Members’ Session Overall PDEP Futures Project Project Goal: To confirm each partner group’s mandate; clarify the PDEP’s mandate and function while identifying its strengths and limitations; and clarify the terms and conditions under which each sector group will support PDEP into the future. Inside: 1. Context, Background, Introduction p. 2 2. Gathering input on how to advance PDEP’s functions p. 3 Creates a Common Vision p. 4 To set the overall context for a conversation about the future of PDEP Develops, monitors and maintains the currency of the integrated competencies p. 7 To gather input on how to advance PDEP’s 3 functions Implements the Accreditation Standards p. 10 To determine tentative next steps re: this work Maintains effective and efficient Partnership operations. p. 13 3. Closing Remarks and Next Steps p. 14 4. App. A: Session Participants p. 16 5. App. B: G. Zello Visual Aides p. 18 6. App. C: W. Marsh Visual Aides p. 19 Objectives for this Session: June 10th in Ottawa Context: Background & Introduction G. Zello and W. Marsh provided comments on the events and larger context that framed this session. Here are the main points: PDEP Futures Working Group 1st Year in Review (see slides, Appendix B) G. Zello provided a high-level overview: Nov, Dec 2009 Origins of PDEP Since 2009 PDEP actions and explorations May 2013 Partners Working Group on Future Options created June 2013 Victoria PDEP Meeting, group discussions on PDEP’s future June to Aug 2013 Fall 2013 – Summer 2014 Victoria debrief Waves 1 & 2, consultation process re: Facilitator engaged Legitimate mandate for PDEP; Accreditation coming under PDEP; and Other possible joint priorities. WAVE 3 during the fall 2014/winter 2015 will involve validation of work to date and final recommendations. W. Marsh, Introduction to this Session (see slides, Appendix C) The results of the PDEP Futures Initiative to date (text box right) vs. the work commissioned Clearer Core Purpose PDEP is an inter-organizational network (for more on this see: Popp J. et al, Inter-organizational networks A critical review of the literature to inform practice (February 2014)1. Clearer/tighter supportive functions 1 2 Futures Results to Date An Inter-organizational network is 3 or more organizations working together toward a common purpose. While having the potential to achieve things that could not be accomplished any other way, this organizational form has its Popp, J. et al challenges. The literature suggests that PDEP’s growing pains are predictable, given acknowledged stages of development for nonprofit inter-organizational relationships. (see: Charles Lusthaus with Christine Milton-Feasby, The Evaluation of Inter-Organizational Relationships in the Not-for-Profit Sector - Some Observations (June 2006)2. Success with inter-organizational networks depends on the level and quality of trust amongst partners, which in turn is aided by the participants’ motivation and ability to collaborate and engage in different forms of communication and decision-making. Added Decision-Criteria re: Joint Initiatives Affirmed 3-3-3 Steering Ctee Structure Affirmed DC as Secretariat Emerging structure for Accreditation under PDEP (via MOU) http://www.research4children.com/data/documents/NetworkLiReview-Feb27-2013-Final.pdf http://www.universalia.com/sites/default/files/articles/fichiers/2006_ior_notforprofit.pdf PDEP Futures Initiative – Wave 2 Members’ Session 2 Context: Background & Introduction (cont’d) It is assumed that real, other-centred curiosity will lead to: legitimate initiatives advancing more quickly; communication that is clearer and more positive; trust building; confidence rising at the Steering Committee level; and enhanced PDEP/Steering Committee credibility overall. The questions that the PDEP Futures Working Group+ would like the Members to consider today are: 1. 2. What if the annual Members’ meeting were used to gather ideas to inform collaborative development of PDEP’s Work Plan by Function for the upcoming year? To what extent do the proposed PDEP Functions (right, and distributed in advance) provide a useful framework for that process? PDEP Proposed Functions a. Creates a Common Vision for the education and the practice to inform future joint initiatives; b. Develops, monitors and maintains the currency of the integrated competencies; and c. Implements the Accreditation Standards through collaborative structures and processes. d. Maintains effective and efficient Partnership operations. Gathering input on how to advance PDEP’s first 3 functions The purpose of this exercise was to test the validity and usefulness of the proposed functions in focusing the work of PDEP. The Futures Working Group+ considers the 4th proposed function to be an enabler of the other three. It was decided in planning this event that the participants’ energies would be focused on the 1st three functions; the Working Group+ will use findings from this work will help define the 4th function. Each of the following 3 sections begins with the Dialogue Guide used to frame small group conversations about the proposed function. Each table was assigned one of the 3 functions to provide for good coverage. Table composition was pre-determined to ensure diversity across Sector Partner Groups. A Futures Working Group+ member hosted each table, notes were taken, and the small group reports back were digitally recorded to inform this summary report. Note: This a synopsis of themes derived from small group work and doesn’t necessarily represent a synthesized, collective view or formal consensus. PDEP Futures Initiative – Wave 2 Members’ Session 3 How to advance PDEP’s first 3 functions (cont’d) Small Group Context for dialogue regarding the PDEP Function (a): In carrying out its Core Purpose, PDEP: Informs future joint initiatives by creating a common vision for the education and the practice Sector Partner Groups’ respective stated interests in this Core Function Dietitians of Canada Identifying areas of collaboration that are important to move the education and practice forward to meet future health needs of society Alliance of Regulatory Bodies Regulatory bodies are legislated provincially for the primary purpose of ensuring the Canadian public receives safe, competent and ethical dietetic services as the profession of dietetics evolves. By being a partner in the creation of a common vision, regulatory bodies can proactively develop a supporting framework of standards and other regulatory mechanisms at the provincial level. Educators As a partner in the creation of a common vision, educators can proactively shape programs to meet current and emerging practice needs, so that dietitians can contribute to addressing the food, nutrition and health needs of society. Content Question for Dialogue: 1. The purpose of a common vision is to inform choices about joint initiatives that PDEP might undertake. What do you think are areas in need of visionary thinking and action where the Partners’ interests intersect? For example, some might say that health human resource planning could be reflected in a common vision. To what extent do you agree? If you do agree, what role(s) do you see PDEP playing? 2. What might be other priority areas in need of visionary thinking and that align with PDEP’s core purpose? Process Question for Dialogue: What are your ideas about the best ways to build on today’s work to create a genuinely common vision for the education and the practice? Feeding the FAQs for this Function: Be sure to capture relevant questions for which answers don’t seem to be in the room today. We will get the PDEP Steering Committee to wrestle them to the ground and provide answers in the weeks to come. PDEP Futures Initiative – Wave 2 Members’ Session 4 Areas in need of visionary thinking and action where the Partners’ interests intersect (in no particular order) 1. Development of a cohesive, organized forum for communication among educators , so that representatives can speak with one voice. * How might PDEP support the Educators’ group to ‘meet’ regularly and come forward with elements of a common that they would like to move forward? That might require some funds and support from a facilitator. 2. Communication that provides for a 2-way flow*. How do we become clearer, overall in our communication? We put out messaging, but it doesn’t mean the same thing to everyone. Solutions might include: PDEP Proposed Function a. Creates a Common Vision for the education and the practice to inform future joint initiatives; * Deemed near-term priorities by one group a. Creation of SMART goals b. Interpreting high-level messages and repackaging them in brief e-mails so that they provide brief updates to each of the sectors 3. Given the changing landscape relative to how we are practicing, the Vision should look at: a. Ensuring ongoing clarity in the role of the dietitian; b. Inter-professional education; c. Scope of Practice. Increasingly, we have dietitian roles that have expanded to include insulin adjustment, dysphagia management, etc. People might require and benefit from additional training relative to those. How do we provide that? d. Routes to practice, for example: Management, accreditation and regulation of self-directed practicums How we deal with the assessment of internationally-educated dietitians coming to Canada (with implications for regulators including cross-border issues and standards) e. Mobility within the profession, for example from community to clinical. What kind of process could be introduced to make sure that the transition flows well and is not only comfortable for the dietitian changing practice areas but also safe for the public. This might take the form of some type of specialty credentialing. f. Advanced practice, in terms of standards of care that require advanced practice competencies (i.e. whether a masters degree, continuing education for special skills, or even at entry level). PDEP Futures Initiative – Wave 2 Members’ Session 5 Areas in need of visionary thinking and action (cont’d) 4. Advocacy. Develop a common vision and advocate for (for example): a. Work force planning. It might be implicit in the function statement itself, but one group felt we should state clearly that PDEP advocates for a common vision for practice/education with other health professionals (e.g. relative to health human resource planning) … promoting dietitians and what they do. b. Training of and placements for students PDEP Proposed Function a. Creates a Common Vision for the education and the practice to inform future joint initiatives; c. Appropriate jobs for RDs 5. Would training preceptors be a future area of competency development? Work would be needed to better understand the competencies we’d be training to. Best ways to build on today’s work to create a genuinely common vision for the education and the practice 1. In terms of process we need a combination of methods to develop the vision: a. National surveillance at all levels b. A forum for capturing emerging issues. Perhaps something like this face-to-face meeting could be that forum, every year (or two or three). c. What if we were able to do work amongst the sector groups regionally? d. Other methods of communication 2. Standardize the review of integrated competencies and accreditation standards (following a predetermined calendar of milestones)*. a. Feedback and input on pilot accreditations and standards * Deemed a nearterm priority by one group b. ICDEP o Design of a system to evaluate ICDEP o o Evaluation and revision of ICDEP Getting the ICDEPs out there should be part of PDEP’s role. There could be more support for making sure the new ICDEPs for entry-level practice are clear. As we move into accreditation, it is a problem for people to interpret things that are still at a high level, such as: Sims vs. practical training; • Ratings; • # of weeks for practicum; and • PLAR How to advance PDEP’s first 3 functions (cont’d) PDEP Futures Initiative – Wave 2 Members’ Session 6 In carrying out its Core Purpose, PDEP: Small Group Context for dialogue regarding the PDEP Function (b): Develops, monitors and maintains the currency of the integrated competencies Sector Partner Groups’ respective stated interests in this Core Function Dietitians of Canada Seeing that dietetics education and practice keep pace with evolving quality standards for health services and health needs of society Alliance of Regulatory Bodies Regulatory bodies exercise their public protection mandate when they ensure that only qualified applicants enter practice. Regulatory bodies must approve entry to practice standards and ensure they reflect current dietetic practice when dietitians enter practice. Competency standards give regulators a framework for developing competency assessment tools such as the Canadian Dietetic Registration Exam (CDRE). Educators Educators utilize the integrated competencies as a framework for program design and learner assessment. They are committed to participating in the development, monitoring, evaluation and continuous improvement of the competencies, to ensure that they reflect current and emerging practice needs. Content Question for Dialogue: During the Wave I consultations, there was a sense that defining competencies is one thing and announcing them is another, but that some sort of overall support is needed at the system level to ensure implementation is truly standardized across the country. 1. What priorities should PDEP consider building into its work plan in terms of ensuring implementation is truly standardized across the country? 2. What other priorities should PDEP build into its work plan relative to monitoring and maintaining the currency of the integrated competencies? Process Question for Dialogue: What are your ideas about the best ways to build on today’s work to address those priorities? Feeding the FAQs for this Function: Be sure to capture relevant questions for which answers don’t seem to be in the room today. We will get the PDEP Steering Committee to wrestle them to the ground and provide answers in the weeks to come. PDEP Proposed Function Ensuring implementation is truly standardized b. PDEP Futures Initiative – Wave 2 Members’ Session Develops, monitors and maintains the currency of the integrated competencies 7 General Observations: National standardization is very difficult; some flexibility is needed (e.g. in language). Also, we want standardization, but we don’t want to lose the aspects of a program that makes it unique. Also, see relevant comments generated by groups looking at the proposed Vision function (p. 6, item 2(b). Standardize the review of integrated competencies and accreditation standards Specific Suggestions: 1. Reflections on the accreditation experience are useful as feedback on competencies. Use information that DC has collected through its highlights reports concerning implementation as well as feedback through annual reports on how accreditation implementation is going. 2. Ensure accreditation ‘loops back’ and provides another way to capture and share implementation experience across Canada. 3. Do a follow up to the 2012 gap analysis process to identify outstanding problems. 4. Ensure more consistent interpretation of ICDEP. A common assumption is that educators are isolated and working alone, in need of some body to make the connections and deposit useful information. Ideas included: a. Develop more tools and methods to assist implementation by facilitating discussion re: ICDEP interpretation. For example: Forums FAQs Sharing of learning strategies On-line manual/resources Blog: list-serve for posting questions It was noted that there are discrepancies between the interpretation of the competencies in English and in French An interpretative guide for competencies that lack clarity b. Consider PDEP to be a kind of ‘hub’ that stores all of the information, perhaps: Designate a person or small group nationally to be the ‘point person(s)’ for questions/interpretations; Use a (hired) person to help educators make connections / act as a knowledge broker; Create an accessible a library, designed/managed by someone with library science qualifications. c. Share more about the Canadian Dietetic Registration Exam (CDRE), and how the information from that exam could be used to help evaluate whether programs are teaching to the new competencies. Look at the CDRE pass rate (although it’s late in the learning process to be determining that the competencies aren’t there). Ensuring implementation is truly standardized (cont’d) PDEP Proposed Function b. Develops, monitors and maintains the currency of the integrated competencies PDEP Futures Initiative – Wave 2 Members’ Session 8 5. Do more work relative to controversial competencies3, standardized learning plans and use of OSCEs. 6. Establish a better understanding of what practice vs. simulation really looks like. Monitoring and maintaining the currency of the integrated competencies 1. Have PDEP inform education and regulation by capturing/updating what is changing at point of entry to practice a. Update from each area of practice/competency re: concepts, ideas, technology b. Survey dietitians in the workforce around the future so as to inform competency development c. Perhaps the accreditation function could include a resource person for such interpretation. d. Facilitate the sharing of what’s changing: o o Practice –––––––––––> educators/regulators Innovation –––––––––> educators/regulators o Educators/Regulators ––––––––> ICDEP The promise of PDEP. Capitalize on each having different ‘windows’. PDEP should sort out whose responsibility it is to make sure that this information flow is happening. 2. What are the emerging new practices that need to be reflected in the competencies? a. How is practice changing? e.g. where is International Dietetics and Nutrition Terminology (IDNT) being implemented? b. Need an environmental scan and research concerning the work force to inform competency updates c. Consider labour mobility 3. Share the common assessment tool developed in Ontario. 3 DELFO’s March workshop on ‘problem’ performance indicators was cited as having been very helpful PDEP Futures Initiative – Wave 2 Members’ Session 9 Small Group Context for dialogue regarding the PDEP Function (c): In carrying out its Core Purpose, PDEP: Implements the Accreditation Standards through collaborative structures and processes Sector Partner Groups’ respective stated interests in this Core Function Dietitians of Canada Supporting a quality assurance system that promotes and supports programs that attract and retain students and interns, and that lead to attainment of dietetics competencies as needed and expected by those who employ and rely on services of dietitians Alliance of Regulatory Bodies Registration is a key regulatory function that protects the public by ensuring that only qualified applicants enter practice. Regulatory bodies rely on accreditation for the purpose of ensuring safe, competent dietetic practice at point of entry into the profession. Regulatory body interest in the development of accreditation standards and the accreditation process is rooted in our legal responsibility to either approve education programs or approve the agency responsible for accreditation. Educators Educators utilize accreditation standards and guidelines as key tools for program planning and curricular development. They value the contribution that accreditation processes make towards ensuring that programs meet minimum quality standards, are sustainable, continuously improve and strive for innovation. Accreditation status provides an opportunity for programs to be recognized, both internally and externally, for excellence in professional practice education. Question for Dialogue: A Joint Communiqué on Accreditation issued in March indicated that PDEP would be exploring with the 3 Sector Groups, the merits of considering a model that would see: Governance of accreditation come under PDEP; Operational management and decision-making about program accreditation become the responsibility of a new PDEP Council for Accreditation; and Administration of the accreditation services rest with a contracted Service Provider (Dietitians of Canada). Preliminary thinking around potential structure and role descriptions were also provided in the Joint Communiqué and are being refined with a view to appointing members of the PDEP Council for Accreditation in September. As this continues to unfold, what is your best advice on how to advance this important function including the model’s collaborative structures and processes? Feeding the FAQs for this Function: Be sure to capture relevant questions for which answers don’t seem to be in the room today. We will get the PDEP Steering Committee to wrestle them to the ground and provide answers in the weeks to come. PDEP Futures Initiative – Wave 2 Members’ Session 10 Best advice on how to advance this important function including the model’s collaborative structures and processes General Observations: Some people are concerned about this moving too fast. For PDEP to do this well will require a lot of work … i.e. continuing to monitor and developing the processes around it. PDEP Proposed Function c. Implements the Accreditation Standards through collaborative structures and processes There are also concerns that fees will be added to ensure sustainability. Shouldn’t the function also include: “ Develops, monitors, maintains currency?” Specific Suggestions: 1. Communications: a. We can’t rely on chains for communication. Determine the best way to communicate … what is communicated out, how, by whom, and to whom. b. Then convey clearly more detailed information to all partners: A clear timeline for when the pilot will start. This will help all university partners know how to prepare and when to start evaluation. What piloting means (as opposed to established accreditation). How it differs from the real accreditation that will follow later. The reasoning behind the questions (the lack of which causes anxiety and undermines trust). The level or degree of evidence required What constitutes a reasonable interpretation (includes being resource-able within an institution). Let’s not pursue standardization so heavily that we’re dealing with books of definitions. Rather, as a way to learn and grow, have conversations about what a reasonable interpretation of the standards looks like. Tools that will be used … will they be the same? A lot of tools seem to be missing to help prepare for accreditation. The structure that will receive and address feedback and make adjustments both during and after the pilot. o Perhaps form a Working Group to do address the pilot, receive ongoing feedback and make adjustments. o Information must be shared re: pilots for new standards (to enable learning from pilot sites as we go) PDEP Futures Initiative – Wave 2 Members’ Session 11 Best advice on how to advance this important function (cont’d) 2. Remember that accreditation is a quality assurance framework … i.e. it is about feedback loops, about learning from, and about sharing the information. It’s not about the pass/fail of a program. PDEP Proposed Function c. Implements the Accreditation Standards through collaborative structures and processes a. Provide a tailored report back to the accredited organization to meet their needs in developing and sustaining their program (not a highly standardized report but a personalized one); and b. Communicate the results of accreditation processes to others as we go, so everyone can learn from the experiences; c. Will results be shared with the regulators or just with the educational institutions? d. Reflections upon debrief regarding QA standards would help avoid this being top-down. 3. People would like to have known more before commenting but how will this be operationalized? a. The educators’ voice and input are essential. b. Faster processes are needed; they are currently slow (provisional to full) and there are related program concerns and safety concerns. c. We need to strike the balance between having concrete operating processes and ensuring flexible and fluid processes. d. Will the model it vary depending on the type of program … e.g. integrated internship? 4. Continued sustainability: a. Is membership still voluntary? There are concerns that there will be added fees to ensure sustainability. b. Has to be digital and easier, in order to be sustainable. c. There are concerns about the number of accreditors required to survey multiple sites. 5. Clarify roles: a. More information is needed concerning the role and structure of the PDEP Accreditation Council and the Service Provider. b. Why are multiple layers needed? … i.e. what is the role of the PDEP Steering Ctee vs. the Accreditation Council, vs. the Service Agency? c. How is the decision regarding the Service Provider going to be made? What criteria will be used? More info is needed. 6. Accountability and fee structures (which is related to communication of information and sharing) PDEP Futures Initiative – Wave 2 Members’ Session 12 Small Group Context for dialogue regarding the PDEP Function (d): In carrying out its Core Purpose, PDEP: Maintains effective and efficient Partnership operations. As mentioned earlier, the Futures Working Group+ considers the 4th proposed function to be an enabler of the other three. It was decided in planning this event that the participants’ energies would be focused on the 1st three functions. Although input wasn’t specifically sought, here are the thoughts of one group concerning PDEP operations: 1. At this stage, PDEP should deal with some operational issues: a. Adopt an operational decision-making tool that makes it clear what goes into decisions and their rationale b. Develop a values framework c. Do strategic planning d. Develop standardized mechanisms for communication and reporting decisions 2. One group issued a caution regarding moving forward with a couple of ‘really big things’ still on the table. Specifically, a lot of work is needed to finish off accreditation and perhaps even the competencies. PDEP Futures Initiative – Wave 2 Members’ Session 13 Closing Remarks and Next Steps According to the chart below, the challenges that PDEP faces as a network are to be expected at this point in its evolution (somewhere between stages 2 and 3). PDEP Futures Initiative – Wave 2 Members’ Session 14 Closing Remarks and Next Steps (cont’d) The findings from this session will help the Partnership continue to shift into the Maturity Stage and adopt more of a results orientation. Specifically, a work plan will be developed that is consistent with the purpose, functions and decision criteria that the Futures Working Group+ has proposed. Details of that work plan should be available to the Members in the Fall. PDEP Futures Initiative – Wave 2 Members’ Session 15 Appendix A June 10th Members’ Session Participants Name Organization Name Kayla Charna Terri Michelle Leslie Natasha Organization Brescia University College UT MPH - CN Brescia University College of Dietitians of Manitoba London Health Sciences Centre Saskatoon Health Region Anderson Arseneau Bates Berenbaum Berube Bouchard Barb Geneviève Heidi Shawna Sonia Joanie Acadia University New Brunswick Association of Dietitians University of Alberta University of Saskatchewan Université de Moncton Ordre professionnel des diététistes du Québec Glynn Gord Grad Hagglund Harden Haskey Brockest Buccino Burke Buscher Carrier Cividin Beverly Jennifer Tracie Lori Natalie Theresa IDPP-Ryerson University The Hospital for Sick Children University Health Network Ryerson University Université de Moncton Vancouver Coastal Health Hewko Hubbard Knox Koski Lemire Lengyel Sarah Fern Carolyn Kristine Nicole Christina DC Board of Directors College of Dietitians of BC PEI Dietitian's Registration Board McGill University University of Ottawa University of Manitoba Cook Cook Daneault Driedger Eisenbraun Everett Doug Douglas Suzanne Lorna Corinne Deborah College of Dietitians of Alberta DC Board of Directors Université d'Ottawa College of Dietitians of Alberta Dietitians of Canada Capital District Health Authority Liefhebber Lordly MacLellan Marsch Marsh McLearn Monica Daphne Debbie Phyllis Wayne Michelle Vancouver Island Health Authority Mount Saint Vincent University University of PEI DC Board of Directors Independent Facilitation Services DC Board of Directors Foote France Galibois Garcia Garus Gignac Connie Rioux Isabelle Alicia C. Jennifer Mary Lou Acadia University Université d'Ottawa Université Laval Brescia University College Nova Scotia Dietetic Association College of Dietitians of Ontario Moore Morris Omstead Payne Phillips Pilat Burns Lana Melanie Megan Ann Sandy Charlotte Saskatchewan Dietitians Association DC Board of Directors Ryerson University Université Laval McGill University Saskatchewan Dietitians Association Gillis Doris St Francis Xavier University Raftis Denise Northern Ontario School of Medicine Prescod Reid Alexia Laura University of Guelph St Francis Xavier University PDEP Futures Initiative – Wave 2 Members’ Session 16 Name Organization Name Organization Rioux France Université d'Ottawa Tomalik Helen St. Michael's Hospital Roebothan Barbara Memorial University Traviss Karol UBC Savoie Nadya The Moncton Hospital Vandenbussche Katherine Sunnybrook Health Sciences Centre Savoie Nathalie DC Board of Directors Wadsworth Laurie DC Board of Directors Sharp Marsha DC Board of Directors Walker Sharon Regina Qu'Appelle Health Region Simpson Patrice DC Board of Directors Whalen Cynthia NLCD Skaff Dina University of Ottawa Wyatt Marlene Dietitians of Canada Smith Linda University of Prince Edward Island Yeudall Fiona Ryerson University Spencer Nicole DC Board of Directors Zello Gordon University of Saskatchewan PDEP Futures Initiative – Wave 2 Members’ Session 17 Appendix B Visuals used by G. Zello PDEP Futures Initiative – Wave 2 Members’ Session 18 Appendix C Visuals used by W. Marsh PDEP Futures Initiative – Wave 2 Members’ Session 19