving any such request.