April 7, 2020

Line Dempsey: Welcome to our podcast, Regulation Matters: a CLEAR conversation. I'm your host, Line Dempsey. Today, we're bringing you a special episode of the CLEAR podcast talking about information and resources related to the COVID-19 emergency. This is a very challenging time for everyone, especially as we respond to this global health emergency, dealing with it on a personal level as well as dealing with it as an employer or employee and dealing with implications for our regulatory organizations, our licensees, and the public we serve. So it's very important that we talk about it. CLEAR is working to bring together the regulatory community to share resources and information about the regulatory response to COVID-19. So today I'm very happy to be joined by some of my fellow CLEAR board members. I have the CLEAR president, Kym Ayscough, as well as president-elect Ginny Hanrahan, and CLEAR's executive director, Adam Parfitt. Thank you all for being with me here today.

Guest speakers: Thank you, Line.

Line: Absolutely, and also thank you for our listeners for joining us. Today, we want to highlight some of the resources that CLEAR has put together and resources that CLEAR members have shared. And I'd like to start with asking each of you what resources you found most helpful. For us here in the states and for me in North Carolina, it's been particularly helpful to have access to the Department of Health and Human Services for a lot of the information there as well as our Center for Disease Control, or the CDC, and obviously OSHA is another thing that I've found very, very helpful. But let me start with Kym, how about on your end?

Kym Ayscough: Thanks, Line. So from Australia, a big island a long way from other people, what's really helpful for us is to be able to connect with our regulatory colleagues around the world. So of the resources that CLEAR has shared, I really loved the webinar recording. And not just because I was part of it, but because it was actually a fantastic way to feel really connected with other regulators and to really see that we're all facing the same challenge at this time. As a health profession regulator working with the Australian Health Professions regulator, it's absolutely fantastic to hear directly from others about what they're doing to keep this essential service functioning.

I was really interested to hear about the business continuity plans and how they're working for regulators who are continuing to provide such an essential service. It's also been really fascinating to understand how permissive our regulatory legislation can be in a crisis. And I'm so impressed by how regulators around the world are demonstrating their regulatory craft, so doing work to ensure as many safe and competent practitioners are supporting the response to COVID-19 without losing sight of our primary public protection purpose.

Line: Thank you. How about you, Ginny?

Ginny Hanrahan: I'm really very aware of the WHO information; I think that's been most useful. And also the learning that we have from other places who've been ahead of using, looking at China, looking at the issues in Italy as well. We have a daily update from our public health people and are very progressing and changing, so that's been very helpful for us. I would also be in regular contact with my Department of Health. We've actually had to get legislation amendments made, which is quite difficult when you have a temporary government in place. And I've also been, obviously, in touch with the providers of the healthcare services, looking at what they're requiring and looking at what we can do. And I, again, like Kym, I would be saying it's been really, really interesting to look at what we can move on to try and ensure that we have more health professionals ready to go. But also, I think, being aware of where you have to stop the line. So I think it's that very fine balance of being able to work very closely to make sure you have safe practitioners who can go out and you do not lose sight of your public protection role.

So for example, we're looking at restoration of people who've previously been on the register and want to come back, looking at the impact on the students. So all of those are very useful. And I've certainly been keeping an eye on what other regulators have been doing, my colleagues in Australia, and the HCPC in the UK. I think also looking at webinars and issues coming through at CLEAR. I think this is where CLEAR is shining because it's dealing with a particular issue for regulators.

Line: Absolutely. Adam, your response?

Adam Parfitt: Certainly, Line. I think given the speed with which the crisis is unfolding, and the way in which each new day seems to bring new pressures and questions, it's been really encouraging to see so much information shared, really immediately and with immediacy, through the Communities by CLEAR resource. And that's the online forum and you can receive those questions and the responses either in real time or via a daily digest.

And recently, we've had questions about fingerprint requirements being relaxed, business continuity plans being shared and circulated, and most recently, shortened clinical experience requirements. In addition to that, it's been really interesting to look at the blog at clear.blogs.com where we share the headlines from across the regulatory community. And we can see a fairly consistent approach from regulators right across the international community around easing the path to those returning to practice, but also for those entering practice for their first time and just being mindful about reducing some of the costs and some of the ongoing CPD or continuing competence requirements as well. So I think both of those have been particularly useful.

Line: Right. I think that I've gotten something from the American Heart Association, at least on the healthcare side of them allowing expirations to be extended for CPR and advanced cardiac life support, because those are things that maybe people are not necessarily thinking about immediately, but a lot of times in healthcare are required things. So it's great that so many people are taking an active role and trying to make this accessible and get people to where they need to be.

Let me ask you this, Adam. I know recently that CLEAR developed a COVID-19 Survey for Regulators. Can you share with us any of the feedback that we received from CLEAR members about those resources and maybe what has helped them?

Adam: Certainly, and I think again it's going back to this theme of staying connected with one another, feeling updated in this very fast-moving crisis, and learning from peers in other organizations. So the bi-weekly COVID-19-focused webinars are frequently cited by members as being useful. And this, as I said before, the opportunity to share up-to-date information via Communities is really very much appreciated; when the sands are shifting so rapidly, that's particularly important. And I think we're also just getting a taste of the hunger, really, for once the crisis is over to share some of the learnings and some of the data that will be generated too, so that we can all learn from this experience as well.

Line: So I guess, how will you guys be doing that as far as that? Obviously, it's great that we have our community at CLEAR and that they're willing to share these resources. So I guess what are we gonna be doing with a lot of these responses to the survey? How are we gonna get that out?

Adam: Certainly, the survey results themselves will be shared, but we're also using the requests contained in the data to guide many of our efforts. Those inform some of the information requests that are actually being made by the Communities resource that I've mentioned, but also helping shape some of the webinars and ensuring that the information that CLEAR is providing is really responsive to the needs of the regulator as they've been stated. We've also got a dedicated resource page on the COVID-19 crisis and some resources for regulators on CLEAR's website at clearhq.org. And that will be updated on an ongoing basis as new resources become available.

Line: That's fabulous. I know that's gonna be a very valuable resource for our CLEAR members. And I know we've also had a couple member webinars that have highlighted the regulatory responses to COVID-19. From what I understand, those reached registration capacity really quick, which is great. But I guess now those recordings are available online. I know, Kym and Ginny, you guys were among some of the presenters for these webinars. So first I wanna thank you for your involvement there. I think it's always important especially that we have leaders from our organization that are taking part in these things. But I guess what types of regulatory responses were highlighted during the webinars? Let's start with Kym first if you would.

Kym: Thanks, Line. As I said earlier, I really loved the webinar format, and we were able to deal with a lot questions and answers during the webinar, which really showed how engaged people were and how thirsty people were to share information with each other, which is fantastic. In the webinar that I was part of, we were able to share some early information about how we're actually keeping our own regulatory organizations running in these changed circumstances. So we spoke about our business continuity plans, the sorts of things that we are needing to do to enable people to work from home, to enable applicants and registrants to interact with us remotely since many of our offices at that time were starting to close and now I think many more will be operating entirely remotely.

We also talked quite a bit about our experiences of working with government, and I think particularly because in the webinar I was part of, we were all involved in health professional regulation in one way or another, so a lot of discussion in the webinar about working with government in supporting the surge workforce capacity that we need everywhere to respond to this crisis. We talked about the different approaches to the sorts of temporary exemptions or policies to aid mobility in the healthcare workforce so that people can get to providing healthcare wherever it's most required.

The approaches that regulators are taking to make sure that practitioners stay informed, so what kind of outreach and guidance is being provided to practitioners, especially for providing services safely during this really challenging set of circumstances.

I thought the other thing in the webinar that was really important was recognizing that this COVID-19 crisis will eventually pass and then there'll be new challenges for regulators. So we spent very little time, but I think there's opportunity to do a bit more to think about, what's the future going to look like for regulation? What is the impact going to be on the future workforce? And I know we started to have some conversations about how current students in our regulated professions are impacted by limits on training places and things like that. So there's a lot of great information in the webinar about how people have responded to this point in time, and I think some clues about some of the conversations we'll need to be having in the near future.

Line: Excellent, thank you. Ginny, did you see similar things highlighted during the second webinar?

Ginny: Yeah, we had Lise Betteridge from the Ontario College of Social Work and Social Service Workers, Peggy Benson, Alabama Nursing and myself. And some of the issues that came up were about crisis communication, how critical it is and getting your communications right. Looking at the perspective of varying messages that need to go to stakeholders, and I think that would include government. Looking at making sure that you're keeping up to date with what is happening and make sure you're moving with them. Being sure that your registrants are being kept up to date about what is happening as well, and how you go about that. One of the things was obviously taking questions that people were raising using our Frequently Asked Questions and really looking at supporting registrants to provide the work to keep them safe from the public.

I think core regulatory operations, again like what Kym was saying, but now moving to organizations who are some or mostly, including mine, 100% working from home and the impact of that. And looking at identifying what are the core things that you must do, what can be delayed, and the impact that will have. And I think that would be a future conversation about how we're going to pick ourselves up after this has all gone through because obviously what happens is that you are focusing on the most important that has to happen then, and for the health and social care regulators, that's going to be getting people on the front line as safely as possible, looking at your governance, what have you been able to maintain.

For us like quite a number of our board and council members would be over 70 and they're not allowed out at the moment, so we moved to a lot of video conferencing and meetings and that, but looking at the limitations. While video conferencing is good, there are some limitations about what you can discuss and not discuss and again, how you work with that and that whole fundamental limitation to government. And then practice support for members or the registrants; I think that's a really important part, looking at what's essential to them, what's not essential, where they can move to and what they can work at. And I think Lise did a really good section on that.

I think Peggy had a look at how the states are approaching things, looking at the level one, two, three, and how you're coding your work and moving to telework. And then messaging again, very much communication, looking at what you're using your website, Facebook, Twitter for your various audience. About managing staff; I think that was one of the most critical things you're looking at, how we treat our staff, what expectations will be from them about what they can actually do and looking at some of the limitations of working from home and also how you manage with temporary staff and contracts.

So again, I think what you'll see is that there's quite a mix of approaches too, and I think that's actually one of the major learnings that we would have. I think and finally just messaging to key government stakeholders about what you can and cannot do and being quite firm on that. So I think there's quite a lot that would be of help to people.

Line: Absolutely I think one thing that seems to be apparent is the value of regulators and regulation obviously during an unprecedented crisis or time like this. I guess what are some ways you're seeing the roles of regulators take on maybe a heightened relevance and significance and regulators really stepping up to be a part of the solution?

Kym: So, Line, in Australia, I think many people will know that AHPRA is a national health profession regulator for 16 professions across the country, but Australia's government is a federated system. So one of the things that has been really helpful for us is to be able to take that national perspective. So we have been working regularly with key representatives of state government health departments to understand on a national scale what the requirements are in the healthcare surge workforce in particular and looking to see as a regulator, what we can do to support those overall requirements.

So there's been a lot of internal challenge for us to look at our own processes and how we can bring in the assessment process for practitioners seeking to come onto the register or to come back onto the register. And combined with our own move to working remotely, needing to look at our willingness to accept documents electronically for example, where previously we may have required hard-copy documents or wanted to test what signatures, etc. So looking at how do we provide necessary safeguards but keep the registration function working.

And then a particular interest for us has been how we could safely move practitioners back onto the active register who have come off that active register in recent times. And I know many healthcare regulators around the world have taken similar approaches. So we have had a really dedicated team across AHPRA working on creating what we're referring to as a pandemic response subregister, which is essentially administratively placing back on our register of practitioners every practitioner in the priority professions of medicine, nursing, midwifery and pharmacy who either moved to non-practicing registration or left the register within the last three years. And for us that amounts to around 40,000 healthcare practitioners. And we've created that subregister on an opt-out basis. So those practitioners are automatically on that register, but they're not required to return to work and they can opt out of the register at any time without giving us any reason. But it's really about enabling that surge workforce capacity and giving the employers in the health sector a level of assurance about practitioners who were recently in practice and could be safely transitioned back into the workplace.

Ginny: And I suppose if I continue... Yeah, so essentially we regulate health and social care professions, but I don't regulate nurses or doctors or pharmacists. However, the groups that are really in demand would be radiographers, medical scientists, physiotherapists, and a number of the other professions.

So what's been interesting has been that the Irish Health Service has what they called "On Call for Ireland," essentially people volunteering to come back into the services. And what we have to be very careful about is where people can get back on to the register. And we actually have legislation amended which allows us to put a register in place for COVID-19 and that would be reviewed in the end of July. So that allows us to allow people to come onto the register who have previously been on. Our challenges were people are applying to get on who have never been on previously and I think we're having a little bit of a battle about that. I'm concerned that there may be rogue practitioners who might be trying very hard to get on and really would probably cause more damage.

The other thing we have to reassure the Department and to reassure the main health firm executives is that there are many professions who their professional role may not be critical at this stage, but they can be available to help the approach; they're looking at contact tracing, etc. So for me, it's the balancing of that, and I think we've just had to be really careful in how we're managing it. Groups like social workers are an interesting group. One of the things they've been doing is moving ordinary services such as the counter services out of the public hospital system and moving it into the private hospital system who would not have a lot of our health and social care positions. So looking at how that's going to work. So again, I think as a regulator of health and social care professions, we have to very mindful of what we can do, where we can be supportive, and where we need to set some limits. So I think that there's been a really very cooperative approach among the regulators and how we do that.

Line: Excellent, while still all maintaining to try to protect the public. Adam, how about a response from you?

Adam: Certainly. Well, I think as we all know, regulation by nature tends to be somewhat reactive, and it's often criticized for being slow to evolve and adapt. But I think what's struck me particularly during this unfolding crisis is the speed with which regulators have worked, but also creatively as Ginny and Kym have shared, to ensure that the numbers of the retired or the soon-to-be qualified are able to enter or re-enter the workforce quickly, so that surge workforce is in place. And there's also careful steps being taken as we've mentioned to remove barriers to deployment and ensure the financial costs to those returning or entering the workforce are minimized.

And I think it's just going to be very interesting to see how many of these initiatives are eventually unwound post-crisis and what simply becomes part of the new normal.

Line: Right. Well, I think those are all areas where regulators play a significant role and they're really going to have an impact as we all face this together. To bring this back to resources for CLEAR members, Adam, how can members get in touch with CLEAR to request resources or assistance related specifically to COVID-19?

Adam: Certainly. So, CLEAR's website is always a great starting point. That's at clearhq.org. And on the website, you'll find resources and all of the relevant contact information for us. We're in the process of rescheduling countless of our training programs, some of which are being moved online, and information about all of this can also be found on the website. But in terms of assistance requests, please feel free to email me; I'm at aparfitt@clearhq.org. We've also got a dedicated email address covid19info@clearhq.org. Or please contact us via our social media channels. Like many of the other organizations and stakeholders, we're working remotely, but we are ready to assist and we deeply appreciate the network of stakeholders and volunteers that stands behind everything that we do.

Line: Absolutely, I think we could all share that sentiment for everybody who's put in so many countless and tiresome hours, so thank you. I'm really happy that we were able to come together and let our CLEAR audience know about these resources. We're certainly all facing this global health emergency together, which is very unique, and I think it's great to have these tools and examples from a range of regulatory organizations that we can all learn from and adapt to best fit our organizations. So let me just personally thank you all, Kym, Ginny and Adam, for speaking with us today. I really appreciate you guys being here today.

Guest speakers: Thank you, Line. Thanks.

Kym: Thank you, Line. And if I might just go a step further than just saying thank you, Line. As CLEAR's President, I'd just really like to take this opportunity to say thank you to the CLEAR staff who continue to work tirelessly and remotely to make sure that these resources are available to regulators across the regulatory community. And thank you to CLEAR's members who so willingly share their resources, their information, their expertise in the interest of safe regulation in all of the professions and occupations that we regulate. I feel really privileged to be a part of this community and find the sharing to be just infinitely beneficial. So thanks to everyone for that.

Line: Thank you, Kym; I appreciate that. I share these sentiments exactly. It's amazing to be a part of this organization, and I'm so fortunate to be working with all of you. Thank you also to our listeners for joining us today. We really hope that this information has been helpful to you. And as the situation continues to evolve, please know that CLEAR will continue to be a resource for you and provide a forum for important information sharing during this challenging time.

And CLEAR also wants to continue providing you with the resources that you need for all aspects of your regulatory work. CLEAR is working hard to reschedule the training programs as well as moving to online and virtual offerings where possible, to continue providing that important regulatory training. We'll be back with our regular scheduled episodes of Regulation Matters: a CLEAR conversation on the second Tuesday of each month. CLEAR's website, as Adam mentioned earlier at www.clearhq.org, remains a resource for your regulatory information and updates about upcoming programming. So again, thank you for your involvement and support of CLEAR. I'm so happy to be a part of this organization. Again, my name is Line Dempsey, and I hope to be speaking with you very soon.

The audio version of this podcast episode is available at https://podcast.clearhq.org/e/covid19_resources/

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