Systems of regulation in #physical #therapy

Dr Elizabeth Ellis sets out how regulation can help ensure that high professional standards are maintained nationally. SYSTEMS FOR UPHOLDING PROFESSIONAL STAN DARDS There are many systems for maintaining and improving professional standards. Each has advantages and disadvantages. This paper concentrates on regulation, but there are other ways of attempting to keep standards high: o International conventions. Many countries incorporate these into local law. o The legalsystem. The criminallaw civilaw and special regulations for professional groups can all help protect the public from bad practice. o Government policies. Governments can regulate the behaviour of practitioners through policies and sanction those who do not comply. o Codes of ethics. Professional associations attempt to control professional behaviour with rules, often referred to as codes of ethics. o Systems of health payment. In some countries, health insurance schemes can dictate the treatments provided. o Ethical training. A very strong influence on professional behaviour is the ethical training of practitioners, learned from role models. WHY REGULATE? Regulation protects the public from unqualified people assuming positions of responsibility without the ability to maintain standards of care. It can also be a means of tracing and managing qualified professionals whose practice falls below the acceptable standards. A professional group that is regulated often has a special standing and trust in the community. The professional group can, however, have limits put on its scope of practice by regulation. TYPES OF REGULATION Register of names Authorities can establish a simple register of the names of people who claim the title of physical therapist. This allows practitioners to be traced, and may provide information on the size and nature of the workforce, but achieves little else. Paper 1 Restriction on professional title A more significant sep is when only those on the register can call th emselves physical therapists. Usually this is accompanied by a recognition that only people with a certain qualification will be recognised as physical thera pists. Th is provides some control on the nature of the programmes leading to recognition. This type of regulation usually acknowledges that there is an overlap between professional fields. Howeve4 itshould also recognise that even though other professionals may apply techniques used by PTs, they are not practising physical therapy. Restricting practices A further step is to restrict certain practices to those on the professional register This is particularly relevant when the purpose of regulation is to protect the public. A more comprehensive process is to define the scope of the complete professional field and prohibit anyone from carrying out any of these practices. On the other hand, an extensive description of every task and procedure tends to limit the scope of practice, and can become dated very quickly. Licensure In some countries, there is a distinction between being registered and being licensed. In these countries, you can be on the register and call yourself a physical therapist, but still be unable to practise legally unless you have a current licence. This will usually be available annually for a fee, and may be dependent on the applicant updating and maintaining skills. This two-tiered approach can mean that administration of regulation is more complex. DEBATE ABOUT REG U LATION There is debate in many countries about deregulating health professionals. Registration is sometimeseen as anti-competitive, particularly when the profession itself has control over the supply and scope of practice. lt is sometimes claimed that the risk of injury is so low that the cost of administering regulation outweighs the public benefits. Some say that market forces should determine who offers what Keynotes is a series of occasional papers dealing with important professional, practice and policy issues relevant to physical therapists across the world, and to the development of physical therapy internationally. Keynotes are written by independent authors and do not necessarily represent WCPT's opinion. For further WCPT Kensington Charity Centre 4th Floor, Charies House 375 Kensington High Street London, W14 8QH عنوان البريد الإلكتروني هذا محمي من روبوتات السبام. يجب عليك تفعيل الجافاسكربت لرؤيته. ffi.wcpt.org Physical Therapy is a registered charity in the UK, no234307 owcPT 1999 health care services, and the result would be lower health care costs . This argument is flawed however, since the profession usually covers the cost of administration through renewal fees. There are also clear advantages to the public if there is an independent regulatory body to discipline individuals, advise on standards of education and practice and protecthe public. PUTTING INTO PRACTICE There are many decisions to be made if a system of registration is to be introduced, and they will be best resolved after open debate between legislative authorities and the groups which represent the profession. The profession will benefit from listening to fellow citizens, not just experts, on what is required for a fair and equitable system of handling complaints about standards of care. Reg istration requ irements Examination When establishing national or state exams for graduates, a registering authority has to consider whether the exam properly measures competency, and whether the standards expected for locals and therapists trained abroad are similar. The use of computers can improve access to exams, and ease administration over large geographic areas. Qualifications Recognising qualifications is administratively simpler. But the registering authority must decide on the system of recognition. There is a range of options. For example: . programmes can be formally accredited to verify the educational and practical standards of their graduates, and this usually requires a set of objective national standards against which the programme can be evaluated; o well-accepted and established programmes are sometimes automatically recognised ; o older qualifications are sometimes accepted on the assumption that practitioners with these will have developed skills and knowledge during their career Good character Another common entry criteria is that the person should be of "good character" and therefore fit to practice in a trusted profession. This can be assessed by: o charactereferences; o declarations concerning prior convictions; o a system of reporting convictions to the registering authority. Conditional reg istration In some countries, registration can be accompanied by conditions on practice: there may be a limit on time or the nature of practice, or a requirement that the practitioner should be supervised. These provisions are often used if a practitioner is visiting a country for a short time and wishes to teach or carry out research. MAINTAINING STANDARDS Once a proper system of registration is in place, maintaining standards becomes easier because practitioners can be held accountable. In an attempt to maintain standards, some countries have introduced mandatory continuing education. Others have introduced annual licensure exams. Other facets of the continuing process of maintaining standards are as follows. Dealing with complaints A system for maintaining professional standards must involve an independent, objective system for handling complaints with the power to investigate and prosecute. In most instances the outcomes will be determined by the laws and values of the relevant country. It is very important that there is guidance available for the complainant on where and how to lodge the complaint. lf a complaint goes to the courts and the individual is found guilty, then the registering authority can consider the outcome of the court case and the professional association can consider both the court decision and the decision of the registering authority. Because registering authorities receive complaints of varying severity, they need to have plenty of options for action. Sometimes practitioners are having problems themselves and need medical examination, counselling and rehabilitation rather than disciplinary action. Many complaints are resolved through alternative dispute resolution methodsuch as direct resolution or mediation. An apology or explanation can be enough to resolve some complaints. Gommittees of inquiry A committee of inquiry is a more formal mechanism for dealing with serious allegations. These committees can question the practitioner directly. Lawyers can accompany the practitioner and provide advice, but cannot act as advocates. For serious allegations which could have serious consequences such as de-registration, the court-like hearing is usually chaired by a person with legaltraining, and the practitioner isallowed to be represented by an advocate. Informal safeguards Although formalegislation and disciplinary provisions provide some safeguards, most control of professional behaviour probably occurs informally. The development of professional values in undergraduates should not be neglected, as this is one of the greatest opportu nities to infl uence professional standards. It is also wise to ensure that mechanisms such as peer review continue. Every professional has an interest in preventing unprofessional conduct in their peers. To ignore professional misconduct is to condone it. Keynotes i Reading list Health Care and the Law by M Wallace, (Law Book Co, Sydney, 1 995) Law for the Medical Profession in Australia by A Dix, l\il Errington, K Nicholson, R Powe (Butterworth Heineman, Sydney 1995) Striking a New Balance: a Blueprint for the Regulation ot Ontario's Health Professions (Ministry of Health, Ontario Canada,'1989) Disciplinary Irlbunals by JS Forbes, Law Book Co Ltd, 1 990 The Incompetent Doctor: the remedy by A Samuels, Medicolegal Journal 6412 1996 The Mediation Process by C Moore (Jossey-Bass, San Francisco,1987) What People Want from l\4ediation by DE Peachey in Mediation Research, edited by K Kressel, DG Pruitt and Associates (Jossey-Bass, London 1 989) Administrative Law: Neutrality, the Judicial Paradigm and Tibunal Procedures by M Allars (1 991 ) Mediation in Interpersonal Disputes: Effectiveness and Limitations by JA Roehl, RF Cook in Mediation Research 

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