REPORT TO THE BOARD – December 11, 2024
Submitted by: Kelly Dobbin, Registrar and CEO
The Registrar-CEO Quarterly Report assures the Board that the College operates effectively and achieves its strategic goals, and that the Registrar performs in accordance with the expected duties outlined in the Board’s Governance Policies.
The Registrar-CEO is accountable for the College’s performance in six main areas:
- Strategic Leadership and Direction Setting
- Development and Achievement of Goals
- Reputation and Relationship Management
- Financial Accountability and Management
- People and Organizational Leadership
- Board Governance and Engagement
Strategic Leadership and Direction Setting
Registration Regulation
We are continuing to work with the Ministry of Health in anticipation of a potential July 1, 2025, effective date for the new proposed changes in the Registration Regulation. In preparation for this change, the Registration Committee will be putting forward several policies for the Board’s recommendation in the coming months.
At the last Registration Committee in November, members reviewed a proposed policy to assess currency as a measure to demonstrate sufficient knowledge, skills and judgment to practise midwifery safely. Given the transformative nature of the policy and its impact on registrants’ relationship with the College, the Registration Committee has tasked College staff to consult with the registrants and system partners before finalizing the policy. The consultations are taking place over the next two months.
In early 2025, the Registration Committee will also review a proposed policy related to supporting new registrants. The policy will define the relationship between the mentors and mentees and outline any requirements necessary to support the registrants as they commence independent practice.
The Board can expect to review both proposed policies at their next meeting in March 2025.
Pathways to Registration for Internationally Educated Midwives
- Bridging programs
College staff is continuing to collaborate with the Chang School of Continuing Education to finalize the proposed International Midwifery Pre-Registration Bridging Program. The Registration Committee has made a recommendation to the Board to recognize the Chang School of Continuing Education’s proposed International Midwifery Preregistration Bridging Program (IMPBP) as qualifications equivalent to holding a midwifery education program in Ontario (please refer to the briefing note under Agenda item 9). The Chang school has already begun accepting applications as other Canadian jurisdictions have recognized the program.
We are continuing to meet 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 francophones midwives.
- Competency-based Assessment Tool
Considering the recent progress made on the Registration Regulation, the project has been realigned to fit with the revised Registration Regulation potential summer implementation date.
An environmental scan of various resources aimed at addressing deficiencies in midwifery competencies has been conducted. A synthesized version of these resources will be presented to the Registration Committee as a decision-making tool for approval in the new year, along with a policy to determine who will be subject to the competency-based assessment.
Office of the Fairness Commissioner
The Office of the Fairness Commissioner recently launched a client satisfaction survey, to help ensure that their approach to improve fair registration practices was based on the principles of transparency, professionalism, and collaboration. We completed the survey to help them improve their programming as an oversight body.
Laboratory and Specimen Collection Center Licensing Act, General Regulation
The College has met and communicated with the Ministry of Health’s Lab Branch at regular intervals since our last Board meeting regarding the proposed expansion to Schedule 2 of the General Regulation of the Laboratory and Specimen Collection Centre and Licensing Act, which permits midwives to order laboratory tests and perform point-of-care tests (POCT).
The College continues to provide relevant evidence to support the expansion despite opposition to several of the proposed tests raised during the Ministry-led public consultation that concluded in May. All remaining tests under continued discussion support clients’ direct access to essential laboratory and POCTs tests within the practice of midwifery as defined by the scope of practice statement in the Midwifery Act. The College continues to focus on the public interest in all our communications.
College staff acknowledge that the resources expended through this years-long process of negotiating back and forth on specific tests is a poor use of ours and the Ministry’s time and financial resources. We have reminded the Ministry that the Board’s formal submission in 2018 to permit midwives to order laboratory tests and conduct POCT in accordance with midwifery scope (as physicians, dentists, and nurse-practitioners do) is a more appropriate use of resources and regulatory authority.
Designated Drugs and Substances Regulation
As discussed with the Board in October, following the implementation of the Designated Drugs and Substances Regulation O.Reg. 188/24 in May, which included the Respiratory Syncytial Virus (RSV) vaccine for newborns, the College was made aware of a significant change in clinical guidance related to immunization of newborns against RSV, making the RSV monoclonal antibody (not the vaccine) the recommended immunization.
Midwives, their colleagues in Pediatrics, Public Health Ontario, hospital administrators, and the Association of Ontario Midwives have worked hard to establish workarounds to allow infants of midwifery clients to have direct access to the monoclonal antibody, Beyfortus. The College acknowledges that these workarounds are not sustainable and do not serve the interests of midwifery clients who were expected to have access to the RSV immunization from their midwife.
The College maintains our evidence-informed position that a list-based regulation has significant limitations, resulting in additional work by physicians, midwives, and system partners to deliver the recommended care, and additional resources for clients to access that care. The Board is reminded that the expansion of the list in May was considered by the Board and Ministry to be a temporary measure to bridge the gap between current needs and future changes permitting midwives to prescribe and administer to scope. The College shares this perspective with several other health profession regulators and associations and together have requested to meet with the Minister about this issue.
Development and Achievement of Goals
Public Opinion Survey
The College’s public opinion survey was conducted in late September and early October 2024. Key findings will be presented to the Board at its December meeting. Highlights include high satisfaction rates among midwifery clients; high levels of trust and respect from midwifery clients; insights about the factors that contribute to a client’s decision to choose a midwife; and information about the public’s awareness of a regulator generally, and the College specifically. Staff will be using the findings of this survey when considering our public engagement plan for the 2025-26 fiscal year, and in preparation for strategic planning.
Website Assessment
In September-October 2021, the College engaged Campaign Gears, an external consultant to assess our website’s functionality. Several areas for improvement were identified, most relating to website users having challenges accessing the information they were seeking on the site. In March 2023, we launched our redesigned website, applying the learnings from the previous assessment and working to ensure the content was accessible. This fall we repeated the external assessment of our website from September-October 2024 and are pleased to report significant improvements to key metrics. Campaign Gears provided some recommendations to fine-tune the site further that we will be implementing in next year’s operational plan.
Presentation at Toronto Metropolitan University Midwifery Class
As part of our strategy to engage students, we have been in touch with midwifery faculty, offering to visit classrooms and talk about the College. On November 20, 2024, Director of Governance and Strategy, Nadja Gale, and Director of Professional Practice, Megan McCarrell, presented to a group of first-year students at Toronto Metropolitan University. They covered the system of regulation in Ontario, midwifery standards, the midwifery scope of practice, the concept of self-regulation, and College resources.
Completion of the First Reporting Cycle of the Professional Development Portfolio
On October 1, 2024, the first reporting cycle of the updated Quality Assurance Program concluded, with over 95% of midwives declaring completion of their Professional Development Portfolio. The goal of this program is to encourage midwives to set learning goals for themselves, based on self-reflection and self-identification of gaps or areas for enhancement of skills and knowledge. Over the course of the reporting period, midwives complete learning activities which relate to their goals, in addition to clinical case reviews. This 3-year plan is flexible, expansive, and inclusive of the broad spectrum of midwives’ professional knowledge.
Of the total number of reporting registrants, 20% were selected for review of their portfolio submission and peer case review documentation. Additionally, all midwives who were not in compliance with the Quality Assurance Program by the end of the renewal period were added to this group, with a total of 218 midwives included in the audit pool.
Following review of the submissions, 209 midwives (96%) were marked compliant, having successfully met the expectations of the portfolio program. Midwives in the audit pool showcased their learning goals in clinical areas, such as expanding their skillset in perineal repair, emergency management, and prescribing. Non-clinical activities included participation in leadership and communication skill development, quality improvement initiatives, and interprofessional teambuilding. We received certificates of completion of formal education programs, and detailed self-directed learning pathways developed by midwives on their own, reflecting a variety of different learning goals and activities. Nine midwives were marked non-compliant at the culmination of the auditing period, and their cases have been referred for review by a panel of the QAC on December 12, 2024.
The College continues to review the program to learn from the first year of implementation. We plan to reach out to program participants in the New Year to receive feedback on the program, and tailor ongoing communication with registrants to support them in meeting their QAP requirements.
Strategic Planning
The College’s current strategic plan will end March 31, 2026, therefore, we have started the process to plan for and launch the next strategic plan by April 1, 2026. The strategic planning process will be led by the Director of Governance and Strategy and will involve all staff and all Board Directors. The goal is to implement a process that is inclusive, collaborative, and results in a plan that provides a framework for strategic work across the organization and connects to the Board’s oversight responsibilities.
Strategic planning is a process to map out longer-term organizational objectives and shorter-term goals and initiatives to fulfill vision, mission, and mandate. It helps to:
- Build a strong organizational culture by clearly defining and aligning on our organization’s mission, vision, and goals.
- Align the Board and staff on a shared purpose and ensure all departments and teams are working toward common objectives.
- Ensure resources are allocated to the most high-impact priorities and risks.
- Assess our current situation (developing our current risk matrix) and identify any opportunities or threats to achieving our mandate, allowing our organization to mitigate potential risks in accordance with our regulatory outcomes.
Strategic planning has been established as a standing item on our monthly all-staff meeting agendas and the same will be true for Board agendas going forward. At each staff and Board meeting we will provide updates and/or hold working sessions as needed. We anticipate holding an in-person strategic planning session with all staff and Board Directors, facilitated by an external consultant, on June 24, 2025 (previously scheduled training day). The training day will therefore be rescheduled and held online. The Board will have an opportunity to provide feedback on a draft strategic plan in November 2025 and will be asked to approve the final strategic plan (and costed plan) in February 2026.
In the meantime, staff are conducting research and an environmental scan to inform our process. In addition, the leadership team have completed a review and update of the College’s risk register, which helps us identify and categorize risks to our regulatory outcomes, and the risk assessment matrix, which helps us determine the level of risk, any gaps or issues and mitigating strategies. All of this will help inform the future strategic plan, along with internal and human resource and program priorities, understanding the environment we are operating in and possible future developments.
Reputation and Relationship Management
Registration Renewal
On October 1, the College’s renewal process closed. The renewal process proceeded as expected, with most of our registrants completing their renewals on time. We are continuing to work closely with those who have yet to renew, aiming to minimize the likelihood of suspension or any disruption to their registration.
Autumn Edition of On Call Digital Newsletter Published
This edition of our digital newsletter included 2023-24 Annual Report, Board highlights from our October meeting, information on our resource for New Registrants, and more.
Meeting with the Association of Ontario Midwives
The College met with the Association of Ontario Midwives on October 30, 2024. We discussed areas of mutual interest, including regulatory changes and midwifery scope of practice.
Association of Ontario Midwives (AOM) Queen’s Park Reception
Director of Governance and Strategy, Nadja Gale, and Communications and Stakeholder Relations Officer, Victoria Marshall, attended the AOM’s reception at Queen’s Park on October 21, 2024. Staff had brief conversations with Deputy Premier and Minister of Health Sylvia Jones and Official Opposition Health Critic France Gélinas. Members of Provincial Parliament from all parties attended and spoke, with a focus on midwifery scope of practice.
Meetings Requested with MPPs
Following the Association of Ontario Midwives’ reception at Queen’s Park, we have sent meeting requests to the elected officials who spoke about midwifery scope of practice in their remarks. We have requested meetings with Deputy Premier and Minister of Health Sylvia Jones, Official Opposition Health Critic France Gélinas, MPP Mike Schreiner, and MPP Adil Shamji.
New Social Media Channel
Diminishing returns on X (Twitter) led us to decide to deactivate our account on that platform. We have a new account on BlueSky which can be followed here: https://bsky.app/profile/cmo-osfo.bsky.social. When we left X, our follower count was at 915. Within five days of launching our BlueSky account, we have already exceeded 650 followers and expect to grow more before the Board meeting.
Financial Accountability and Management
Statement of Operations
The Q2 Statement of Operations was approved by the Executive Committee at its last meeting and is presented under the Executive Committee’s report to Board (please refer to Agenda item 8) for your information.
Assessment of External Auditor
The annual assessment report of the external auditor was presented and approved at the October 2024 Board meeting. This marked the first use of the condensed version of the annual assessment. The Executive Committee has decided to conduct a similar annual review for the upcoming 2024-2025 fiscal year, noting that there have been no major changes in the organization’s structure or financial operations, and that previous reviews have been positive. A more comprehensive review will be conducted in the 2025-2026 fiscal year.
People and Organizational Leadership
Human Resources
The College has been engaged in discussions and activities to review and update our Culture Statement. We plan to finalize the revised statement in the new year. Once completed, staff will present it to the Board of Directors, as the Board plays a key role in upholding the organization’s culture by providing leadership and governance that aligns with the desired culture.
The College is currently recruiting for the position of Policy Development Officer within the Registration Department. Following a recent vacancy, we have taken the opportunity to reassess our needs over the next three to five years. Through this review, we identified a gap in policy development and implementation. With upcoming changes to the registration regulation, we anticipate an increased demand for policy development and implementation. Additionally, there is a need for the management of special projects that will help advance our regulatory objectives, including responding to the evolution of midwifery practice.
Board Governance and Engagement
Professional Board Director Elections
Changes to the governance schedule which will now see the governance year commencing in June rather than October will have implications for the College’s Professional Board Director elections process. Currently, registrants are notified of professional elections in April, the deadline for nominations is in May, and the elections take place during the month of June so that newly elected Board Directors can be confirmed to the Board slate at the October meeting. In anticipation of transitioning to the new governance schedule as of June 2025, the College will need to begin the election cycle earlier so that newly elected Board Directors can be confirmed at the June meeting. The following articles in the College’s General By-law outline the elections timeline:
5.11 – Notice of Election and Nominations
At least ninety (90) days before the final date for voting in an election, the Registrar shall notify every registrant of the date of the election, and of the nomination procedure including the deadline for returning nominations to the College.
5.12 – Nomination Deadline
The nomination of a candidate for election shall be in writing and shall be received by the Registrar at least sixty (60) days before the final date for voting in the election.
Given this, the timeline for elections in 2025 will be as follows:
- January 30, 2025 – elections are announced
- March 1, 2025 – deadline for nominations
- April 1, 2025 – voting begins
- April 30, 2025 – final day for voting
Successful candidates will be announced in May and will participate in an orientation process in advance of the Board meeting on June 25, 2025.
This new timeline has implications for three Professional Board Director terms that are up for re-election in 2025. Where these terms would have concluded in October 2025, they are now ending (and commencing) upon the June 2025 Board meeting date.