CLEAR 2008 Annual Conference

Anchorage, Alaska

If the Military can do it:Why can’t we?

How the Canadian Forces does “it”!

Presented by: LCol Susan GrovesCanadian Forces Health Services Pharmacy Senior Practice Leader

On behalf of BGen H. Jaeger, Surgeon-General

Canadian Forces

CLEAR, Sept 2008

Outline

• Overview of the Canadian Forces (CF)

• Overview of the CF Health Services

• Professional-Technical Chain/ Chain of Command

• Challenges

Canada

The Canada Health Act

Canada Health Act

• Canada's federal legislation for publicly funded health care insurance.

• Primary objective is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers

• Provincial/territorial responsibility – Constitution Act 1867

• Excludes members of the Canadian Forces

The Canadian Forces

Our People:

• 62,000 Regular Force members • 25,000 Reserve Force members

• Three “environments”: Land, Sea, Air

• Drawn from and located across Canada and around the world

Visible from sea to sea to sea

A presence in each province and territory, and practically every major community

A Worldwide Presence

NORAD

NATO

UN

Overall Goals of CF Health Group

• Improve or maintain health and mental well-being in CF members.– prevent disease and injury– diagnose or treat injury, illness, or disability

• Sustain or restore function, enabling the member to serve effectively in the CF.

Range of Services

CF Health Services is comprised of two branches

–Medical

–Dental

Provides a full range of services internally and purchases some specialty services

The CF has representation from virtually all regulated health professions including but not

limited to:

• Physicians• Dentists• Pharmacists• Nurses• Social Workers• Physiotherapists• Dieticians

• X-ray techs• Lab techs• Dental hygienist• Dental assistant• Physician Assistants

So how does the CF ensure that health services are provided by

competent practitioners?

CLEAR 2008 Annual Conference

Anchorage, Alaska

Health Services Professional-Technical Chain

QR&O Art 3.33No officer who is not a Medical Officer shall exercise command over a Medical Officer in

respect of his treatment of a patient

Health Services Professional-Technical Chain of Command

Health Professionals within the CF have two Chains of command (CoC)

• CoC defines who each individual reports to and who reports to them. It deals with all the various aspects of military life including military discipline

• The Prof-Tech chain is separate from the chain of command and deals with all the various prof-tech issues – licensure, education, training, equipment, scope of practice and professional discipline

Clinical Practice Leaders

Each of the various health professional disciplines has a Clinical Practice Leader. This person acts as the technical authority for that discipline and can also function in the role of regulator.

Practice Leader Responsibilities

• Ongoing licensure• Maintenance of Clinical Skills• Adherence to policy• Education and training• Liaison with the provincial bodies• Scope of Practice

Challenges faced

• Licensure in multiple jurisdictions• Varying Scopes of Practice• Combination of Canadian Forces, Public

Servants and Contracted Employees

Policy

Extensive, well-developed policies allow the CF to manage the challenges.

Policy Documents

• High-level direction with broad organizational application

• For example the release of medical/dental documents would be covered in a policy

Direction Documents

Usually flow from a Policy and include CF Health Services Group:

• Instructions

• Orders

• Directives

• Standards

Instructions

• Based on a higher-level policy

• Defines a course of action to be taken

• Empowers a subordinate to take a specific action

Orders

• Convey compulsory direction

Directives

• Provide interim direction

• Usually prof-tech in nature

• Valid for a fixed period of time

Standards

• Define the level of performance or service to be achieved

Standard Operating Procedures

This is less formal direction and includes:

• Standard Operation Procedures (SOPs)

• Advisories

• Guidelines

SOPs

• Established procedure to be carried out to perform a given task/function

Advisories

• Information communicating an opinion/guidance about what could or should be done in a particular situation.

• For example an out break of Flu

Guidelines

• Direction which is not mandatory to follow but should be followed.

Crown Liability and Proceedings Act

Public Servants, including military members, are covered under this act for any action on their part in performance of their duties.

- In other words this is our “malpractice insurance”

Investigations

The CF has numerous levels of investigation:

• National Investigation Services

• Military Police

• Board of Inquiry

• Summary Investigation

• Professional-Technical Investigation

Sanctions

The CF can and does sanction members:

• Limit Scope of Practice

• Order Retraining

• Report to College

Civilian-Military Co-operation

• CF does not do it alone. There is interaction between the various Practice Leaders and the Provincial Regulatory Bodies

• Practice Leaders can and do sit on National Regulatory Associations

Questions?

Thank you!

Speaker Contact Information

• LCol Susan Groves

• Canadian Forces Health Services Group Headquarters

• Groves.sv@forces.gc.ca