In 2010-11, a number of legislative amendments were made by the Ontario government that have a direct impact on physicians working in hospitals. The following summary provides an overview of these legislative amendments.
Public Hospitals Act – Regulation 965 (NP Admit and Discharge)
Regulation 965 under the Public Hospitals Act (PHA) was amended to allow nurse practitioners (NPs) to admit and discharge hospitals in-patients. The amendments enabling NPs to discharge in-patients came into force as of July 1, 2011; the amendments enabling NPs to admit patients, are not effective until July 1, 2012.
Other sections of Regulation 965 were also amended to extend other related duties and authority to NPs including the authority to complete Medical Certificates of Death in hospitals in accordance with the Vital Statistics Act and a duty to report dangerous or infectious patients.
Public Hospitals Act – Regulation 965 (Board Composition)
On May 3, 2010 subsection 2(2) of Regulation 965, which sets out the composition of the hospital board of directors was repealed and replaced with new language that prohibits any member of the medical, dental, extended class nursing or midwifery staff or any employee of the hospital from being voting members of the board.
On December 2, 2010 a new subsection 2(1.1) was added to Regulation 965 to provide that, in addition to the members of the board appointed or elected in accordance with the authority whereby the hospital is established, the following persons must be members of the board: the administrator of the hospital; the president of the hospital’s medical staff; chief of staff of the hospital, or where there is no chief of staff, the chair of the hospital’s medical advisory committee; and the chief nursing executive of the hospital.
The effect of both these amendments is such that beginning January 1, 2011 hospitals are required to have the administrator, the president of the medical staff, the chief of staff (or chair of the Medical Advisory Committee (MAC) where there is no chief of staff) and the chief nursing executive on the board, but these individuals are non-voting members.
Public Hospitals Act – Regulation 965 (Critical Incident Reporting)
To support the Ministry of Health and Long-Term Care’s Excellent Care for All Strategy, amendments to Regulation 965 under the PHA have expanded the requirement for hospitals to disclose critical incidents to the MAC and hospital administrator. As of July 1, 2010, subsection 2(4) of Regulation 965 was amended to provide that the disclosure of a critical incident is to be made, as soon as is practicable not only to the affected patient, but also to the MAC and the administrator.
A new subsection has been added that provides that hospital boards must ensure that the administrator establishes a system for ensuring, following a disclosure of a critical incident, that the incident is analyzed and a plan developed with systemic steps to avoid or reduce the risk of further similar critical incidents.
The board is required to ensure that the administrator provides aggregated critical incident data to the Quality Committee established under the Excellent Care for All Act at least two times per year. In addition, where the MAC identifies systemic or recurring quality of care issues in making recommendations to the board related to the quality of care provided in the hospital by the medical staff, dental staff, extended class nursing (appointed) and midwifery staff, the MAC is now required to make recommendations about those issues directly to the Quality Committee, and the Quality Committee is required to consider the MAC’s recommendations in making its own recommendations to the board.
Excellent Care for All Act
Quality Committee
Section 3 of the Excellent Care of All Act (ECFAA) provides that every health care organization shall establish and maintain a Quality Committee for the health care organization that reports to the organization’s responsible body.
Further to Reg. 445/10, the Quality Committee established by a public hospital under subsection 3(1) of ECFAA shall be comprised of the following:
- At least the number of voting members of the hospital board to ensure that 1/3 of the members of the Quality Committee are voting members of the hospital board
- One (1) member of the hospital MAC
- Chief Nursing Executive (as defined in Regulation 965 under the PHA)
- One (1) person who works in the hospital who is not a member of the College of Physicians and Surgeons of Ontario or the College of Nurses of Ontario
- Hospital Administrator (as defined in the PHA)
- Such other persons as are appointed by the hospital board
The hospital’s board shall appoint a voting member of the hospital’s board to be chair of the Quality Committee.
Section 4 of ECFAA sets out the following responsibilities of the Quality Committee:
- To monitor and report to the board on quality issues and on the overall quality of services provided in the health care organization, with reference to appropriate data.
- To consider and make recommendations to the board regarding quality improvement initiatives and policies.
- To ensure that best practices information supported by available scientific evidence is translated into materials that are distributed to employees and persons providing services within the hospital, and to subsequently monitor the use of these materials.
- To oversee the preparation of annual quality improvement plans.
- To carry out any other responsibilities provided for in the regulations.
Section 8 of the Act requires hospitals to develop a quality improvement plan (QIP) every fiscal year for the next fiscal year and make the QIP available to the public.
Surveys
Section 5 of ECFAA requires the hospital to carry out a number of surveys. Beginning April 1, 2012, hospitals must carry out surveys of employees and of persons providing services within the hospital, including physicians. These provider surveys must be conducted every 2 years. The hospital is also required to carry out yearly surveys of hospital patients and their caregivers.
Performance-based Compensation
Section 9 of ECFAA provides that every health care organization shall, in accordance with the regulations, ensure that payment of compensation for any executive of the organization under a compensation plan is linked to the achievement of the performance improvement targets set out in the annual quality improvement plan.
Reg. 444/10 defines “executive”, with respect to a public hospital as:
- Members of the senior management group of the hospital who report directly to the hospital’s chief executive officer or, where there is no chief executive officer, to anyone who holds a position equivalent to the chief executive officer, regardless of title.
- Where there is a chief of staff of the hospital, the chief of staff of the hospital.
- The chief nursing executive of the hospital within the meaning of Regulation 965 under the Public Hospitals Act. [Note that section 1 of Regulation 965 defines “chief nursing executive” as the senior nurse employed by the hospital that reports directly to the administrator and is responsible for nursing services provided in the hospital.]
Freedom of Information and Protection of Privacy Act
The BPSAA also contained amendments to bring hospitals under the Freedom of Information and Protection of Privacy Act (FIPPA). As of January 1, 2012 FIPPA will apply to “records” that have been in the “custody or control” of a hospital since January 1, 2007, unless the record is subject to an express exclusion under the Act.
Records that are subject to express exclusions under the Act are not covered by the Act. For example, subject to specific exceptions, records that relate to: employment, labour relations, the appointments or privileges of health professionals, regulated health professionals’ private practice records, as well as research and teaching records, hospital foundation and charitable donation records, and records relating to the provision of abortion services are excluded from the Act. It is also important to note that FIPPA does not apply to personal health information that is subject to the Personal Health Information Protection Act (PHIPA), and as a result of an amendment to the Quality of Care Information Protection Act (QCIPA), FIPPA does not apply to quality of care information prepared by or for a designated quality of care committee under QCIPA.
In April 2011 FIPPA was amended to include a new exemption for quality of care records. These include records that contain “information provided in confidence to, or records prepared with the expectation of confidentiality by, a hospital committee to assess or evaluate the quality of health care and directly related programs and services provided by a hospital, if the assessment or evaluation is for the purpose of improving that care and the programs and services.”