Back to Summit ProceedingsNational Summit on State Regulation of Health Professionals in the 21st Century
Linda Siderius: I just wanted to take a couple of minutes to wrap up the discussion, and I'm going to turn it over to Roy Swift, who will, I think, work with you to gather the comments and synopsize what we've talked about over the last two days. I thought the last speaker's last slide was very appropriate when she talked about what they had learned in the process of the dietetic certification program. And it had three things up there, and I kept hearing those three things over and over in the last two days.
The first was seeking input. And I think there was a lot of conversation throughout the two days about the need to have all of the stakeholders, all of the interested involved. People need to be at the table talking, communicating, having input. And I think that's an important theme to take home from this as you look at what you're going to do in your states as you initiate projects, as you look at the change that you might be able to initiate in your state.
The second was answer questions. And I think we just started that process. So actually you are probably leaving with a lot more questions than answers from this discussion. But I think what was important to me in listening to the conversations were there are a lot of questions. And let's keep working on answers. Let's keep communicating. Let's keep talking and keep these issues alive and come to the table prepared to talk and to discuss.
The last was, I think, the most telling. And that is allow a generous amount of time for a change. And I think to a lot of us it is very impatient, especially when you come away from a conference like this where you're full of ideas, energized and ready to go home and tackle those projects. Remember your colleagues, who haven't been here. Remember your constituents who haven't been here, who haven't been part of that discussion, may meet you with some resistance in those changes. And I think it's important to recognize that what we talked about here is ongoing. It is a change, a process that will take us well beyond the beginnings of the new century.
And I think patience is a virtue that we need to perhaps bring along with us in this process. And that's a challenge as we enter a system that is highly driven by technology and speed of information.
But I want to thank all of you for your hard work, your participation; particularly thank the facilitators who put in extra hours gathering the information, developing the questions, responding to the comments and keeping the controversy and the communication going.
I'd also like to thank our speakers as well who provided a lot of provocative information for us to discuss. I would also like to remind you at your place, if you haven't already picked one up, is a brochure for the CLEAR annual conference in Portland. And there is a specific session that is designed to continue and update the conversation from this conference. And you are all particularly invited to participate in that and to continue to share your ideas.
At this time I'm going to turn it over to Roy Swift, who I also would really like everybody to give a round of applause to because it was really his efforts--who pulled this all together.
And one last thank you to Adam in the back of the room for all the nuts and bolts on this conference. Thank you. Good luck and keep in touch.
Roy Swift: And also all the people that served on the Steering Committee, maybe you also should stand up too.
I tell you, without the facilitators and the Steering Committee this wouldn't have been the success that it is. I tell you, I had a great group of people. And I think I found a family for ongoing-they may not think so. But we're going to be looking at this, because you will see one of the themes and actions.
To try to summarize this particular conference is almost impossible. In fact, it is impossible. But the facilitators got together at lunch today, and they had to swallow their sandwiches, to help us look at what we thought we were hearing in general. We haven't even touched on all of the themes that could probably be listed. But we try to hit some of the major themes that we think are ones that we need to keep in mind as well as we develop the proceedings and look at more detail that was developed in the various sessions.
So we've developed, and we'd like for you to add to the things that we have thought about also, because we know that maybe in our trying to be a little more reductionistic in trying to get it down to some workable kinds of themes and some initial first steps, that we may have missed something. And we certainty want to hear from you in that regard, or even after you get home. In some respect we probably should need to develop a listserv or something that gives ongoing types of feedback to CLEAR in this regard, and that's probably something we need to look at.
But we decided that one of the major themes that we continually heard was the need for evidence-based decision making; that a lot of people are trying, and they do have resources available to them. As we heard from Senator Hollinger, she said that as the people are presenting in the Maryland Senate, she brings up things on the Internet and she's able to identify who is and is not telling the truth.
But the importance is having this more systematically available for regulation in regard to the development of research, the development of pilot studies and finding a place where we can all identify a clearinghouse for regulations.
The second theme that we heard is that there probably is a need to develop--identify and develop a national non-governmental--and that was very important to most people--advisory body. And the word "advisory" was extremely important also. And that this body would look at such things as clearinghouse doing analysis and doing research. Certainly that would have to be tweezed out and we'd have to think about this more. But that that certainly is something that people want to explore more as to what can be done.
Another theme is that too often a regulation bill makes decisions in isolation and doesn't really try to look at who the major stakeholders are in some of the processes that need to be developed. And as Linda was saying, and we heard in several presentations, the input is extremely--and the process by which things get done--is extremely important for the success of any initiative in that regard.
So we want to build connections among the stakeholders. Who are the people who have, generally, control over regulation? The state legislators. So if we don't include state legislators in our processes, we move along with our dialog and action, we are missing the major component of where we're going to go. The Council on State Governments, the academic institutions. You know, accreditation is one of the prerequisites, many times, for licensure. And many times--and we look at the various processes in scope of practice about what's being taught, what's being practiced and what's being regulated. Sometimes those three particular spinning circles, first of all, do not overlap; and secondly, sometimes are incongruent with one another.
So these are just examples, but we would need to think more about how to enlarge and encompass this dialog of regulation and make sure that the people who are involved in the regulatory system get involved in the ongoing process of how we look at regulation for the 21st Century.
The fourth theme is that there is definitely a need for ongoing dialog and action: that this cannot be the one time that we get together as a summit and discuss where regulation should go. There is a need for this ongoing dialog and action. That public members are important but there are a lot of questions about public members; about how to locate them, how to train them, how to use them, and what kind of a role should they represent, and who are they representing in this regard.
The other one, that scopes of practice are creating professional turf wars. And that this is an area that is and needs to be looked at and explored. Maybe they need to be done away with, maybe they need to be modified, maybe we need to have more of an Ontario model - who knows?
There is a need for innovative research. And the examples that people gave in innovative research, that we need more qualitative research, more ethnographic research that goes out and looks at systems, that help systems and what people are really doing, and to decide for ourselves about the various people who contribute to the quality of health care delivery.
Theme eight is that the process is very important. And that the way we proceed is critical. And we heard that time and time again; that this is extremely important. And that many times we are our own worst enemy; that increasing marketing of regulation is not only important to the outsiders who maybe don't have a clue, but within our own system, of what we are doing and how it's functioning.
You know, one of the issues is that Pew never looked at the good things that would happen, or at least it was the perceived that that was the case. And yet there are a lot of good things. But many times the marketing to the public and to the consumer about what regulation is doing for them just does not exist. So the whole issue of marketing and how that is related to consumers and within the system, outside the system, is extremely important.
Now, those were the themes. Do you have any reaction to those nine themes; things that you feel, gee, you know, you really missed this one and I think this is extremely important, the theme?
Grady Barnhill: A comment about the public members on the regulatory boards. I think it's a very important concept; it's something that the Pew folks have thought was a good idea. And I think it's something we'll see more of. In working in state government I've seen that work in a variety of ways. I've seen it work very badly if you have some folks that just don't have the right personality, maybe the right interests, they're there for the wrong reason; maybe because they're married to the right person who is politically connected or whatever. So I think it's important to talk about the selection criteria for those, and looking at ways to try and get people with more powerful personalities that are used to dealing perhaps with associations. Things that I've seen that have worked have been folks that have been in more powerful positions with associations or maybe other non-related organizations, being in sort of--I don't know if there's such a thing as an empowered profession. Sometimes an attorney coming in and serving as a public member is not used to being ignored. And so sometimes that's a helpful thing. So I think looking at ways to do better selection with the public members I think is a real good way to look at things.
Roy Swift: Right. I'll add that specifically selection. So based on those themes, how can we conquer the world? Well, we can't. But we think that there are four or five steps that we can take to proceed along.
First of all, we need to identify an ongoing process for dialog and action. And this is one thing that we will be working on, so that this isn't the initial step and then nothing else happens. And there are many ways in which we could approach that: a Summit Two, a strategic look at where regulation goes, to give presentations to other agencies, a variety of ways; regional meetings, even specialized state meetings, things of this sort. And there needs to be an overall strategy regarding that, and we need to look at how that could be done.
The other thing, of course, which is crucial, and you know it's coming, is we have to find money to keep the effort going. I know in the one group that I was in we talked a lot about ways in which money, obtaining grants from agencies maybe such as Robert Wood Johnson or others who might have an interest in looking at this particular type of initiative and also whether, if we got the support of state legislators, whether there could be some sort of fee attached to assessing various state agencies that would contribute to this sort of national task force and dialogue.
That we want to publish and distribute the proceedings. And the distributing of the proceedings not among ourselves just like we have talked about the marketing issue, is that creating the distribution pattern where we strategically are sending out our message to the various people that encompass the total regulation system, as well as having it on the Internet. Because people who don't know CLEAR, they won't even know to go to the Internet space. So it is an encompassing, and I think our obligation to identify, where it is we want to send the message to begin the process of who we want to relate to.
Create an informational clearinghouse, one-step shopping kind of thing, became an extremely important type of initiative in this regard. People have mentioned various places which the clearinghouse might take place. It might be the national body, it could be CLEAR developing. There is a need for information, even though it may be in 50 places in different web sites. The way of trying to connect all of that data together of which people then can start to begin to use more and more data in their decision making is extremely important.
And to begin--and this is an ongoing process certainly--to begin to develop the coalition and partners that is going to help regulation begin to move toward a model that they feel is important. One of the suggestions is that there would be a representative from this summit that might give a presentation at the National Conference of State Legislators meeting this fall. It could be other types of organizations. But it is the strategic plan of where we begin to reach out and to connect with the various people that develop the systems. It could be meeting with the National Accrediting Bodies, the Association of Specialized Accrediting Bodies--I forget their new name.
So these are the five steps that we think are reasonable to begin our sort of baby steps toward trying to move the ongoing dialog and keep the fires burning. Certainly you heard the CLEAR President say that we're going to have at least one session at the annual conference in September with the Clear Annual Conference, and we hope that all of you will be there to continue the dialog there. And maybe we will have even a specific proposal that we can dialog about a strategic plan for moving what we've learned at the Summit further. And we welcome your ideas and thoughts about that.
Comments about this? It's very difficult. The wealth of information is overwhelming. But it also shows the power that is available among all of us. And utilizing the power to analyze the system and how the system can be affected to allow us to move regulation into a new era in the 21st Century.
If we don't have any more comments I want to thank all of you as participants. You have made this two-day a success.
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Regulation (CLEAR)