Legislating collaborative self-regulation in Canada: A comparative policy analysis

Genetic counselors and legal recognition: A made-for-Canada approach

Genetic counseling is a fast‐growing profession in Canada. Yet, despite its growth, genetic counseling lacks legal recognition in the majority of Canadian provinces. Legal recognition serves to regulate professions, including genetic counseling, that if not properly regulated, expose the public to the risk of harm. Under Canadian law, there are three models of legal recognition: 1) the constitution of a professional order, 2) inclusion in a professional order, and 3) delegation. This paper explores the practical implications of these different models of legal recognition for genetic counselors. It focuses on the balancing act between protecting the public and the resources required to seek legal recognition under the three different models. With a small number of genetic counselors (n = 484, with 89% found in 4 provinces) compared to other professions, the route toward professional regulation for genetic counselors can be challenging. Though legal recognition occurs at the provincial rather than federal level in Canada, we nonetheless advocate for pan‐Canadian discussions that may benefit future pursuits of legal recognition.

Interprofessional collaboration and health policy: results from a Quebec mixed method legal research

Interprofessional collaboration (IPC) is central to effective care. This practice is structured by an array of laws, regulations and policies but the literature on their impact on IPC is scarce. This study aims to illustrate the gap between the texts and clinicians' knowledge of the legal framework using an anonymous web-based survey. The survey, sent to nurses and physicians in Quebec, Canada, focused on the IPC legal framework, legal knowledge sources and IPC perceptions or beliefs. The primary outcome was to determine the gap between the law and understanding of the law. The secondary outcome was to identify legal knowledge sources for clinicians in Quebec. A total of 267 participants filled in the survey. For knowledge acquisition, 40% of physicians turned to insurers whereas 43% of nurses turned to their regulatory body. Only 30% of physicians correctly identified what activity is reserved for physicians while 39% of nurses correctly identified their reserved activity. Regarding legal perceptions, 28% of physicians and 39% of nurses thought IPC could increase their liability. These participants have a higher tendency to name liability-related issues as barriers to IPC. These results show an important discrepancy between clinicians' knowledge about law and policies, and the actual texts themselves. This gap can lead to misinterpretations of the law by clinicians, ineffective policy changes by policymakers and can perpetuate ineffective implementation of IPC.

Conceptualizing interprofessional working - when a lawyer joins the healthcare mix

Research, policy and practice in the field of interprofessional collaboration have focused on how medical, nursing, allied health and social care practitioners work together to positively impact patient care. This paper extends conceptual thinking about interprofessional practice by focusing on lawyers as part of the interprofessional mix. This attention is prompted by medical-legal partnerships (MLPs), a service model by which lawyers join health care settings to assist patients with unmet, and often health-harming, legal needs. MLPs are present in around 450 hospitals and other health care sites across the United States and the model has spread to other countries, including Australia, the United Kingdom and Canada. However, enthusiasm for the MLP model is not yet matched by good evidence on how, when and for whom the model works. Interprofessional scholars contend that imprecise terminology and poor conceptualization of interprofessional arrangements hinder high-quality research and evaluation. In response to their critiques, this paper formulates a stepwise conceptual framework to guide the design, implementation and study of interprofessional arrangements that connect health, social care and legal practitioners. This framework draws on findings from national surveys of MLP initiatives in several countries and adapts several key conceptual frameworks that have been developed from systematic reviews of interprofessional working in primary health care. These conceptual frameworks are valuable because they promote clarity about different modes of interprofessional working and characterize the factors at macro (policy, funding), meso (organizational) and micro (practitioner, patient) levels that help or hinder professionals from different disciplines in working together. The paper considers factors at these three levels that require particular attention when lawyers join health care settings and proposes questions for future research in this emerging area.

Interprofessional education and collaborative practice policies and law: an international review and reflective questions

BACKGROUND

Healthcare is a complex sociolegal setting due to the number of policymakers, levels of governance and importance of policy interdependence. As a desirable care approach, collaborative practice (referred to as interprofessional education and collaborative practice (IPECP)) is influenced by this complex policy environment from the beginning of professionals' education to their initiation of practice in healthcare settings.

MAIN BODY

Although data are available on the influence of policy and law on IPECP, published articles have tended to focus on a single aspect of policy or law, leading to the development of an interesting but incomplete picture. Through the use of two conceptual models and real-world examples, this review article allows IPECP promoters to identify policy issues that must be addressed to foster IPECP. Using a global approach, this article aims to foster reflection among promoters and stakeholders of IPECP on the global policy and law environment that influences IPECP implementation.

CONCLUSION

IPECP champions and stakeholders should be aware of the global policy and legal environment influencing the behaviors of healthcare workers to ensure the success of IPECP implementation.

Factors influencing health practitioners' cognitive processing and decision-making style

Successful interventions, healthcare planning, and patient-centered care require explanation, justification, and collaboration through interprofessional clinical decision-making (CDM). Understanding health practitioners' decision-making styles and influencing factors can enhance CDM capabilities. Health professionals and students (N = 229) completed an online survey on their decision-making styles, interprofessional education, interprofessional practice, discipline education, clinical experience, processing styles, personality, interpersonal motivational factors, and age. To assess the influence of task structure, participants answered CDM questions on a high- and a low-structured case study. Age demonstrated an effect on the level of clinical experience, while clinical experience also mediated the effect of age on rational processing styles. While personality results were mixed, consistent with previous findings, conscientiousness predicted rational processing style. Effects of interpersonal motivation on personality were also mixed, insofar as results indicated an association between conscientiousness and both experiential and rational processing styles. Interpersonal motivation also predicted rational processing styles. The complexity of CDM and factors influencing healthcare practitioners' processing and decision-making styles was highlighted. To optimize CDM processes by addressing errors and biases, CDM, and practice complexity, healthcare practitioner education should include theory-driven CDM orientation frameworks.

Cognitive continuum theory in interprofessional healthcare: A critical analysis

Effective clinical decision making is among the most important skills required by healthcare practitioners. Making sound decisions while working collaboratively in interprofessional healthcare teams is essential for modern healthcare planning, successful interventions, and patient care. The cognitive continuum theory (CCT) is a model of human judgement and decision making aimed at orienting decision-making processes. CCT has the potential to improve both individual health practitioner, and interprofessional team understanding about, and communication of, clinical decision-making processes. Examination of the current application of CCT indicates that this theory could strengthen interprofessional team clinical decision making (CDM). However, further research is needed before extending the use of this theoretical framework to a wider range of interprofessional healthcare team processes. Implications for research, education, practice, and policy are addressed.