B.C. puts patient safety first

British Columbia has recently taken significant steps to improve public protection and patient safety in their health-care system.

Over the past few years, British Columbia has turned its attention to how the professional health regulatory system can be more attuned to patient safety issues. A report by the British Columbia ombudsperson found that regulatory college boards “do not appear to have fully accepted or understood what it means to act in the public interest.”

In 2018, Harry Cayton, an expert in health profession regulation, identified several problems with the B.C. regulatory framework including “the construction of college boards, a lack of relentless focus on patient safety, and secrecy into the complaints, among other things.”

Cayton’s findings align with Ontario’s Goudge report which concluded that their medical complaint system provided “little apparent benefit to the public in terms of better or safer patient services.”

Over the course of three years, the B.C. Ministry of Health consulted with stakeholders and partners to determine their priorities in health-care regulatory modernization. The result was the Health Professions and Occupations Act which comes into force on April 1, 2026.

Significant changes include establishing the Office of the Superintendent of Health Professions and Occupations Oversight, which is to be independent from the colleges. The intent of this position is to protect the public from harm and discrimination and to make sure that colleges are accountable and follow best practices for good governance.

Professional self-regulation has long been criticized as being self-serving. The new model of oversight is designed to address these concerns

The superintendent’s office will house the director of discipline, which allows for separation between colleges, which continue to investigate complaints; and a tribunal, which will administer disciplinary hearings. Within this new framework, there will be greater transparency concerning the disclosure of all disciplinary orders,

The HPOA requires that college boards be appointed, based on merit and competency, rather than elected. Under the HPOA new appointments will be made up of 50 per cent health professionals and 50 per cent public members, versus two-thirds professional and one-third public.

It is interesting to compare this system to the one in Manitoba. The College of Physicians and Surgeons of Manitoba, for example, elect physicians to be on their board. It is a widely held view of patient advocates that elections send the wrong message. One legal expert stated that “you shouldn’t be there because you are the most popular doctor; you shouldn’t have a constituency.”

The B.C. approach will also improve access to safer health care. Cultural safety, humility and the provision of Indigenous support services for Indigenous people going through the complaint process are also important components of the new act.

Health professionals have objected to specific provisions in this act, notably a section which defines health professionals as those who “provide health services that may present a risk of harm to the public.” No professional wants to be considered a potential felon. Certainly, the vast majority of health professionals function with a high degree of integrity, respect and compassion for their patients.

It has, however, been well established that patients do need protection from the small minority of health professionals who take advantage of their position of trust with their patients. In Britain, for example, the clinical governance structure was drastically changed after it was discovered that a general practitioner, Dr. Harold Shipman, had killed as many as 250 of his patients.

The HPOA breaks new ground in creating a legal obligation for health professionals to treat patients with respect and to encourage them to participate in the decisions that affect them. Gone are the days when these professionals could dismiss complaints about rudeness and paternalism by saying that their only obligation to their patients was competence.

The HPOA creates a new template for a safe patient experience. The changes in this act may soon spread across Canada. And that will be good news for patients.

Mac Horsburgh is a patient advocate and a patient partner in several medical research initiatives. He lives in Winnipeg.