Registrar-CEO Quarterly Report (Q2)

REPORT TO THE BOARD OF DIRECTORS – October 2, 2024

Submitted by: Kelly Dobbin, Registrar and CEO

Each quarter, in advance of the College’s Board Meeting, the Registrar-CEO prepares her Quarterly Report to assure the Board that the College operates effectively and achieves its strategic goals, and that the Registrar performs per the expected duties outlined in the Board’s Governance Policies.

The Registrar-CEO is accountable for the College’s performance in six main areas:

1. Strategic Leadership and Direction Setting
2. Development and Achievement of Goals
3. Reputation and Relationship Management
4. Financial Accountability and Management
5. People and Organizational Leadership
6. Board Governance and Engagement

Strategic Leadership and Direction Setting

Registration Regulation

We have been working closely with the Ministry to clarify questions related to the proposed changes to the Registration Regulation. Their questions primarily relate to timing and potential costs that could affect registrants once the proposed Registration Regulation is in effect.

This fall, we will meet with the Registration Committee to propose related policies to bring forward to the Board for approval and develop an implementation plan in preparation of the Registration Regulation coming into force which may be as early as the summer of 2025.

The Office of the Ontario Fairness Commissioner (OFC)

We recently met with our OFC compliance analyst for our annual check-in. Discussion focused on the Chang School of Continuing Education’s new International Midwifery Pre-Registration Bridging Program and the registration work planned in the next year.

Pathways to Registration for Internationally Educated Midwives

We continue to seek ways to create pathways and remove barriers to registration for internationally educated midwives. To this end, we are exploring various registration options tailored to support internationally educated midwives’ needs for entry-to-practise, including:

• Bridging programs

Following the Board’s directive to College staff to continue collaborating with the Chang School of Continuing Education to finalize the proposed International Midwifery Pre-Registration Bridging Program, we have held regular meetings to align admission criteria, policies, implementation, and communications strategies. The Registration Committee is scheduled to review the final proposal at their November meeting, after which a recommendation will be made to the Board in December. The Chang School anticipates the program will launch in the spring of 2025.

We have also initiated preliminary discussions with the Ordre des Sages-Femmes du Québec, the Midwifery Council of New Brunswick, and the Canadian Midwifery Regulators Council to explore opportunities to leverage the French midwifery bridging program currently delivered at the Université du Québec à Trois-Rivières as a potential pathway to registration for internationally educated francophone applicants who wish to register outside Quebec.

• Orientation and Assessment Pilot Program (OAP)

Over the summer, we conducted a second remediation session on Emergency Skills, followed by a final exam for candidates who were unsuccessful during the initial week-long in-person intensive of the second cohort. Two candidates were unable to meet the requirements of the OAP after the remediation opportunity and are no longer eligible to pursue registration.

Since its inception, 10 candidates in the OAP have successfully passed the Canadian Midwifery Registration Exam, and six of them have registered with the College.

• Competency-Based Assessment Program

During the summer, we hired a consultant to conduct an environmental scan aimed at identifying potential remedies to address a midwife’s deficiencies identified following the completion of the competency-based assessment. Remedies could include coursework, training, reading, etc. The consultant has now completed this work and is currently developing a decision matrix that aligns the relevant remedy with the corresponding competency. This decision matrix will play a crucial role during panel deliberations, and the Registration Committee will review the proposed decision matrix at their upcoming meeting in November.

Health Professions Discipline Tribunal

Health Profession Regulators of Ontario (HPRO) hosted a presentation from the Health Professions Discipline Tribunal (HPDT). We believe joining the tribunal would advance governance modernization and would benefit the College. College staff are making further inquiries and will bring items for discussion or decision to the Board as necessary.

Development and Achievement of Goals

Public Opinion Survey

In June, we issued a request for proposals for a public opinion survey to advance our initiatives under Strategic Priority 2: effective use of data to identify and act on existing and emerging risks, to better understand client’s needs and expectations of midwifery care. As well, we have set out to survey the public to track their perceptions of the College so we can better understand the impact of our work, an initiative under Strategic Priority 3: building engagement and fostering trust with the public and the profession. We received excellent submissions from several vendors, and following a thorough review process, selected Pivotal Research to work with on the public opinion survey. The process of building, fielding, and receiving results from the survey will span Q2 and Q3. We expect to present results to the Board in December.

New Registrant Centre on Website

Under Strategic Priority 3: building engagement and fostering trust with the public and the profession, the College invited midwives in their first three years of practice to participate in a College survey asking what kind of information they think we should provide to New Registrants, and what tools we should use to reach New Registrants. Based on their feedback, we have put together a helpful website with all the information New Registrants need in their first year of practice including the New Registrant Policy, New Registrant Conditions Reporting Form, targeted videos, information on registration and professional practice requirements, and a list of College resources.

Website Survey

Three years ago, we surveyed users of our website to ask if they found the information they were looking for. We also used analytics to learn how long people spent on each page, and whether they hit dead ends with their searches on the website. We used these results to inform the redesign of our website, an initiative under Strategic Priority 3: building engagement and fostering trust with the public and the profession. As part of our evaluation of the project, we planned to replicate this survey a year after the new site had launched. This survey is currently live on the website and will run until October 31. We expect to have results from the survey prior to the December Board Meeting.

Implementation of the Amended Professional Misconduct Regulation

The updated Professional Misconduct Regulation, made under the Midwifery Act, 1991, came into effect on July 1, 2024. We provided registrants with an overview of the changes, FAQs, and updated the Professional Misconduct Guide. In addition, we revised the College’s Guideline to Ending the Midwife-Client Relationship to reflect the new Professional Misconduct Regulation, providing clearer guidance on when it may be appropriate to discontinue care. The updated guideline emphasizes the appropriateness of discontinuing services based on the midwife’s reasons, the client’s condition, the availability of alternate services, and the opportunity given to the client to arrange such services. This information was shared with registrants via email and posted to our website. These initiatives support our Strategic Priority 3 of building engagement and fostering trust with the public and the profession.

Implementation of Changes to General By-law

Following the August 1 implementation of the amended General By-law, staff updated relevant governance documents to ensure language on our website and in our documents is consistent with the amended by-law (e.g., Council changed to Board, Council Member changed to Board Director.)

Implementation of Changes to the Fees and Remuneration By-law

Following the August 1 implementation of the amended Fees and Remuneration By-law, Letters of Professional Standing (LOPS) and Letters of Standing and Professional Conduct (LSPC) are now issued within seven days at a cost of $50. We made updates to the forms to clearly distinguish their purpose, making it easier for midwives to select the appropriate form. Additionally, the College sent a communication to midwives about this, including a reminder that the public register provides real-time, downloadable PDFs, which may be accepted by hospitals and birth centres in place of a LOPS, potentially saving time and eliminating the $50 processing fee.

Rescinding the Prescribing and Administering Standard

On July 15, 2024, the Prescribing and Administering Standard was rescinded. Upon review of the standard in June, the Board determined that there were sufficient measures under existing federal and provincial legislation, and the Professional Standards for Midwives, to ensure midwives meet expectations of safe prescribing and administering of drugs and substances. The Board’s decision to rescind the standard demonstrates our risk-based approach to regulation and was announced via email and posted to the College’s website.

Reputation and Relationship Management

Launch of Registration Renewal and Professional Development Portfolio Reporting Window

On August 1, the College launched the registration renewal process and opened the window for selected registrants to report on their Professional Development Portfolio. We have published information on our website to provide registrants with step-by-step instructions on how to renew, and to answer frequently asked questions on renewal, the Professional Development Portfolio, and Active Practice Requirements. Our social media and email reminders are frequent and increase in regularity closer to the October 1 deadline. College staff continue to engage with midwives seeking exemptions from components of the Professional Development Portfolio and provide individualized support to registrants who report barriers to completion of the program.

Summer Edition of On Call Digital Newsletter Published

This edition of our digital newsletter included information on our new resource for New Registrants, highlights from our June Board meeting, the new Professional Misconduct Regulation, the recording from our recent Designated Drugs and Substances webinar, and more.

Meeting with the Association of Ontario Midwives

The College met with the Association of Ontario Midwives on June 27, 2024. We discussed areas of mutual interest, including change management for Ontario midwives, midwives’ liability insurance, and changes to the Designated Drugs and Substances Regulation.

Ontario Midwifery Strategy Council Meeting

The College met with the Association of Ontario Midwives, representatives from the Midwifery Education Program (MEP), staff from the Ottawa Birth Centre and the Toronto Birth Centre, and a representative from the Provincial Council for Maternal and Child Health on September 9, 2024. We discussed areas of importance for the midwifery sector including challenges in growing the profession through the MEP, health human resources, and professional development opportunities for midwives.

Letter to Deputy Premier and Minister of Health, Sylvia Jones

On June 20, 2024, the College received a letter from Deputy Minister and Minister of Health, Sylvia Jones requesting new data from the College. We sent a response offering to provide data that could help reduce red tape and barriers in access to midwifery care for clients. Our first new data report was submitted by the August 31^st deadline.

Update on the Designated Drugs and Substances Regulation

When the Designated Drugs and Substances Regulation came into effect this spring, the College maintained our position that a list-based regulation has significant limitations, and that the expansion of the list was a temporary measure to bridge the gap between current needs and future changes permitting midwives to prescribe to scope.

The College has recently engaged with the Ministry and other system partners about the limitation of naming specific drugs in the regulation, specifically the newly added Respiratory Syncytial Virus (RSV) vaccine. The current recommendation from the National Advisory Committee on Immunization (NACI) is to administer the RSV monoclonal antibody, as opposed to the RSV vaccine, to protect newborns from serious illness. Support for midwives to administer the Respiratory Syncytial Virus (RSV) monoclonal antibody has come from the Association of Ontario Midwives, and many sector partners and interested groups (including representatives from BORN, the Kids Health Alliance, the Children’s Healthcare Coalition, and the CEOs of all of Ontario’s Children’s Hospitals). We are meeting with the Ministry and representatives from the Office of the Chief Medical Officer of Health on September 20^th to resolve the matter so that midwifery clients aren’t negatively impacted and can receive the immunization from their midwife as originally intended. We will provide a verbal update on this at our upcoming meeting.

Update on Laboratory and Specimen Collection Centre Licensing Act, 1991, General Regulation

Over the past quarter, the College has continued to work with the Ministry to update and expand the list of laboratory and point-of-care (POC) tests that midwives may order (under the General regulation, Schedule 2 “Tests – Requisition by Midwife, Section 18.”). Similar limitations exist for midwives and their clients with the laboratory regulation as with the Designated Drugs and Substances Regulation described earlier (as again, a list-based system is utilized). The College continues to provide evidence to the Ministry to support ordering and testing to midwifery scope. The Ministry has agreed to provide updates to the College and discuss public consultation outcomes in mid-September. We will provide a verbal update on this at our upcoming meeting should we have additional information to share.

Financial Accountability and Management

Q1 Statement of Operations

The Q1 Statement of Operations was approved by the Executive Committee at its last meeting and is presented under the Executive Committee’s report to the Board for your information.

2023-2024 Annual Report and Audited Financial Statements

The College’s 2023-2024 Annual Report and approved Financial Statements (approved by the Board in June) will be submitted to the Deputy Premier and Minister of Health, Hon. Sylvia Jones, as per our requirements under s.6 of the Regulated Health Professions Act, 1991.

People and Organizational Leadership

Human Resources

We are pleased to share that Megan McCarrell was selected for the Director, Professional Practice position at the College. Megan previously held this position on a fixed-term contract while covering for a leave of absence. As the role shifted from a fixed-term to a permanent position, the College conducted an external search to ensure fairness and address any potential barriers that the fixed-term nature of the role might have posed in the initial recruitment process.

We announce that Pamela Aedo left the organization in August. We thank Pamela for her contributions in the Registration department during her time with us and wish her success in future endeavours. We are currently assessing the needs of the department and will begin recruitment in the fall.

Learning & Development

The College created an internal Learning and Development strategy and plan to align our learning goals and initiatives with our strategic and operational objectives. The purpose of the plan is to guide our activities and measure our learning goals and initiatives. As part of this plan, we have partnered with BIPOC Executive Search to deliver a training program on advancing equity, diversity, and inclusion in the workplace. The program addresses topics such as unconscious bias, cultural competency, systemic and societal racism, and generational differences in the workplace.

Over the last quarter, the College staff have engaged in learning sessions on the following topics: unconscious bias, cultural sensitivity and competency, systemic and societal racism, and giving and receiving feedback.

Board Governance and Engagement

Directors, Appointments, and Onboarding

As shared with the Board in July, we received confirmation of Anna Boudria’s appointment to the Board as a Public Director for a one-year term. When Anna was appointed, we were advised by the Public Appointments Secretariat that they would revoke Jacqueline Morrison’s Order in Council following Jacqueline’s resignation from the Board. While the College has not yet received the official revocation, the Board remains properly constituted.

We received notice of resignation from Naa Yoyo Nartey-Khama, Professional Director, effective September 1, 2024. Naa’s principal residence and place of practice are now outside of Ontario and therefore she no longer meets the eligibility criteria to serve as a director.

Alexia Singh will be continuing with the Board and Lynne-Marie Culliton will be joining the Board at the October meeting, both having been acclaimed in this year’s Professional Director elections. Hardeep Fervaha will be leaving the Board after the October meeting having not sought re-election.

We thank Jacqueline, Naa, and Hardeep for their contributions and welcome Lynne-Marie.

Staff have updated the onboarding process for new Directors, and orientation and onboarding meetings were held in the month of September.  

Board and Committee Training

In June, Board Directors and non-Board committee members convened for a day of training. The first session titled “Leaders in Regulatory Excellence” addressed the College’s approach to governance and principles that guide Board and committee decision-making in the public interest. The second session focused on putting compassionate and person-centred regulatory concepts into practice. The final session was a conversation between all Board Directors and committee members on the Board’s continuous learning priority of engagement and participation.