The Governance Hub

“Good governance is a journey.”

                                                                                    Cathy Trower, Ph.D., President, Trower & Trower Inc.

 

In the fall, 2021, the CPhM Governance Committee began an intensive journey to fulfill its assigned task of governance reform.  The work that ensued resulted in recommendations to Council which described transformative change to governance of the organization.  With courage and determination to follow regulatory best-practice, the Governance Committee, and in turn, Council, set out a framework that would create an environment that supported effective professional regulation and sustainable governance into the future.

 

The method of council selection was a key topic for review.  In a modern regulatory environment, best practice suggests that selecting council members through a process of (accepting) applications and (making) appointments to council is preferred.

 

The College of Nurses of Ontario (CNO) was an early adopter of an appointment process.  In a report from CNO Task Force studying the topic (“A Vision for the Future – Leading in Regulatory Governance”, May 2017), the strengths of an appointment process were outlined:

• Appointing, rather than electing, council members eliminates the perception of “constituency” and the misconception that professional council members represent a constituency of fellow professionals, rather than the public interest.
• Competency-based appointments ensure a council has the right mix of knowledge, skills, experience, and attributes to make evidence-informed decisions in the public interest.
• Appointments supports diversity. The process can identify and seek appointees who work with specific types of patients, in specific communities, and that represent diverse populations.
• Historical data revealed poor registrant engagement in the election process; alternately, registrants were more engaged in processes which included the element of volunteering (or applying) to serve on college governance entities, like committees.
• An appointments process supports succession planning for council composition; an election process does not.
• An appointments process is fair, transparent, accountable, and effective because it is based on a pre-determined set of competencies that Council, collectively, maintains.
• A robust set of procedures guides the appointments process to further ensure fairness, transparency, and accountability.
• Council member turnover is managed, with the constant goal to maintain a stable, appropriate balance of experience, new ideas, and vigor.

 

In contemplating a significant shift in governance framework such as this, it is often helpful to understand the policy statements that support such changes.  In Manitoba, the College of Registered Nurses of MB (CRNM) adopted an appointment process to select council members before CPhM.  CRNM policy statements assisted the CPhM governance reform to support the transformation to appointment of council members.   The following set of policies were developed to guide the appointment process of council member selection for CPhM:

 

Appointments Committee Terms of Reference

Appointments Committee – Council Member Selection Process

Competencies for Council Appointments Process

 

These policies assist in understanding the governance “infrastructure” that support an appointments process.

 

Other regulators who have eliminated elections and adopted the process of appointing council members, report unexpected, positive consequences:

• The stigma of a “popularity contest,” that is associated with elections, is removed from the process of selecting council members
• Perhaps because this stigma is removed, there is greater interest from the general registrant population to apply for council service
• The process of selecting council members by appointment is more concise and punctual. The selection panel charged with bringing forward recommendations to Council for appointments sets out a call for applications for council positions and brings forward recommendations in a timely manner.

 

Conclusion

 

As more professional regulators adopt an appointments process to select council members, it is becoming the broadly accepted ‘gold-standard’ to which regulators aspire.  With robust procedures in place, the appointments process can be objective, impartial, and promote equity and inclusion, based on evidence of candidates’ merit to best meet the needs of the governing body.  CPhM continues to evaluate its procedures to eliminate unintended bias or discrimination and enhance fairness and transparency, to the greatest extent possible.

 

REFERENCES

1. A Vision for the Future – Leading in Regulatory Governance,” College of Nurses of ON, May 2017
2. Council Member Recruitment and Selections Policy , College of Registered Nurses of MB, March 2023
3. Council Member Selection Panel – Terms of Reference , College of Registered Nurses of MB, March 2023

Council’s Role in Public Protection 

The governing body of a health professions regulatory college is known as a council.   

 

A council is responsible for setting the strategic direction of the organization and ensuring that the organization meets its mandate to uphold the public interest. 

 

A council is accountable to the Minister of Health (the Minister) and has a fiduciary duty to operate in good faith and carry out its activities in a manner that serves and protects the public interest. 

 

Council of the College of Pharmacists of Manitoba (CPhM) oversees the regulation of the pharmacy professions and conducts the business and affairs of the organization in a transparent, objective, impartial manner.  It makes decisions to establish and enforce regulations, by – laws, policies, and programs that protect the public interest, as outlined in the Pharmaceutical Act of Manitoba, (the Act).  These policies and programs: 

• set education and other entry-to-practice and licence requirements for pharmacists, pharmacy technicians and pharmacies 
• set professional and ethical standards of practice for the profession of pharmacy 
• set quality assurance programs to ensure the continuing competence of pharmacy professionals  
• ensure CPhM is able to receive complaints about professional conduct, carry out investigations, and take appropriate disciplinary action when required. 

Individuals contribute by bringing their own unique set of knowledge, skill and experience to the role of council member.  Council involvement provides individuals with rewarding opportunities to participate in both public protection and the continuing development of health care professions. 

 

Council Selection and Composition 

CPhM Council is composed of twelve members:   

• one (1) pharmacy technician 
• six (6) pharmacists 
• four (4) public representatives 
• one (1) ex-officio, the Dean of the College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba (or designate) 

The CPhM has adopted an appointment process to select pharmacy professional council members each year.  As part of this process, Council determines a list of competencies that are being sought in a particular term.  The competencies are established on principles of good governance, public interest, and reflect the constructs of equity, diversity and inclusion. 

 

 Following a call for applications, the Appointments Committee will select the number of pharmacy professionals required to fill the vacant seats on Council.  A slate of appointees is then presented for Council confirmation. 

 

Public Representatives are appointed by the Minister responsible for health. 

 

Term of Office 

Pharmacy professional council members serve a three – year term and may serve two consecutive terms, for a total of six consecutive years on Council. 

 

Appointed Council members serve a length of term as determined by the Minister. 

 

Council Member Participation 

The appointments process ensures that there are a wide variety of perspectives and backgrounds on Council, representing different geographical areas, cultural and work environment perspectives, backgrounds, etc., based on the competency matrix.  The competencies set out certain qualities that all Council members are expected to have and certain skills and experience that the Council, as a whole, seeks to encompass.     

 

All members of Council are expected to be effective contributors and Council aims to be diverse, inclusive, and representative of the public it serves. 

 

Generally, an effective council member: 

• Is committed and willing to uphold the public interest mandate of CPhM 
• Understands principles of regulation in the public interest and ability to make decisions in the public interest 
• Is willing to learn about regulation and governance and a commitment to participating in orientation and on-going education. 
• Has high standards of ethics and integrity 
• Has strong interpersonal communication 
• Is a good critical thinker 
• Is committed to preparing for and attending Council meetings as per the annual schedule 
• Is open-minded 
• Commits to uphold the concept of “council speaking with one voice” once decisions are made 

• Commits to serve a term as  appointed, typically a term of three (3) years 

Council members should be aware of the Pharmaceutical Act, the regulations and by – laws, as well as various other provincial and federal legislation which form the regulatory framework for pharmacy practice in Manitoba. 

 

Exclusionary Criteria 

Members of Council must not have a conflict of interest that would interfere (or could be perceived to interfere)  with the duty to regulate and govern in the public interest.  An individual who is an employee, board, or council member of a union or professional advocacy group, or who is a recent employee of CPhM may be perceived to have a conflict of interest. 

 

Council members come from all segments of the Manitoba population; however, it is stressed that Council members do not represent specific interests, communities, or constituents. 

 

Annual Time Commitment 

General meetings of Council are held five times a year (February, May, June, September, December).  Meetings are typically held on a weekday between the hours of 9:00 a.m. and 4:30 p.m.  Council members also attend topic – specific meetings from time to time as well as other planning and education events. 

 

In addition to attending Council meetings, Council members serve on statutory or standing committees of CPhM.  The number of committee meetings per year varies according to committee workload.   

 

Council members also spend time preparing for meetings. 

 

Meetings 

Council meetings are held by video conference and in-person at CPhM office, 200 Taché Avenue, Winnipeg.  All individuals on Council must have access to a computer equipped with a webcam and audio capabilities and facilitate their own attendance by video conference. 

 

Council Orientation 

Council members receive orientation regarding the role, mandate and governance framework of CPhM.  As well, there are other opportunities for Council members to participate in learning sessions which address the fundamentals of governance, professional regulation, and the roles and responsibilities of Council. 

 

Council Member Reimbursement 

Council members are eligible to receive remuneration for time while engaged in Council and committee meetings in accordance with CPhM policy.  As well, Council members are reimbursed for reasonable expenses incurred in the course of attending meetings, according to policy.

The following article is reprinted with permission by author Bruce Matthews. This article was originally published by the Council on Licensure, Enforcement, and Regulation (CLEAR).

“Successful regulatory boards reflect and embrace a diversity of perspectives, and they acknowledge that the public interest is the only interest that must impact their decision making.” – B. G. Matthews

 

Many Perspectives, One Interest

In my 17 years of professional and occupational regulatory experience, including 11 years involved with CLEAR, I’ve worked with numerous boards and exchanged views with senior staff at countless regulatory organizations. I’ve always been struck by the commonality of experience on a broad range of issues. Board governance, board composition, and the primacy of the public interest are just a few of those issues.

 

The composition of professional and occupational regulatory boards can vary greatly within a given jurisdiction, and it does vary greatly across jurisdictions, nationally and internationally. Some boards are filled with appointed members, some have only elected members, and many include a combination of the two. In any case, it is more than likely that specific members are selected, or elected, to fill a specific requirement—e.g., they come from a specific geographic region, they come from some pre-defined subset of the practitioner base, or they possess some specific qualification or credential required by statute.

 

It is both reasonable and appropriate for governing legislation to enumerate such requirements for the composition of a board. Having a diversity of perspectives—driven by geography or other factors—makes for a more balanced, inclusive and effective board. The challenge faced by regulators, however, is that the individual board members who are chosen or elected based on these subdivisions often feel that they “represent” that group. This is especially true of board members who are elected—there is a natural tendency to believe that they have a constituency to represent when serving on the board. This is patently untrue, but it can be a significant challenge to communicate and educate such board members about their core roles and responsibilities.

 

At the heart of the challenge is understanding the difference between interests and perspectives, or in other words the difference between representing a group versus employing personal knowledge and experience based on membership within a group. A professional or occupational regulatory board has one interest only—the public interest. It is sometimes expressed more specifically as the public welfare or public safety, but at its essence is the notion that the regulator exists so that there may be a well-ordered society in which public interest risks are mitigated and managed. This is the foundation of risk-based regulation.

 

A regulatory body is not a club, and the interests of the practitioners do not matter. These are probably the biggest hurdles for board members who are practitioners, and/or have been elected by practitioners, to overcome. It can be very hard for them to understand that there is no constituency to be represented at the board table. It can seem unnatural for elected board members to not be a voice for those who elected them.

 

What needs to be explained and illustrated, initially during an onboarding or orientation process and frequently reinforced thereafter, is that board members are there to represent the public interest—period. Fairness to practitioners and to others who engage the regulator is essential, and tenets of accountability and transparency must be followed, but the only interest is the public interest.

 

Board members must be made to realize that they are there to provide their particular perspective, whether it is borne of geography or some other subdivision of the practitioner population, or based on some other qualification or credential. A board of like-minded individuals with identical backgrounds cannot function well—it cannot foresee challenges and cannot respond to them in a fulsome way. Such a board is like a toolbox filled only with hammers. The unique perspective of a diverse range of individual board members, based on their life experiences, both related to the practice of the profession and otherwise, enriches the board as a whole and brings benefits where the total is greater than the sum of the parts.

 

Getting a board, and its individual members, to accept and adopt the philosophy of “many perspectives, one interest” isn’t easy. Primary responsibility should fall on the board chair, and perhaps extend to the executive committee. But what does a regulator do when the board chair doesn’t “get it,” and takes on the persona of a representative of a constituency and promotes other interests? This is when the CEO or Executive Director of the regulatory organization must step in and set the record straight.

 

The orientation and training of board members is an ongoing effort. In most jurisdictions, board members are volunteers and/or are only engaged in regulation on a limited, part-time basis. They do not live and breathe regulation as staff do. The best chance for success is when the seed of “many perspectives, one interest” is planted early, and frequently revisited. This message should not be delivered only after individuals are appointed or elected to the board, but rather communicated to individuals who are considering appointment or running for election. It is in this way that expectations can be managed—both early and comprehensively, and newly appointed or elected board members won’t have to deal with whiplash associated with their actual roles and responsibilities.

 

Successful regulatory boards reflect and embrace a diversity of perspectives, and they acknowledge that the public interest is the only interest that must impact their decision making.

The following chart outlines key distinctions between a regulator, exemplified by the College of Pharmacists of Manitoba (CPhM), and an association in the context of healthcare professions, particularly pharmacists and pharmacy technicians. The regulator, CPhM, is accountable to both the public and the government, ensuring mandatory registration for professionals and maintaining a transparent register. It actively engages in public education and regulates the conduct of its registrants. On the other hand, the association operates on a voluntary membership basis, advocating for professional interests, providing benefits, and engaging members for their professional needs. The chart underscores the differing roles, responsibilities, and orientations of these entities in the healthcare landscape.