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 practice 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:
- continuing education or professional development designed to:
- promote continuing competency and continuing quality improvement among the members
- address changes in practice environment; and
- incorporate standards of practice, advances in technology, changes made to entry to practice competencies and other relevant issues in the discretion of the Council;
- self, peer and practice assessment;
- 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 practice environments and patientsí needs. The Quality Assurance Program is intended to be supportive and helpful to members, it is not punitive in nature.
The Collegeís Quality Assurance Program is made up of the following six components:
- A mandatory Continuing Education component
- An Assessment component to evaluate a memberís clinical ability
- An Evaluation component to assist a member in correcting any deficiencies in the memberís practice or clinical ability
- A Remedial component to assist a member in correcting any deficiencies in the memberís practice or clinical ability
- A component to assist in appraising the practice or evaluating the clinical ability of an member by the Registrar
- A component to obtain information from members to assist the Committee in carrying out the programís objectives
Members are required to participate in the Continuing Education component in order to ensure their continuing competence and quality improvement, to address changes in practice environments, and to ensure members of the profession remain current with changes in technology, scope and standards of practice, 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 Collegeís 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.
A Quality Assurance (QA) Practice Assessment consists of a review of an optometristís patient records by a ďpeerĒ. That is, it is conducted by a QA Assessor who is an optometrist and who has been trained by the College. The Practice Assessment promotes accountability and helps members enhance their patient care and management. The Practice Assessment is an excellent way to provide a positive learning experience that is directly related to each optometristís practice.
Members usually come before the Quality Assurance Committee for a Practice 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 Practice Assessment Questionnaire (to provide the QAC and its Assessors with detailed information about the nature of the optometristís practice);
- 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 Committeeís 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 practice,
- 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 memberís 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 Committeeís 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 practice 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.
A Practice Evaluation is designed to assess a memberís clinical ability. It may be used in cases when a member who is required to complete a Practice Assessment is unable to provide the College with the required patient files. A Practice Evaluation is also used by the Quality Assurance Committee to determine whether deficiencies identified during the course of a Practice Assessment are a result of the memberís lack of knowledge, skill or judgment, or from the memberís lack of application of the knowledge, skill or judgment.
A Practice 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 Practice 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 Practice Evaluation and/or direct the Registrar to impose terms, conditions or limitations on a memberís certificate of registration.
Registration Assessment or Evaluation
An applicant for registration may be referred for a Practice Assessment or Practice Evaluation if it has been more than three years since he or she successfully completed the Canadian Standard Assessment in Optometry examination.
The College frequently receives applications from optometrists from other jurisdictions. According to the College's Registration Regulation, where the applicant completed the national entry-to-practise examination more than three years prior to applying to the College, he or she must, among other things, undergo either a record assessment or a practice evaluation. In some cases, an applicant may have to undergo both processes in order to satisfy the Registration Committee that they are competent to practise optometry in Ontario in accordance with the standards of practice. The practice evaluation is more thorough (and, therefore, more expensive) than the records assessment.
The Registration Committee is often unable to determine an applicant's competence on the basis of a records assessment alone. Therefore, in order to avoid having an applicant incur the costs and additional time associated with two processes, the College is offering applicants the option to volunteer to undergo a practice evaluation at the very beginning.
To be clear, applicants do not have to do so. There is no prejudice to an applicant who undergoes a practice assessment, and an applicant who volunteers to undergo a practice evaluation will not receive any kind of preference in the handling of their application. Both processes are fair, neutral and objective.
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 Registration 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 practice 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 Registration 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.