Governance Modernization

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People sitting around a conference table

Upcoming consultation on governance modernization

Council provided the College with a clear agenda for change after government indicated it will initiate a comprehensive consultation on governance modernization over the coming months.

As government may soon be holding conversations about amending the Regulated Health Professions Act, 1991 (RHPA) and profession-specific statutes, Council expressed hope transformative change could be achieved. They provided CPSO with direction to help shape the government’s governance modernization agenda and inform the necessary legislative and regulatory changes.

Council also provided direction on red-tape reduction strategies should the government consider broader changes to regulatory colleges at this time.

Governance modernization has been a significant priority for CPSO since 2018. Much work has been done to develop governance principles and make best-practice structural changes, which update and strengthen the integrity of our regulatory system and mandate to ensure public protection.

We began with a plan to implement reforms that could be made without legislative change, but rather by Council approving changes to the by-laws (including term limits and the removal of standing committees). Still, many of the identified reforms required legislative or regulatory change. Therefore, in March 2019, a proposal for legislative and regulatory change was submitted to the Minister of Health and Long-Term Care.

Since then, CPSO has been working with government to advocate for the adoption of these suggested changes.

At its meeting, Council not only affirmed the catalogue of governance modernization changes that were previously supported, but, in some instances, took the opportunity to strengthen a number of the recommendations.

The following are CPSO’s recommendations:

1. Reduce the size of the board (a.k.a. Council)

Council supported pursuing a board size of 12 members with a minimum of eight members. Previously, Council supported a range of 12 to 16 members.

Best practices continue to support a lower ceiling of 12 members. Currently, CPSO Council is comprised of 34 to 37 members.

2. Implement a competency-based board selection process

Council supported pursuing a competency-based appointment process for all members of the board. This approach is considered a best practice, as it supports the right mix of knowledge, skills and experience amongst board members to ensure it can effectively discharge its functions.

In 2018, Council indicated it preferred a hybrid model that would see some physician Council members appointed and others elected.

However, since 2018, there has been a growing consensus outside the College on the value of competency-based appointments.

3. Eliminate overlap between board and statutory committee membership

Council continued to support the elimination of overlap in membership between the board and statutory committees.

Separating committee membership from the board will enhance the integrity and independence of both groups, and help strengthen public confidence in the regulatory system.

4. Equal composition of public and professional members on the board

Council continued to support equal composition of public and professional members on Council. Currently, public members occupy less than half of Council.

Ensuring a balance between public and professional members will allow for a broader range of expertise and competencies on Council and help strengthen public confidence in the regulatory system.

5. Allow CPSO to compensate public members

Council continued to support CPSO’s bid to compensate public members.

CPSO has long argued that government’s compensation scheme for public members is inadequate and unbalanced against the compensation received by Council’s physician members.

CPSO compensates physician members of Council and has sought the ability to compensate public members as well. The rate of compensation would be set in the by-laws as it is for Council’s physician members.

6. Eliminate the Executive Committee

Council supported eliminating the Executive Committee should board membership be reduced to 12 members. The Executive Committee serves as CPSO’s decision-making body in between regular meetings of Council.

The previously submitted legislative change recommended keeping the option of an Executive Committee should the board have 16 members. If Council were reduced to 12 members, the need for an Executive Committee would be further diminished.

7. Presidential term

Council supported the ability to have greater flexibility in Presidential and Vice-Presidential terms by seeking the power to set the term-length and appointment process via by-law.

One-year terms are not considered best practice and are, instead, seen as hyper-rotation. In keeping with ongoing considerations and discussion regarding this issue, legislative change would promote stability and enable flexibility regarding length and appointment process for Presidential and Vice-Presidential terms. This would enable CPSO and other colleges to determine the approach that works best for them.

Council also supported changing the terminology of President/Vice-President to Chair/Vice-Chair. This language is consistent with broader board nomenclature and clarifies the role of Council as a governing board.

8. Urge government to address title protection for “osteopath”

 Council supported advocacy that encourages government to better address use of the title, “osteopath.”

The Medicine Act provides title protection for “osteopath,” leading to significant confusion as osteopathy is not a regulated profession in Ontario. There are a small number of CPSO members whose undergraduate medical degrees are Doctor of Osteopathic Medicine, a degree granted by some American institutions. Currently, only these members of the College can use the title, “osteopath.”

However, in spite of this restriction, there are a sizable number of people in Ontario who are not a Doctor of Osteopathic Medicine but refer to themselves as “osteopaths.”

Council is recommending government rectify the confusion surrounding title protection of “osteopath” and clarify CPSO’s role in protecting the title.

CPSO will keep the profession informed of the progress toward governance modernization.