council meeting - cmo.on.ca

Council Meeting October 6, 2021

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NOTICE OF MEETING OF COUNCIL

AVIS DE RÉUNION DU CONSEIL

A meeting of the College of Midwives of Ontario will take place on Wednesday, October 6, 2021 from 9:30 AM to 1:00 PM by videoconference.

This meeting is open to the public. Any individuals wanting to observe the meeting should contact the College at [email protected] or 416.640.2252 ext. 227 for access details.

L’Ordre des sages-femmes de l’Ontario tiendra une réunion par vidéoconférence, de 9 h 30 à 13 h, le 6 octobre.

Cette réunion est ouverte au public. Toute personne intéressée peut obtenir les détails pour accéder à la réunion en écrivant à l’Ordre, à [email protected], ou en composant le 416-640-2252, poste 227.

Kelly Dobbin, Registrar & CEO/ Registrateure et PDG

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CMO Council Meetings – Guidelines for Observers

• The Council meetings held by videoconference may be observed by the public, please contact the college for information on how to attend.

• Those attending the Council meetings as observers do not participate in the meeting.

• Observers are required mute their microphone during the videoconference.

• If a portion of the meeting is closed to the public, an announcement will be made to move in-camera. Observers do not participate. If known in advance, in-camera items are noted on the agenda. The agenda is posted to the CMO website two weeks prior to the scheduled Council meeting.

• Observers can access the Council package materials from the College website approximately two weeks prior to the scheduled Council Meeting.

If you have any questions regarding the Council meeting or would like to register as an observer, please contact the College at [email protected] or by phone at 416-640-2252, ext 227.

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mailto:[email protected]

Strategic Framework 2021–2026

The 2021-2016 Strategic Framework is a high-level statement of the College’s vision, mission, outcomes and key priorities over the next five years. It paves the way forward for the organization, builds a stronger sense of common purpose and direction and a shared understanding of why we exist, what guides our work, and what we want to achieve as an organization.

Our VisionA leader in regulatory excellence, inspiring trust and confidence

Our Mission Regulating midwifery in the public interest

Key Outcomes We Are Expected to Achieve1. Clients and the public can be confident that

midwives possess and maintain knowledge, skills and behaviours relevant to their professional practice and exercise clinical and professional judgment to provide safe and effective care.

2. Clients and the public can be confident that midwives practise the profession with honesty and integrity and regard their responsibility to the client as paramount.

3. Clients and the public can be confident that midwives demonstrate accountability by complying with legislative and regulatory requirements.

4. Clients and the public trust that the College of Midwives of Ontario regulates in the public interest.

Our Strategic Priorities1. Regulation that enables the midwifery profession

to evolve.

2. Effective use of data to identify and act on existing and emerging risks.

3. Building engagement and fostering trust with the public and the profession.

Our Guiding PrinciplesThese interrelated principles define how we strive to work as an organization, shape our culture and our relationships with the public, midwives, and partner organizations.

AccountabilityWe make fair, consistent and defensible decisions, incorporating diverse and inclusive views.

EquityWe identify, remove and prevent

systemic inequities.

TransparencyWe act openly and honestly to enhance accountability.

IntegrityWe act with humility and respect and apply a lens of social justice to our work.

ProportionalityWe allocate resources proportionate to the risk posed to our regulatory outcomes.

InnovationWe translate opportunity into tangible benefits for the organization.

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College of Midwives of Ontario Council Meeting Agenda October 6, 2021

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COUNCIL MEETING AGENDA Wednesday, October 6, 2021 | 09:30 am to 1:00 pm Zoom Meeting ID: 998 7259 8612 Passcode: 917918

Item Discussion Topic Presenter Time Action Materials Pg

1. Call to Order, Land Acknowledgment

C. Ramlogan Salanga

9:30 INFORMATION - -

2. Conflict of Interest C. Ramlogan

Salanga 9:35 DISCUSSION - -

3. Review and Approval of

Proposed Agenda C. Ramlogan

Salanga 9:36 MOTION 3.0 Agenda 5

4. Consent Agenda

- Draft Minutes of June 23 ,2021 Council Meeting

Q1 Reports for: - Inquiries, Complaints

and Reports Committee Report

- Registration Committee

- Quality Assurance Committee

- Discipline Committee - Fitness to Practise

Committee - Client Relations

Committee

C. Ramlogan Salanga

9:38 MOTION 4.0 Draft Minutes 4.1 ICRC Report 4.2 Registration

Committee Report 4.3 QAC report 4.4 Discipline

Committee report 4.5 FTP Report 4.6 CRC Report

7

5. Chair Report C. Ramlogan

Salanga 9:40 MOTION 5.0 Chair Report 32

6. Executive Committee Report C. Ramlogan

Salanga 9:50 MOTION 6..0 Executive

Committee Report 6.1 Q1 SOP 6.2 2023 Dtes

34

I. Council Evaluations S. Goodwin 10:00

6.3 Proposed Council Evaluation Process 6.4 Appendix 1 6.5 Appendix 2

37

BREAK: 10:45

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https://zoom.us/j/99872598612?pwd=NDEzczJjRWN0eHZ5RkNyb2Vrb0lLUT09

College of Midwives of Ontario Council Meeting Agenda October 6, 2021

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Item Discussion Topic Presenter Time Action Materials Pg

7. Quality Assurance Committee: Professional Development Portfolio document

L. Martin 11:05 MOTION 7.0 Briefing Notes 7.1 PDP document

59

8. Registrar Report K. Dobbin 11:35 MOTION 8.0 Registrar’s Report

8.1 Annual Report

79

9. IN CAMERA C. Ramlogan

Salanga 12:15 MOTION - 106

10. Executive Committee

Elections K. Dobbin 12:30 - - -

11. 2021-2022 Slate of Council C. Ramlogan Salanga

12:45 MOTION 11.0 2021-2022 Slate 107

12. Housekeeping

Z. Grant 12:50 INFORMATION 12.0 Code of Conduct Form

12.1 Conflict of Interest Form

12.2 Confidentiality Form

12.3 Committee Expression of Interest Form

108

13. Adjournment C. Ramlogan

Salanga 1:00 MOTION - -

Next Meetings:

December 7-8, 2021 2022 March 29-30, 2022 June 21-22, 2022|

INFORMATION

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College of Midwives of Ontario Minutes of Council Meeting Held on June 23, 2021

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MINUTES OF COUNCIL MEETING Held on June 23, 2021, 9:30 am to 4:30 pm Videoconference

Chair: Claire Ramlogan-Salanga

Present: Jan Teevan, RM; Lilly Martin, RM; Edan Thomas, RM; Maureen Silverman, RM; Claudette Leduc, RM; Isabelle Milot; Marianna Kaminska; Judith Murray; Don Strickland; Pete Aarssen; Sarah Baker; Karen McKenzie, RM; Oliver Okafor

Regrets:

Staff:

Kelly Dobbin; Carolyn Doornekamp; Marina Solakhyan; Johanna Geraci; Nadja Gale

Observers: Sarah Kibaalya (MOH); Julie Toole (AOM); Amy Moland, RM

Recorder Zahra Grant

1. Call to Order, Safety, Welcome and Land Acknowledgement

Claire Ramlogan-Salanga, Chair, called the meeting to order at 9:31 am and welcomed all present. Lilly Martin presented a Land Acknowledgement.

2. Declaration of Conflict of Interests No conflicts of interest were declared.

3. Proposed Agenda

The proposed agenda was approved as presented. MOTION: That the proposed agenda of June 23, 2021, be approved as presented.

Moved: Marianna Kaminska Seconded: Maureen Silverman CARRIED

4. Consent Agenda MOTION: THAT THE CONSENT AGENDA CONSISTING OF:

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• Draft Minutes of March 24, 2021, Council Meeting • Executive Committee Annual Report • Inquiries, Complaints and Reports Committee Annual Report • Registration Committee Annual Report • Discipline Committee Report • Fitness to Practise Committee Report • Client Relations Committee Annual Report • Quality Assurance Committee Annual Report

Moved: Edan Thomas Seconded: Maureen Silverman CARRIED

5. Chair Report

Claire Ramlogan-Salanga, Chair introduced her report, providing highlights of activities, governance related and/or with stakeholders over the past quarter. Regarding the Professional member elections to Council running throughout the month of June, the Chair advised the Council the College held two lunch and learns in April that were open to professional members interested in standing for election. Two sessions were held, a general session open to all membership and a second session for Indigenous, Black, and racialized members. The sessions were intended to be a safe space to provide information and answer questions members have about sitting on Council to help build comfort and encouragement among professional members about putting their nominations forward. Both sessions were well attended, and feedback was very positive. The College hopes to continue these sessions with future election cycles. A communication from the Chair was sent to all Council members prior to the meeting were some equity-based questions for consideration when reviewing materials. The Chair requested feedback from the Council as to whether they found them useful, what they liked or didn’t like. Feedback will be considered to develop a standard tool that Council and committees will be able to use in their decision-making process which would come to Council for formal approval when ready. Council will send their comments and feedback to the Chair by email. Lastly, a warm welcome was extended to Oliver Okafor, newly appointed public member to Council who attended both the training day and meeting. A fond farewell and note of thanks for her contributions to Council and committee was shared for public member Sarah Baker who will be leaving Council in the coming weeks due to family relocation to the United States. MOTION: That the Chair Report to Council be approved as presented

Moved: Pete Aarssen Seconded: Claudette Leduc CARRIED

6. Executive Report

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The Chair introduced the Executive Committee report providing a summary of the committee’s activities in the last quarter. The Q4 statement of operations was reviewed and approved by the committee on behalf of Council and included in the report as an attachment for Council’s reference. The committee also met with the audit team during the financial audit to complete their annual assessment of the external auditor report which will be shared with Council in the fall. A motion to approve the Executive Committee report was made prior to Blair MacKenzie of Hilborn, the external independent auditor joining to present the audited financial statements.

MOTION: That the Executive Committee Report be approved as presented.

Moved: Lilly Martin Seconded: Jan Teevan CARRIED

Blair MacKenzie, of Hilborn joined the meeting at 10:02 am.

Blair MacKenzie of Hilborn Associates joined the meeting to present the audited financial statements of the fiscal year ending March 31, 2021, to Council. Hilborn is a firm that operates independently of the College to perform the audit in accordance generally accepted auditing standards. It was presented to Council that in the opinion of the auditor, the financial statements present fairly, in all material respects, the financial position of the College at March 31, 2021, and the results of its operations and cash flows for the year ended in accordance with Canadian accounting standards for not-for-profit organizations. Mr. MacKenzie emphasized that it was a very collaborative process during the entire audit, with the firm working with management and the Executive committee to the accomplish the goal of audit which is to determine that there are no material misstatements within the financial statements. Mr. MacKenzie walked the Council through an in-depth review of the audited financial statements, going over how the firm forms the basis for their opinion and the roles and responsibilities of management and the Executive committee in the process. Council members were able to ask questions and get clarification where needed before a motion was made to approve the audited financial statements. MOTION: That the Audited Financial statements as of March 31, 2021 of the College of Midwives of Ontario be approved as presented.

Moved: Judith Murray Seconded: Claudette Leduc CARRIED

7. Registrar Report

The Registrar, Kelly Dobbin introduced her report, noting for Council that the report has new format to align with six areas of college performance. An update was provided regarding Bill 283 which received Royal Assent on June 3rd2021. The bill creates a regulatory oversight system for Personal Support Workers. For now, it is a voluntary registration system and there is no title protection. Oversight will be under Delegated Administrative Authority rather than Regulated Health Professions Act (RHPA). Unlike the RHPA, where professions are self-regulated with Council made up of public and professional

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members, the Board of Directors will be constituted by competency-based appointments. The legislation does leave room for the possibility that health professions from the RHPA could move to this format, however at this time there is no indication that this is something the Ministry is looking to do any time soon and if so, there is no reason to believe that the College of Midwives would be a profession considered. An update was provided regarding the Laurentian University Midwifery Education Program, which was recently cancelled on short notice leaving full-time students enrolled in program with uncertainty with their future as midwifery students. Ryerson and McMaster Midwifery Education Programs have been able to accommodate those students into their programs. There is still a lot of uncertainty in terms of what access to midwifery in Northern and Francophone communities will look like in the future but there does seem to be some informal discussions happening in the sector about potential solutions. Staff updates were also provided to the Council and lastly the Registrar provided some additional comments regarding communications received from the Ministry regarding a potential ‘Burden Reduction Bill’ for the fall that the Ministry is exploring. Considerations would include opportunities for governance reforms, many of which are issues that are not new to our Council and have been discussed before. For instance, the College of Nurses met with our Council prior to proposing similar changes to the Ministry which our Council was supportive of and have already communicated to the Ministry that support. At the time, our College also expressed some concerns around the significant costs we would have to manage as a smaller College around the implementation of these changes. At this point it seems the Ministry is just gathering feedback and the Council will be kept informed of things as they progress. MOTION: That the Registrar’s Report be accepted as presented.

Moved: Maureen Silverman Seconded: Jan Teevan CARRIED

8. IN-CAMERA

The IN-CAMERA session of the of Council meeting excludes the attendance of public observers pursuant to the Health Professions Procedural Code of the Regulated Health Professions Act, 1991, section 7(2)(b). The Council went in-Camera to discuss the annual Registrar Performance Review. MOTION: Be it resolved that Council move in-camera at 11:31 am.

Moved: Maureen Silverman Seconded: Jan Teevan CARRIED

MOTION: Be it resolved that Council move out of in-camera at 12:23 pm.

Moved: Claudette Leduc Seconded: Don Strickland CARRIED

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9. Implementation of Quality Assurance Regulation Lilly Martin, Chair of the Quality Assurance Committee introduced two program documents the committee is bringing forward for Council approval now that the new Quality Assurance Regulation has been approved and came into force November 2020. With the new regulation now in force, two program documents set out the Continuing Education/Continuing Professional Development requirements in one and the other the details of the Peer and Practice Assessment Program. There was a discussion regarding the requirements of the Professional Development Portfolio which will now also require Inactive registrants to comply with the requirements. There was some concern that the document does not make clear the full consideration of midwives who are Inactive for reasons such as disability leaves, which may also impact their ability to participate in the program. The program does have provisions for exemptions and the committee is working on what that process would look like for midwives under this sort of circumstances, however it was noted that the document itself could be a clearer in considering equitable needs of midwives especially those in the Inactive class to ensure there is an understanding what the requirements are as well as when and why exemptions would be reasonable. The Peer and Practice Assessment Program document was approved as presented. ACTION: More robust description around exemptions to be added to Professional Development Program Guide document and will be brought back to Council for approval in fall. MOTION: That the Peer & Practice Assessment Program Guide under Quality Assurance (QA) Regulation (O.Reg 669/20) be approved as presented.

10. Measuring Regulatory Performance Marina Solakhyan, Director of Regulatory Affairs presented the Regulatory Performance Review 2020/2021 report. While not legislatively mandated, the College has made a voluntary commitment to evaluate performance and demonstrating success in regulating in the public interest. The framework approved by Council in 2019 describes expected outcomes of the College based on four broad domains: Regulatory Policy; Suitability to Practise; Openness and Accountability and Good Governance. The Council was walked through the report, where findings determined that the College fully met 15 of 20 standards and partially met the remaining five. Where the College partially met recommendations and timelines for achievement of meeting the standard were clearly outlined in the report. Council approved the report, and it will be posted publicly to the College website post-meeting. MOTION: That the Regulatory Performance Review Report 2020/2021 be accepted as presented.

Moved: Edan Thomas Seconded: Claudette Leduc CARRIED

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11. ADJOURNEMENT

MOTION: THAT THE MEETING BE ADJOURNED AT 4:33 pm. Moved: Jan Teevan Seconded: Oliver Okafor CARRIED

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College of Midwives of Ontario Inquiries, Complaints, and Reports Committee

INQUIRIES, COMPLAINTS & REPORTS COMMITTEE REPORT TO COUNCIL - Q1 April 1, 2021 to June 30, 2021 Committee Members

Chair: Susan Lewis Professional: : Maureen Silverman RM; Lilly Martin, RM; Claudette Leduc, RM, Edan Thomas, RM Public: Judith Murray, Sarah Baker

Non-Council: Christi Johnston, RM, Samantha Heiydt, Jillian Evans, Susan Lewis, Jessica Raison, RM, Sarah Kirkland RM

Activities of the Panel

Q1 Q2 Q3 Q4 Total Number of Panel Meetings Held 10 - - - 10

Number of Committee Meetings Held 0 - - - 0

Number of Trainings 0 - - - 0

Notes: Q1: 9 panel meetings were held by videoconference, 1 was an email panel Caseload Work of the ICRC

Complaints Reports

Q1 Q2 Q3 Q4 Total Q1 Q2 Q3 Q4 Total

Files Carried Over from previous reporting period

25 - - - N/A 5 - - - N/A

New files 6 - - - 6 1 - - - 1 Closed files

15 - - - 15 2 - - - 2

Active files at end of reporting period 16 - - - N/A 4 - - - N/A

Notes:

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Q1: Six new complaint files were a result of receiving five complaints. One complaint involved more than one midwife.

Themes of New Matters Complaints Reports

Q1 Q2 Q3 Q4 Total Q1 Q2 Q3 Q4 Total

Advertising 0 - - - 0 0 - - - 0

Billing and Fees 0 - - - 0 0 - - - 0 Communication 4 - - - 4 0 - - - 0 Competence /Patient Care 2 - - - 2 1 - - - 1 Fraud 0 - - - 0 0 - - - 0 Professional Conduct & Behaviour 1 - - - 1 0 - - - 0

Record Keeping 0 - - - 0 0 - - - 0 Sexual abuse /Harassment / Boundary Violations 0 - - - 0 0 - - - 0

Unauthorized Practice 0 - - - 0 0 - - - 0 Other: Practice Management 1 - - - 1 0 - - - 0 Other: Masking concerns re COVID 2 - - - 2 0 - - - 0

Notes: Category of themes are based on the current methodology set out by the Ministry for the College Performance Measurement Framework (CPMF) Reporting Tool. These categories may change in the next reporting period to reflect any changes to CPMF reporting requirements and/or categories the College wishes to track. Some complaints involve more than one theme. Source of New Matters

Complaints Reports

Source of New Matters

Q1

Q2

Q3

Q4

Total

Q1

Q2

Q3

Q4

Total

Client 6 - - - 6 0 - - - 0 Family Member 0 - - - 0 0 - - - 0 Health Care Provider 0 - - - 0 0 - - - 0 Information received by Mandatory / Self Report

0 - - - 0 0 - - - 0

Information received from another source

0 - - - 0 0 - - - 0

Additional Concern arising from an existing investigation

0 - - - 1 - - - 1

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Another Midwife 0 - - - 0 0 - - - 0

Outcomes/Completed Cases Number of Resolved Cases and Outcomes

Complaints Reports

Q1

Q2

Q3

Q4

Total

Q1

Q2

Q3

Q4

Total ADR Resolution 0 - - - 0 N/A Complaints Withdrawn 0 - - - 0 N/A

Frivolous and Vexatious 0 - - - 0 N/A

No Action 7 - - - 7 2 - - - 2

Advice & Recommendations 4 - - - 4 0 - - - 0

Specified Continuing Education or Remediation Program (SCERP)

3 - - - 3 0 - - - 0

Oral Caution

0 - - - 0 0 - - - 0

SCERP AND Oral Caution

0 - - - 0 0 - - - 0

Referral to Discipline Committee

1 - - - 1 0 - - - 0

Referral to Fitness to Practise Committee

0 - - - 0 0 - - - 0

Acknowledgement & Undertaking

0 - - - 0 0 - - - 0

Undertaking to Restrict Practise

0 - - - 0 0 - - - 0

Undertaking to Resign and Never Reapply

0 - - - 0 0 - - - 0

Note: where decisions contain more than one outcome or multiple issues, both will be captured. Accordingly, the total number of decisions may not equal the total number of outcomes or cases.

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Themes of Completed Matters where action was taken by the ICRC

Complaints Reports

Q1

Q2

Q3

Q4

Total

Q1

Q2

Q3

Q4

Total

Competence /Patient Care 4 - - - 3 0 - - - 0

• Managing and following up on lab results 2 - - - 2 0 - - - 0

• Prescribing error 1 - - - 1 0 - - - 0 • Management of

hyperbilirubinemia 1

Professional Conduct & Behaviour 1 - - - 1 0 - - - 0

• Outside scope- providing medical advice to a discharged client

1 - - - 1 0 - - - 0

Record Keeping 3 - - - 3 0 - - - 0 • Documenting informed

choice-jaundice and testing 2 - - - 2 0 - - - 0

• Issues with electronic documentation

1 - - - 1 0 - - - 0

Notes: Matters where the ICRC referred specified allegations to the Discipline Committee or did not take any action are not included. Outcomes in this category are the result of the ICRC issuing advice or recommendations, and/or ordering a SCERP. Category of main themes are based on the current methodology set out by the Ministry for the College Performance Measurement Framework (CPMF) Reporting Tool. Sub categories represent the concern of the ICRC that required remediation. These categories may change in the next reporting period to reflect any changes to CPMF reporting requirements and/or categories the College wishes to track. Outcomes of some complaints involve more than one theme. Some complaints may involve more than one midwife. Timelines

Closed cases

Complaints Reports

Q1 Q2 Q3 Q4 Total Q1 Q2 Q3 Q4 Total Number of files closed <150 days 0 - - - 0 0 - - - 0

Number of files closed between 150 days and 210 days

5 - - - 5 0 - - - 0

Number of files closed >210 days

10 - - - 10 2 - - - 2

Average: (reported in number of days) 273 - - - 273 311 - - - 311

Median: (reported in number of days) 251 - - - 251 311 - - - 311

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Notes: Time is calculated from receipt of complaint until the date of the final decision and reasons. Alternative Dispute Resolution

Stats Q1 Q2 Q3 Q4 Total

Open files with ADR (Files carried over) 0 - - - N/A New files referred to ADR 1 - - - 1 Closed files with in 60 days N/A - - - N/A

Closed files with in 120 days N/A - - - N/A

Files returned to ICRC due to timeframe N/A - - - N/A

Files returned to ICRC due to unsuccessful mediation

N/A - - - N/A

Files returned to ICRC - Registrar did not ratify the agreement

N/A - - - N/A

Open files as at end of reporting period 1 - - - 1

Other useful information: Q1 Q2 Q3 Q4 Total

Total Number of Complaints Received 6 - - - 6 Number of complaints that were not ADR eligible

3 - - - 3

Number of Complaints that were ADR eligible 3 - - - 3 Number of Complaints ELIGIBLE that proceeded to ADR upon consent of all parties

1 - - - 1

Number of Members who agreed to participate in ADR

2* - - - 2

Number of Complainants who agreed to participate in ADR

1** - - - 1

Notes: *One member did not respond before being advised that the Complainant declined to participate. **One Complainants response was outstanding at the time of this report. Appeals

Complaint Matters Q1 Q2 Q3 Q4 Total Open HPARB appeals (Appeals carried over) 10 - - - N/A

New HPARB appeals 1 - - - 1 Completed HPARB appeals 1 - - - 1 Open HPARB appeals (at end of reporting period) 10 - - - 10

Notes: Open files: The ten appeals are representative of six complaint matters. Five complaints involve more than one midwife. All appeals are by Complainants.

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The one completed appeal represents a complaint that the ICRC processed as Frivolous and Vexatious. On May 18, 2021, HPARB issued an order advising that the decision of the board was not to process the review as they determined the request for the review to be frivolous and vexatious. Respectfully Submitted, Susan Lewis

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College of Midwives of Ontario Registration Committee

REGISTRATION COMMITTEE REPORT TO COUNCIL - Q1 April 1, 2021 to June 30, 2021 General Committee Members Chair Isabelle Milot, RM Professional Karen McKenzie, RM; Jan Teevan, RM Public Peter Aarssen; Sarah Baker

Non-Council Alexandra Nikitakis, RM; Maryam Rahimi-Chatri, RM; Jillian Evans; Samantha Heiydt

Activities of the Committee

Q1 Q2 Q3 Q4 Total Number of Panel Meetings Held* 3 n/a n/a n/a 3

Number of Committee Meetings Held*

1 n/a n/a n/a 1

Number of Trainings* 0 n/a n/a n/a 0

* Of the 4 meetings held to date, 4 occurred by videoconference using Microsoft Teams. In Q1, the Registration Committee addressed the following items: COVID-19 PANDEMIC UPDATES The College staff provided the Registration Committee with updates around registration related changes that have been implemented to address the ongoing circumstances with COVID-19 Pandemic. Impacted items included the Canadian Midwifery Registration Exam (CMRE) and ongoing use of the Acknoewledgement and Undertaking, the streamlining and extension of Renewal 2021, and the coming into effect of the Requalification Program Approval and Registrar Authorization Policy approved by the Committee. JURISPRUDENCE COURSE FEE Article 12.4 of the College’s Fees and Remuneration By-Law specifies a $300 fee for the Jurisprudence Course. The College staff reviewed the current approach and determined that the College is in a position to reduce the course fee to $150. Under article 12.6 of the Fees and Remuneration By-law the Registrar has discretion to reduce the amount of any fee payable to the College, where the Registrar is satisfied that there are exceptional circumstances which warrant the exercise of discretion. Therefore, in the absence of being able to open the By-Laws to approve a fee change in time for this

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year’s applicants, the Registrar agreed to reduce the Jurisprudence Course fee to $150. This fee will now be applied to all who are required to take the Jurisprudence Course. The reduced fee for members undergoing a class change became effective as of July 1, 2021. REGISTRATION REGULATION PROJECT – ONGOING WORK The Registration Committee continued its work to review and revise the Registration Regulation. The Committee reviewed for the first time, the new draft of the Registration Regulation incorporating many of the recommendations approved by the Committee to date. The Committee completed a review of each section of the draft regulation, discussed wording and provided feedback. The Committee reviewed the Regulatory Impact Assessment (RIA) related to clinical experience at entry to practise and discussed challenges with the current approach, agreeing that the current entry to practice clinical experience requirements mostly regulate one aspect of midwifery care, i.e. attendance at births. In addition, the Committee discussed some key considerations related to being able to develop meaningful clinical experience requirements at entry to practice and ensuring consistency with other jurisdictions. The College staff will continue to further research and analyze data collected from midwives and external stakeholders related to new registrant conditions and clinical experience at entry to practise and will bring forward recommendations to the Committee. The staff will also continue to work with legal counsel to refine the draft of the Registration Regulation based on the feedback from the Registration Committee. The Committee will review the revised draft prior to bringing it forward to Council for their review and approval in late 2021. Committee, panel, membership changes and statistics follow:

Members by Class of Registration

# %

Q1 (1053) Q2 (n/a) Q3 (n/a) Q4 (n/a) Total

General 731 n/a n/a n/a 69 General with new registrant conditions

72

n/a

n/a

n/a

7 Supervised practice

6 n/a n/a n/a 1

Inactive 244 n/a n/a n/a 23 Transitional 0 n/a n/a n/a 0

New Members by Class of Registration

# %

Q1 (30)

Q2 (n/a)

Q3 (n/a)

Q4 (n/a)

Total (30)

Total

General 0 n/a n/a n/a 0 0

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General with new registrant conditions 25 n/a n/a n/a 25 83

Supervised practice 5 n/a n/a n/a 5 17

Inactive 0 n/a n/a n/a 0 0

Transitional 0 n/a n/a n/a 0 0

New Members by Route of Entry

# % Q1

(30) Q2

(n/a) Q3

(n/a) Q4

(n/a) Total (30)

Total

Laurentian University graduates 5 n/a n/a n/a 5 17

McMaster University graduates

10 n/a n/a n/a 10 33

Ryerson University graduates 11 n/a n/a n/a 11 37 International Midwifery Pre-registration Program (IMPP) graduates

4 n/a n/a n/a 4 13

Out of province certificate holders (midwife applicants) from other Canadian regulated midwifery jurisdictions

0 n/a n/a n/a 0 0

Former members 0 n/a n/a n/a 0 0

Panel Referrals Q1 Q2 Q3 Q4 Total

Total Number of referrals to a panel of the Registration Committee

5 n/a n/a n/a 5

Panels Held by Category Q1 (8) Q2

(n/a) Q3

(n/a) Q4

(n/a) Total (8)

Application for registration1 1 n/a n/a n/a 1 Class change – Inactive to General2 4 n/a n/a n/a 4 Active practice requirements shortfall3 3 n/a n/a n/a 3

Re-issuance of a Supervised Practice certificate of registration4

0 n/a n/a n/a 0

Reinstatement within one year following revocation5

0 n/a n/a n/a 0

Variation of terms, conditions and limitations6 0 n/a n/a n/a 0

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Panel Outcomes by Category

Panel Outcomes By Application for Registration1 Q1 (1)

Q2 (n/a)

Q3 (n/a)

Q4 (n/a) Total (0)

Application approved – Registrar directed to issue certificate of registration

0

n/a

n/a

n/a 0

Application approved – Registrar directed to issue a certificate of registration if the applicant successfully completes examinations set or approved by the panel

0

n/a

n/a

n/a 0

Application approved - Registrar directed to issue a certificate of registration if the applicant successfully completes additional training specified by the panel

0

n/a

n/a

n/a 0

Application approved – Registrar directed to impose terms, conditions and limitations on certificate

0

n/a

n/a

n/a 0

Application not approved – Registrar directed to refuse to issue certificate

0 n/a n/a n/a 0

Panel Outcomes By Class change – Inactive to General2 Q1 (4)

Q2 (n/a)

Q3 (n/a)

Q4 (n/a) Total (1)

Requalification program approved – General certificate to be re-issued

1 n/a n/a n/a 1

Requalification program approved with supervision required – Supervised Practice certificate to be issued

0

n/a

n/a

n/a

0

Panel Outcomes By Active Practice Requirements Shortfall3 Q1 (3) Q2

(n/a) Q3

(n/a) Q4

(n/a) Total (2)

Exception granted – extenuating circumstances demonstrated

0 n/a n/a n/a 0

Shortfall plan required 1 n/a n/a n/a 1 Shortfall plan and undertaking imposing terms, conditions and limitations

1

n/a

n/a

n/a 1

Panel Outcomes By Re-issuance of a Supervised Practice certificate of registration4

Q1 (0) Q2

(n/a) Q3

(n/a) Q4

(n/a) Total (0)

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Re-issuance approved – supervised practice extended

0 n/a n/a n/a 0

Re-issuance not approved 0 n/a n/a n/a 0

Panel Outcomes By Reinstatement within one year following revocation5

Q1 (0) Q2

(n/a) Q3

(n/a) Q4

(n/a) Total (0)

Requalification program approved – no supervised practice required

0 n/a n/a n/a 0

Requalification program approved –supervised practice required

0

n/a

n/a

n/a

0

Panel Outcomes By Variation of terms, conditions and limitations6

Q1 (0) Q2

(n/a) Q3

(n/a) Q4

(n/a) Total (0)

Application refused 0 n/a n/a n/a 0 Registrar directed to remove any term, condition or limitation imposed on the certificate of registration

0

n/a

n/a

n/a 0

Registrar directed to modify terms, conditions or limitations on the certificate of registration

0

n/a

n/a

n/a 0

Timelines: from referral to a panel to a written decision

Q1 (2) Q2 (n/a) Q3 (n/a) Q4 (n/a) Total (2)

Files closed within 30 days 0 n/a n/a n/a 0 Files closed within 60 days 0 n/a n/a n/a 0

Files closed beyond 60 days

2 n/a n/a n/a 2

Shortest: (reported in number of days)

118 n/a n/a n/a 118

Longest: (reported in number of days) 121 n/a n/a n/a 121

Average: (reported in number of days)

120 n/a n/a n/a 120

Note: Six written decisions issued after the end of the quarter not included here.

Registration Decisions appealed to the Health Professions Appeal and Review Board (HPARB)

Q1 (0) Q2 (n/a) Q3 (n/a) Q4 (n/a)

Open HPARB appeals as of quarter end

0 n/a n/a n/a

New HPARB appeals 0 n/a n/a n/a Completed HPARB appeals

0 n/a n/a n/a

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Open HPARB appeals at quarter end

0 n/a n/a n/a

Of those appeals completed, the number of registration decision appeals that:

Q1 (0) Q2 (n/a) Q3 (n/a) Q4 (n/a)

Confirmed the decision n/a n/a n/a n/a Required the College to issue a certificate of registration to the applicant upon successful completion of any examinations or training the Registration Committee may specify

n/a n/a n/a n/a

Required the Committee to issue a certificate of registration to the applicant, with any terms, conditions and limitations the HPARB considers appropriate

n/a n/a n/a n/a

Were referred back for further consideration

n/a n/a n/a n/a

Attrition7 # %

Q1 5 < 1 Q2 n/a n/a Q3 n/a n/a Q4 n/a n/a

Respectfully Submitted, Isabelle Milot, RM Notes:

1. Applications for registration can include first time (initial) applications and applications for re-registration from former members. If the former member resigned within five years prior to the date of re-application, the Registration Regulation requires them to complete a requalification program that has been approved by the Registration Committee.

2. Under the Registration Regulation, members who wish to be re-issued a general certificate of registration and who do not meet one or more of the non-exemptible requirements for a general certificate, with the exception of having to repeat the midwifery education program and the qualifying exam, are required to complete a requalification program that has been approved by a panel of the Registration

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Committee. Often members will be referred because they do not meet the current clinical experience and active practice requirements for a general certificate.

3. It is a condition on every general certificate of registration that the member shall

carry on active practice as outlined in the Registration Regulation. Where a member fails to meet these conditions (i.e. has not attended sufficient births in various settings in a specific timeframe), the member is referred to a panel of the Registration Committee to determine if an exception may be granted or if a shortfall plan is required.

4. Under the Registration Regulation, a Supervised Practice certificate of registration

may only be granted for a period of up to one year. Therefore, if a member has not successfully completed their Plan for Supervised Practice and Evaluation within 12 months of issuance of a supervised practice certificate, the member may request an extension and the certificate may only be re-issued if the Registration Committee approves of it being reissued.

5. Where a former member wishes to be reinstated within one year following

revocation, under the Registration Regulation, the former member is required to complete a requalification program that has been approved by the Registration Committee.

6. Under the Health Professions Procedural Code, Schedule 2 of the Regulated Health

Professionals Act, 1991, a member may apply to the Registration Committee for an order directing the Registrar to remove or modify any term, condition or limitation imposed on the member’s certificate of registration as a result of a registration proceeding.

7. Attrition rate includes the number of midwives who left the profession (e.g.

resignation) and former members’ certificates that have been suspended/revoked/expired. It does not include inactive members. The rate of attrition is expressed as a percentage.

.

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College of Midwives of Ontario Quality Assurance Committee Annual Report June 2021

QUALITY ASSURANCE COMMITTEE

REPORT TO COUNCIL - Q1 April 1, 2021 to June 30, 2021 Committee Members

Chair: Lilly Martin, RM Professional: Jan Teevan, RM; Isabelle Milot, RM

Public: Donald Strickland

Non-Council: Sabrina Blaise, RM; Kristen Wilkinson, RM; Sally Lewis

Activities of the Committee Q1

Number of Panel Meetings Held 0

Number of Committee Meetings Held

1

Number of Trainings

1

Items Committee Training A committee training was provided to review terms of reference, mandate, and objectives of committee. Implementation of QA Regulation With the implementation of the new Quality Assurance regulation in November 2020, the committee was in a position to review and approve the new Professional Development Portfolio program and the Peer and Practice Assessment Program document which were both brought to Council for approval. Quality Assurance Program Reporting Exemption Considering the ongoing COVID-19 pandemic, the committee approved granting an exemption from the reporting requirements of the Quality Assurance Program (QAP), for all midwives registered with the College, for the 2020/21 QAP reporting cycle.

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College of Midwives of Ontario Quality Assurance Committee Annual Report June 2021

Attachments: None.

Respectfully Submitted,

Lilly Martin, Chair

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College of Midwives of Ontario Discipline Committee October 6, 2021

DISCIPLINE COMMITTEE REPORT TO COUNCIL - Q1 April 1, 2021 to June 30, 2021

Committee Members

Chair: Judith Murray Professional: : Edan Thomas, RM, Maureen Silverman RM, Jan Teevan, RM, Lilly Martin, RM, Claudette Leduc, RM, Isabelle Milot, RM, Karen McKenzie, RM Public: Judith Murray, Marianna Kaminska, Peter Aarssen, Donald Stickland, Sarah Baker Non-Council: Susan Lewis

Activities of the Committee

Q1 Q2 Q3 Q4 Total Number of Prehearing Conferences Held 0 - - - 0 Number of Hearing Days 0 - - - 0 Number of Meetings 0 - - - 0

Number of Trainings 1* - - - 1 *One Committee Member attended Discipline Orientation Workshops offered by the Health Profession Regulators of Ontario on April 9, 2021 Caseload Work

Q1 Q2 Q3 Q4 Total

Open files (Files carried over from previous report) 0 - - - 0 Number of new referrals by the ICRC 1 - - - 1 Closed files 0 - - - 0 Open files (Files carried over to next reporting period) 1 - - - 1

Statistics on Closed Cases

Types of Hearings Q1 Q2 Q3 Q4 Total

Number of Uncontested Hearings 0 - - - 0 Number of hearings that resulted in findings of professional conduct

0 - - - 0

Findings of Professional Misconduct Q1 Q2 Q3 Q4 Total

Failed to maintain a standard of practice of the profession

n/a - - -

-

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College of Midwives of Ontario Discipline Committee October 6, 2021

Practicing the profession while the registrant is in a conflict of interest

n/a - - - -

Engaging in conduct that would reasonably be regarded as conduct unbecoming a midwife

n/a - - - -

Engaging in conduct relevant to the practice of the profession that would reasonably be regarded by registrants as unprofessional

n/a - - -

-

Penalties Q1 Q2 Q3 Q4 Total

Reprimand n/a - - - - Terms, conditions and limitations of the Registrant’s certificate of registration requiring the Member to complete remediation

n/a - - -

-

Costs Award n/a - - - - Note: One discipline case may result in more than one finding of professional misconduct and/or penalty component.

Amount of time from referral to the written decision (reported in days)

Q1 Q2 Q3 Q4 Total

Actual n/a - - - - Average n/a - - - -

Respectfully Submitted, Judith Murray

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Fitness to Practise report to Council 1

FITNESS TO PRACTISE COMMITTEE REPORT TO COUNCIL - Q1 April 1, 2021 to June 30, 2021

Committee Members

Chair: Judith Murray Professional: : Edan Thomas, RM, Maureen Silverman RM, Jan Teevan, RM, Lilly Martin, RM, Claudette Leduc, RM, Isabelle Milot, RM, Karen McKenzie, RM Public: Judith Murray, Marianna Kaminska, Peter Aarssen, Donald Stickland, Sarah Baker Non-Council: Susan Lewis

Activities of the Panel

Q1 Q2 Q3 Q4 Total

Number of Hearings Held 0 - - - 0 Number of Committee Meetings Held 0 - - - 0

Number of Trainings 0 - - - 0 Caseload Work of the Panel

Q1 Q2 Q3 Q4 Total Referrals from the ICRC 0 - - - 0


Judith Murray

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College of Midwives of Ontario Client Relations Committee

CLIENT RELATIONS COMMITTEE

REPORT TO COUNCIL - Q1 April 1, 2021 to June 30, 2021 Committee Members

Chair Pete Aarssen Professional Maureen Silverman Public Marianna Kaminska Non-Council Karen McKenzie

Committee Meetings N/A Panel Meetings/Hearings N/A Trainings N/A Items N/A Attachments: N/A


Pete Aarssen, Chair

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College of Midwives of Ontario Chair Report October 6, 2021

COUNCIL CHAIR REPORT

REPORT TO COUNCIL – September 22, 2021 Prepared by: Claire Ramlogan-Salanga RM

1. General Highlights The fall is upon us, and many are returning to some semblance of what was. As vaccination rates increase so does the overall protection of the public and midwives. The College continues to support the choice of birthing people by supporting midwives in the work that they do. As part of the College’s directive, a new and innovative quality assurance program has been developed to help support midwives’ professional development. By creating a self-directed learning plan, midwives will be able to tailor their continued learning to meet their own goals. We are excited to see this program take root and support the growth and quality of midwifery in Ontario. Council continues to work remotely as this format allows members to attend meetings from all over Ontario.

2. Governance

Weekly meetings with the Registrar continue to keep me well-informed of ongoing work at the College. I am happy to report that the Registrar and staff continue to be innovative and efficient with their resources. Last June, our Council training focused on anti-racism. Evelyn Myrie form EmPower Strategy Group led council in a workshop that increased awareness of system racism and racial discrimination in Canada. Additionally, we were able to examine our unconscious biases and the harms of microaggressions. Council found this workshop helpful and directly related to the strategic plan of the College. We also had a workshop hosted by Diana Kawarosky from the Soft Skills Group that sharpened our skills in chairing meetings. This workshop was easily applicable to our work at the College and will help facilitate more effective meetings. I would say goodbye to two of our professional Council members, Jan Teevan and Maureen Silverman. Jan has been on Council for three terms, which amounts to nine consecutive years. In that time Jan has been a member at large on the Executive Committee as well as Chair of the Quality Assurance Committee. She has also served on numerous other committees, including Registration, ICRC, Discipline and Fitness to Practise. Her contributions to the College’s strategic plans have been thoughtful, constructive, and insightful. Council members will miss her cheerful attitude and willingness to uplift individuals. Thank you for your time and contributions; we wish you the best in your retirement Jan!

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College of Midwives of Ontario Chair Report October 6, 2021

Maureen has come to the end of a three-year term and in that time, she has been a member of the Executive Committee, Quality Assurance, Client Relations, Discipline and Fitness to Practise Committees. While on Council, Maureen challenged her peers to consider alternative options as well as encourage others to voice their opinions. Maureen inquisitive participation at Council will be missed. Thank you for your time and contributions Maureen! I would like to welcome two new professional members to Council, Alexia Singh and Hardeep Fervaha. Alexia Singh is joining us from Durham & Markham Midwives and the Alongside Midwifery Unit (AMU) at Markham Stouffville. Hardeep is joining us from Burlington & Area Midwives.

3. Stakeholder Engagement

1. San’yas Indigenous Cultural Safety Training: July-August 2. HPRO Focus Group (EDI research): July 13 3. CMRC EDI Committee Meeting: Sept 9 4. CMRC AGM and Board Meeting: Sept 14 5. OMSC – Sept 20 6. Non-Council Member Lunch n’ Learn webinar: Sept 23 7. Ex-Officio:

Discipline and Fitness to Practice training – July 16 Quality Assurance Committee meeting – Sept 15

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College of Midwives of Ontario Executive Committee Report June 23, 2021

EXECUTIVE COMMITTEE

REPORT TO COUNCIL September 2021 Committee Members

Chair Claire Ramlogan-Salanga, RM Professional Edan Thomas, RM (VC); Claudette Leduc Public Don Strickland (VC); Marianna Kaminska

Committee Meetings September 10, 2021 Items Approved on behalf of Council:

• Q1 Statement of Operations • Non-Competitive Process Procurement • 2023 Council and Executive Meeting Dates

Q4 Statement of Operations The committee reviewed and approved the Q1 Statement of Operations. The College is in good cash flow position with no concerns financially. Non-Competitive Process Procurement The committee discussed and approved the non-competitive process procurement of Sam Goodwin based on current relationship and relevant expertise on additional governance-related matters considering Council’s satisfaction with his work and his expertise on governance issues in general. The committee also discussed and approved the same process for the procurement of Holliday Tyson to develop a proposal for a College-delivered assessment and bridging program for IEMs. Holliday is the sole expert in Ontario doing this work in the midwifery sector and time constraints were a significant issue as well. 2023 Council and Executive Dates The Committee approved the following dates for Council and Executive Committee meetings in 2023. Dates have been added to Board Effect and are available for calendar synching.

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College of Midwives of Ontario Executive Committee Report June 23, 2021

Council Evaluations The Committee met with Sam Goodwin, Goodwin Consulting who presented a revised approach to Council Evaluations. The proposed changes and rationale will also be presented to Council by Goodwin Consulting at the Council meeting. The Committee recommends that Council approve a pilot of the proposed approach which will include an evaluation before formalizing any policy changes Attachments:

1. Q1 Statement of Operations 2. 2023 Council and Executive Committee Dates 3. Council Evaluation – Proposed Approach 4. Council Evaluation – Appendix 1 5. Council Evaluation – Appendix 2


Claire Ramlogan-Salanga

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The College of Midwives of OntarioQ1 Statement of Operations (Fiscal April 1, 2021 - March 31, 2022)April 1, 2021 - June 30, 2021

F22 Projected Revenue

F22 Projected Revenue to end

of Q1 Q1 Revenue

F22

Q1 Revenue

F21

Percentage Variance

Against Budget REVENUEMembership Fees 2,502,042$ 625,511$ 605,009$ 599,871$ 24%Administration & Other 62,551$ 15,638$ 20,005$ 23,739$ 32%Project Funding - Birth Centres 65,000$ 16,250$ 15,910$ 16,780$ 24%TOTAL REVENUE 2,629,593$ 657,398$ 640,924$ 640,390$ 24%

F22 Budget F22 Budget to

end of Q1

Q1 Spending

F22

Q1 Spending

F21

Percentage Variance

Against Budget EXPENSESSalaries & Benefits 1,527,370$ 381,843$ 337,082$ 331,372$ 22%Professional Fees 118,963$ 29,741$ 12,097$ 3,269$ 10%Council and Committee 146,018$ 36,505$ 31,876$ 17,785$ 22%Office & General 143,261$ 35,815$ 16,404$ 18,963$ 11%Information Technology, Security & Data 157,067$ 39,267$ 22,797$ 25,562$ 15%Rent & Utilities 200,086$ 50,022$ 46,887$ 47,386$ 23%Conferences, Meeting Attendance & Membership Fees 72,500$ 18,125$ 54,605$ 54,598$ 75%Panel & Programs 297,053$ 74,263$ 4,001$ 8,536$ 1%Birth Centre Assessment & Support 65,000$ 16,250$ 15,071$ 12,459$ 23%Capital Expenditures 43,689$ 10,922$ 10,875$ 9,910$ 25%TOTAL EXPENDITURES 2,771,007$ 692,752$ 551,695$ 529,839$ 20%PROJECTED LOSS (141,414)$

ADDITIONAL NOTES

1

Total Accrual 146,624$ Accrual Budget to end of Q1 36,656$ Accrual Spending to end of Q1 20,539$

An accrual was set aside at the end of the previous fiscal to bring outstanding Professional Conduct matters to their conclusion. Tracking of the spending in this area against the accrual recorded is as follows:

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Council Self Evaluation Piloting Changes for 2021-22

October 2021

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This report describes potential changes to the current CMO approach to Council Evaluation that could be piloted starting this fall.

The changes are a further evolution of CMO’s approach, not fundamental change.

“Pilot” means that Council would have an opportunity to test out the new approach for the year, including an evaluation of the approach, before formalizing any policy changes.

At the end of the pilot, Council members and senior staff would have the opportunity to provide input on how it worked, any adjustments, etc.

Council Self Evaluation Changes - October 2021 2 of 128

Over the years, CMO has demonstrated a strong commitment to continuing to enhance Council governance.

Refined and streamlined as recently as last year, the current approach has the following components:

1. An Evaluation of each Council meeting, including a report and discussion at the next Council meeting

2. A year-end evaluation of Council that is also reported publicly

3. A Council peer review process

4. Individual Council member self-evaluation that focuses on competencies, personal attributes and skills.

The current Annual evaluation captures three components:

• Council’s performance as a whole

• The performance of Committee and Panels/Panel Chairs

• The performance of the Council Chair

The above are administered for Council by the Council & QA Coordinator, with the exception of the peer view process, which is managed directly and confidentially by the Council Chair.

CMO Commitment to Continuous Improvement


The CPFM has a number of specific provisions related to Council Evaluation:

Council regularly assesses its effectiveness and addresses identified opportunities for improvement through ongoing education.

Council has developed and implemented a framework to regularly evaluate the effectiveness of Council meetings and Council.

Evaluation and assessment results are discussed at a public Council meeting.

The framework includes a third-party assessment of Council effectiveness at a minimum every three years

Ongoing training provided to Council has been informed by the outcome of relevant evaluation(s), and/or the needs identified by Council members.

Aligning with the College Performance Management Framework (CPMF)

CMO’s approach to Council evaluation anticipated the CPMF requirements.

Rather than a review of Council governance every three years and identifying improvements across many different policies all at the same time, Council has approved a “rolling” approach that emphasizes ongoing reflection and continuous improvement, rather than a point-in-time approach.

Goodwin Consulting has been retained to providing ongoing advice to CMO on Governance policies and practices. Each year, a manageable number of policies are identified for third party review and potential enhancements are identified for Council’s consideration.

Using this approach, the first two policies that have been reviewed are:

• CEO Performance Evaluation (completed in December 2020 – with the new process being utilized for 2020-21)

• Council Self-Evaluation (the focus of this report)


The main opportunities in the current approach are:

• Puts a lot of weight on the annual evaluation as a point-in-time assessment – the proposed changes build in more ongoing reflection and improvement throughout the year.

• There is an opportunity to focus more on consistent Good Governance behaviours for members, whether they are meeting as Council or as Committees – the proposed changes emphasize consistent Good Governance behaviours for Council members, regardless of whether they are in Committee or at Council.

• Doesn’t include a consistent way for Executive Committee to have a “line of sight” into the governance performance of Committees – in order to be able to monitor for effectiveness and address issues and opportunities – the proposed approach creates new opportunities for Executive Committee to monitor overall performance and effectiveness and stay engaged with Committee Chairs

• Puts the onus on the Chair to drive parts of the process, identify issues, etc. as well as directly manage the Peer Review process – the proposed changes make more use of the Council & QA Coordinator and the external advisor

• The Peer Review component is a more labour intensive way to identify annual training and development priorities for Council – the proposed changes would eliminate the Peer Review and get a useful result in a more efficient way

• The Panel evaluation might be misplaced given that Council members on Panels are not acting in the role of Governors, but rather as adjudicative/quasi-judicial decision makers – the proposed approach would create a separate process to evaluate panel adjudicative effectiveness as separate from governance.

Opportunities in the current approach to further refine via this pilot


The Key Recommendations

1. Approach both Council

Meetings and Committee Meetings (“business” meetings only – not panels) as governance venues for Council members –use the same evaluation process and look for real time continuous improvement opportunities.

2. Connect the questions asked for the year-end

evaluation with the questions for Council/Committee meeting evaluations to ensure alignment and consistency throughout the year.

Use the results of Council and Committee meeting evaluations to build towards and generate insights that feed into the year-end evaluation.

3. Monitor Council and Committee meeting

evaluations on an ongoing basis (via the Council & QA Coordinator and the external advisor) –bring forward issues and opportunities in a timely way and give Executive Committee a quarterly line of sight into Committee governance performance.

4. Add a substantive discussion of

governance Continuous Improvement priorities for the coming year to the year end evaluation and bring the results to the December Council Training Day to discuss and set priorities.

5. Convert the individual Council member self-

assessment into an optional/ voluntary tool that interested Council members can use.

Use the year end evaluation to identify Council training and development priorities (see #4 at left).

6. Create a separate process to evaluate

Panels and Panel Chairs – one that focuses on their unique (non-governance) role as quasi-judicial adjudicators.


Plus two additional actions to consider

A. Create a separate year end self-

evaluation process for Executive Committee that fosters dialogue within Executive about continuous improvement and supports succession planning.

B. Create an opportunity 2 times a year for

Executive and Committee Chairs to meet collectively as a leadership and Chairing “check-in” and quality assurance exercise.


Pilot Recommendations

• Recognize that Council meetings and Committee meetings are the two most important venues for Council members in their role as Governors, and that the requisite Good Governance behaviours are essentially the same in both.

• Evaluate Committees using the same questions as for Council meetings, with discussion of the results at the next meeting. This would be applied only to Committee business meetings, not panels, i.e. just 2-3 meetings each year per Committee.

• Use the evaluation process for Council and Committee meetings to look for emerging themes, issues, concerns and continuous improvement opportunities.

• Chairs would be evaluated as part of each meeting evaluation rather than via the year end evaluation as at present.

1. Approach both Council Meetings

and Committee Meetings (“business” meetings only – not panels) as governance venues for Council members – use the same evaluation process and look for real time continuous improvement opportunities.



• Use consistent evaluation questions for both Council and Committee meetings that communicate and reinforce Good Governance behaviours.

• Use a subset of the Council year end evaluation questions for Council and Committee meeting evaluations.

• Bring forward any recurring themes from Council and Committee meeting evaluations to inform Council members as they evaluate their annual performance.

• Use the Council and Committee meeting evaluation process throughout the year to keep the Good Governance behaviours front and centre in the minds of Council members – as they think about their own performance and as they prepare to participate in any setting or event where they are acting as Council members.

• Confirm the expectation of 100% participation in the evaluation processes for attending members – use the external advisor to follow up as required.

• 100% participation would include non-Council Committee members – and would reinforce the role that Committees play as a “feeder” group for membership on Council.

2. Connect the questions asked for the

year-end evaluation with the questions for Council/Committee meeting evaluations to ensure alignment and consistency throughout the year.

Use the results of Council and Committee meeting evaluations to build towards and generate insights that feed into the year-end evaluation.

Appendix A is a set of year end evaluation statements.

Appendix B is a subset of A that would be used to evaluate Council and Committee meetings.



• Meeting evaluation results would be reviewed and reports prepared by the Council & QA Coordinator, with the external advisor.

• Members would have an ongoing opportunity to speak confidentially to the external advisor to raise issues and share insights. The external advisor would also be able to follow up with Council members where significant concerns were expressed or “low” scores given. Where appropriate, issues would be discussed with the Chair and where relevant with the Registrar.

• Meeting reports would be reviewed by the (Committee or Council) Chair – and then:

o Sent out to the Committee (or Council) members while the meeting is fresh in their minds – by the Council & QA Coordinator – also sent to senior mgt.

o Also included in the meeting package for the next meeting for discussion as the first agenda item.

• Executive Committee would review the Committee reports on a quarterly basis (materials and analysis prepared by the Council & QA Coordinator and external advisor) and would note that review in their quarterly report to Council.

3. Monitor Council and Committee

meeting evaluations on an ongoing basis (via the Quality Assurance Coordinator and the external advisor) – bring forward issues and opportunities in a timely way and give Executive Committee a quarterly line of sight into Committee governance performance.



• Through the year end evaluation survey, get input from Council members about governance continuous improvement priorities or themes for the coming year.

• Typical priorities or themes could include: a focus on one or more key governance behaviours; specific training and development for Council; greater emphasis within Council on financial or other types of oversight questions, more consideration of diverse perspectives, etc.

• Collect, assess and bring forward the suggestions for review by Executive Committee in November and discussion at the December Council Training Day. Also, incorporate relevant insights from Council and Committee meetings throughout the year and seek senior mgt. input.

• Make decisions about priorities at the December training day and then convert those into an action plan.

• Report publicly on the year end evaluation and continuous improvement priorities at the next Council meeting.

• As part of each Council and Committee meeting evaluation, remind members of the continuous improvement priorities and ask for their views on progress being made.

4. Add a substantive discussion of

governance continuous improvement priorities for the coming year to the year end evaluation and bring the results to the December Council training day to discuss and set those priorities.



• Provide the self-assessment tool as an option for interested Council members.

• Ask mentors to encourage new Council members to complete the tool and reflect on the results – and help the new member convert the results into actions.

• Incorporate Council input on training, skills, and other developmental needs into the year end evaluation – focusing on priorities that will strengthen their performance as Governors – and use those results to inform training needs for Council as a whole.

• Eliminate the annual Peer Review process.

5. Convert the individual Council

member self-assessment into an optional/ voluntary tool that interested Council members can use.

Use the year end evaluation to identify Council training and development priorities.



• Panels play a very significant role in RHPA colleges – one that can very directly and significantly impact members of the public and registrants.

• However, that Panel role is one of quasi-judicial adjudication, not Governance.

• Given the potential impact that Panels can have, it is very important that Council be assured of things like reasonable and fair decision making, accessible processes, timely access for the public and registrants, etc.

• Being able to separately assess the effectiveness of Panels will become even more important for Councils in the future, when/if the changes to Council Governance as proposed by HPRO are made, i.e. Council members no longer sit on panels – which will require a Council to have a means to be assured of effectiveness.

6. Create a separate process to evaluate

Panels and Panel Chairs – one that focuses on their unique (non-governance) role as quasi-judicial adjudicators.



The process for Council and Committee meetings

All Committee members complete

the evaluation

Results are pulled together

in a meeting report

Draft report is reviewed by Committee

Chair

Meeting report goes out to Committee

members and is shared with Senior Mgt.

Meeting report is discussed at

the beginning of the next meeting

Committee Meetings

All Council members

complete the evaluation

Results are brought

together in a meeting report

Draft report is reviewed by the

Chair

Meeting report goes out to Council

members and is shared with Senior

Mgt.

Meeting report is discussed at

the beginning of the next meeting

Council Meetings

Both processes use the same evaluation criteria

focused on Good Governance behaviours

Includes prompts and questions related to

progress on Continuous Improvement Priorities



Typical timeline for meeting reports – preparation and distribution

Council or Committee

Meeting

Report is draftedCouncil & QA Coordinator and the external advisor

Approximately 1 week for members to complete the survey

Report is reviewed by the

Chair

Follow-up discussion re any issues – if

appropriate

Report goes out to Committee members

and is available to Council members

Next MeetingReport is distributed with the package for the next meeting

NextMeeting

Timeline of about 2-3 weeks normally

The first item on the meeting agenda is an opportunity to have discussion about any

issues in the report


All Council members complete

the year end evaluation in

October

Analysis report is prepared– including any themes from in-

year meeting evaluations and

recommendations where appropriate

Draft report is discussed with

Executive Committee in Nov.

Draft report goes to Council members in

advance of the December training

day

Facilitated discussion at the

December Training Day - continuous

improvement priorities agreed on

Year end public report tabled at

next Council meeting

Council Year-End Self-Evaluation

Cycle starts here

External advisor follows-up with individual Council members where appropriate to get more info and explore an issue raising via the survey


Pilot – additional options for discussion

• This optional process would take place at the end of the Council year and include:

o A set of self-evaluation criteria based on Executive Committee’s Terms of Reference

o Conducting the assessment via a group round-table facilitated by the external advisor

o The external advisor prepares a report for Council that is presented by Executive for discussion at the first Council meeting of the next year. Council is invited to ask questions and provide any additional feedback.

• This option is useful if Council members don’t get much insight into what Executive does on an ongoing basis. However, CMO’s Executive Committee already provides fulsome reports to Council on a regular basis – which would already give Council a reasonable view into the activities and effectiveness of the Committee. Also, the Council year end evaluation will include asking Council members for their input on Executive Committee performance and effectiveness over the year.

• As such, the value of this option would be more as a reflection opportunity for the Committee itself, and as a developmental discussion that might contribute to succession planning within Executive Committee.

A. Create a separate year end self-

evaluation process for Executive Committee that fosters dialogue within Executive about continuous improvement and supports succession planning.


Pilot – additional options for discussion

• The focus would be on continuous improvement – an opportunity to reflect and talk about shared experiences, common issues, themes, tactics and techniques, training needs, etc.

• The process would give Executive Committee further insight into the effectiveness of Committees and their Chairs and help inform succession planning.

• The process would also reinforce the role of Executive Committee members and Committee Chairs as a Council leadership group.

• For example, the timing could be February and June.

B. Create an opportunity 2 times a

year for Executive and Committee Chairs to meet collectively as a “check-in” and QA exercise.


What happens to the proposed process if there is no Executive Committee at some point in the future?

HPRO has proposed governance changes that would eliminate Executive Committees from RHPA Councils. If that change is made, the proposed process could be adjusted as follows:

For Council and Committee meeting evaluations

• The evaluation results of each meeting would be reviewed in draft by the Committee Chair, as well as by the Council President and Vice President. Having the latter two Council leaders look at the draft results, along with the Committee Chair, ensures that the effectiveness of both types of meetings are being monitored in real time in way the cuts across the Committees and Council. This means that issues and needs can be identified and that action, where appropriate, can be taken in a timely way.

For the Council year-end self evaluation

• CMO may wish to consider creating a Council Committee whose mandate includes Governance – a common component of most Boards. The Governance Committee would oversee the Council Year-End Self-Evaluation process on behalf of Council (instead of Executive Committee). If there was no Governance Committee, then the process would be overseen by Council as a whole.


Appendix A –Year End Evaluation Statements 1

Appendix A: Council Year End Evaluation Statements For each Statement, members would use a “directional” evaluation scale out of 5, plus provide comments. The external advisor would follow-up with individuals that gave lower scores but without explanatory comments, to obtain additional insights. Members could also reach out to the external advisor to a) provide their input verbally, and/or b) discuss a specific issue.

A. Governance and Decision Making

1. Council members have a good understanding of the mandate, mission and programs of the College.

2. Council members are aligned on their role as Governors to make decisions in the public interest.

3. Council members are clear and agree on the distinction between Council and Management responsibilities.

4. Council regularly monitors and evaluates progress toward strategic goals and monitors organizational and program effectiveness and performance.

B. Leadership

5. Council members have opportunities to develop as leaders through rotation of Committee assignments, Chair roles, and other opportunities to lead.

6. Council leaders (Executive Committee members, Committees Chairs) provide effective leadership and act in accordance with the College’s values and the public interest.

7. Executive Committee has the necessary skills, enthusiasm, and energy to provide leadership to Council.

8. Executive Committee has an effective working relationship with the CEO.

C. Financial Performance and Risk

9. Council, including through the Executive Committee, is actively and appropriately involved in setting direction for and approving the financial plan/budget.

10. Council monitors financial performance regularly and staff are able to explain variances and potential corrective actions, with few or no surprises.

11. Council ensures timely, independent auditing of finances, and audit results are discussed by Council with the Auditor.

12. Council contributes to, and is briefed periodically on regulatory and organizational risk management priorities and actions.

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Appendix A –Year End Evaluation Statements 2

D. Council Performance

13. Council meeting agenda and packages are clear about the key issues and areas for Council consideration.

14. Council receives quality background information and material sufficiently in advance to allow for effective preparation.

15. Meetings start and end on time with an emphasis on substantive discussion of significant matters by Council.

16. All necessary skills to conduct Council business are represented on Council.

17. Council members proactively ask questions, raise issues, and engage constructively in discussion and debate.

E. Continuous Improvement Priorities for the Coming Year

18. Based on your assessment of Council's performance over the past year, please provide your suggestions for one or more Council Continuous Improvement priorities for the coming year. The results of this part of the survey will be discussed at the Council Training Day in December. The resulting priorities will become part of Council's focus for the coming year

and will be incorporated into Council and Committee meeting evaluations.

Plus a general “Is there anything else you wish to comment on?” category.

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Appendix B: Council and Committee Meeting Evaluation Statements

For each Statement, members would use a “directional” evaluation scale out of 5, plus provide comments. The external advisor would follow-up with individuals that gave lower scores but without explanatory comments, to obtain additional insights. Members could also reach out to the external advisor to a) provide their input verbally, and/or b) discuss a specific issue.

Current CMO Council Meeting Evaluation Questions

Proposed Evaluation Statements – focused on Good Governance Behaviours

1. Regarding the outcomes of the Council meeting, do you agree that the decisions and discussions of Council were centred with the objective of protecting the public interest?

2. Regarding meeting process, is there anything Council or staff should CONTINUE doing? Please explain your answer below.

3. Regarding meeting process or materials is there anything Council or staff should START doing? Please explain your answer below.

4. Regarding meeting process or materials is there anything Council or staff should STOP doing? Please explain your answer below.

Quality and Timeliness of Materials

1. The meeting package was received in a sufficient time to allow me to prepare.

2. The agenda items and materials were appropriate to Council/the Committee's role, and the materials were sufficient to assist me in forming opinions on matters before Council/ the Committee.

Effective Meeting Management

3. Time was used effectively, and discussions were focused.

4. Council/the Committee discussions and deliberations remained centred on the public interest, and we avoided getting into administrative and operational management details.

5. Any disagreements were handled openly, honestly, and directly. There was a positive climate of trust and respect.

6. Where appropriate, next steps and action items were clearly identified.

Member Performance

7. Members appeared prepared for the meeting.

8. I was satisfied with the opportunities that all of us had to participate in and contribute to the discussion and debate.

9. The Chair was effective in guiding the meeting and allowing all sides to be heard, while bringing matters to decision.

Council's Continuous Improvement Priorities

10. Council’s Continuous Improvement Priorities for this year are: [to be confirmed each year]. Are you as a Council and Committee member, finding opportunities to act on these priorities in your roles as Council and Committee members?

General

Anything else about the meeting you would like to comment on or share?

For discussion: Optional Question for a Committee that has Panels (if we are not evaluating panels separately)

Do you wish to share any comments about recent experiences you may have had as a panel member?

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College of Midwives of Ontario Council Meeting October 6, 2021

1

FOR APPROVAL

BRIEFING NOTE FOR COUNCIL Subject: Revisions to the Professional Development Portfolio Background:

At the June 23, 2021, Council meeting, the Quality Assurance Committee (“Committee”) brought the proposed Professional Development Portfolio program document to Council for approval. Council did not approve the document and directed staff to revise the document so it is clear that all midwives on leave from the profession, either temporarily or permanently, would not be subject to completing and reporting on their Professional Development Portfolio. Council was concerned that all midwives registered in the Inactive class (including those who are on disability or medical leave and those who have permanently ceased clinical practice), must participate in the Professional Development Portfolio in accordance with the Quality Assurance (QA) Regulation (O. Reg 669/20) that came into force on November 27, 2020. Council felt this requirement does not respect the unique and difficult situations some midwives are in when registered in the Inactive class. While Inactive members cannot be universally exempt from the Quality Assurance Regulation requirements, the Committee has revised the Professional Development Portfolio to address Council’s concerns.

Key Considerations Why must midwives registered in the Inactive class participate in the Professional Development Portfolio? Midwives registered in the Inactive class must participate in the Professional Development Portfolio because participation in the Quality Assurance Program it is a requirement under the Quality Assurance Regulation which was approved by Council in March 2017 after a 70 day consultation with the membership and stakeholders. Do midwives registered in the Inactive class have to participate in all aspects of the Professional Development Portfolio? Midwives who are in the Inactive class for extended periods of time, or permanently, are not required to participate in case reviews according to the Professional Development Portfolio requirements. This reduces their requirements compared with midwives registered in the General class. Why must midwives registered in the Inactive class, who have retired from clinical practice, participate in the Professional Development Portfolio? Midwives registered in the Inactive class, who have retired from clinical practice, must participate in the Professional Development Portfolio because participation is required of all midwives registered with the College and not only midwives who are practising. Midwives who choose to remain registered with the College must meet all the requirements of a College member. This includes completing their registration renewal every year and complying with all regulations as

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https://www.ontario.ca/laws/regulation/200669


2

FOR APPROVAL

they relate to them. Completing the Professional Development Portfolio every three years is one of the requirements of a registered midwife. Can midwives who are having difficulty participating in the Professional Development Portfolio be exempt from its requirements? Every midwife, including those in the Inactive class, can request an exemption from any or all of the requirements of the Professional Development Portfolio as set out in section 4 of the Quality Assurance Regulation.

4. Upon application by a member, the Committee may grant an exemption to the member from any of the requirements of the program because of illness, maternity leave or any other circumstance the Committee considers appropriate.

Is it difficult to apply for an exemption from the Professional Development Portfolio? Applying for an exemption from the Professional Development Portfolio will be a simple process and less onerous than annual registration renewal. The Committee intends to revise the current Exemption Request Form to facilitate exemption requests by including a section specific to the Inactive class. There will also be a section specific to midwives who have an accommodation under the College’s Accommodation Policy. Given how simple applying for an exemption is, even compared with registration renewal, the Committee does not see the need for further tools or processes to facilitate an exemption from the PDP for midwives who are on leave from the profession for reasons that limit their ability to participate in continuing education and professional development activities. To highlight this for members, the Professional Development Portfolio has been revised with the following additions: Under the heading Participation

Addition: Midwives who experience barriers to participating in, or reporting on, their Professional Development Portfoli0 will be accommodated to the point of undue hardship. Midwives who are unable to participate in, or report on, their Professional Development portfolios can apply for an exemption (see Exemptions).

Under the heading Exemptions

Addition: Midwives who are unable to meet their Professional Development Portfolio requirements due to exceptional circumstances such as illness, parental leave, or disability leave can be granted an exemption from any, or all, of the program requirements under Section 4 of the Quality Assurance Regulation. A full exemption means the midwife has no reporting obligations for the entire three year Professional Development Portfolio cycle for which the exemption was requested. A partial exemption means the midwife will complete some, not all of the Professional Development Portfolio requirements for the three year reporting cycle.

Midwives must apply for an exemption at least 15 business days prior to their reporting deadline by submitting an Exemption Request form. The Exemption Request form is designed to facilitate the request and not to pose a barrier for those midwives who have experienced barriers to completing their Professional Development Portfolio requirements.

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https://www.cmo.on.ca/wp-content/uploads/2017/07/QA-exemption-form-2019.pdf

https://www.cmo.on.ca/wp-content/uploads/2020/07/Accommodation-Policy-Final-16JUN20.pdf


3

FOR APPROVAL

If the exemption is not warranted, the midwife will be considered non-compliant with the Professional Development Portfolio if they remain unable to meet the requirements.

Recommendations

The following recommendations are submitted to Council for approval: Approve the Professional Development Portfolio

Implementation Date

Immediately

Legislative and Other References

1. Quality Assurance Regulation (O. Reg 669/20)

Attachments

Submitted by: The Quality Assurance Committee

1. Professional Development Portfolio document

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https://www.ontario.ca/laws/regulation/200669

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PROFESSIONAL DEVELOPMENT PORTFOLIO 1 College of Midwives of Ontario

TABLE OF CONTENTS Introduction ..................................................................................................................................................................... 2

Participation .................................................................................................................................................................... 2

Maintaining Records.......................................................................................................................................... 3

Reporting Cycle........................................................................................................................................................ 3

Submission to the College ...................................................................................................................... 4

College Reviews ..................................................................................................................................................... 4

Compliance ..................................................................................................................................................................... 5

Non-compliance ..................................................................................................................................................... 5

Exemptions ......................................................................................................................................................................6

Confidentiality ............................................................................................................................................................. 7

Professional Development Program Components ...........................................8

1. Self-Assessment 8 2. Continuing Education and Professional Development 9

i. Develop and complete a Learning Plan 9 ii. Participate in case reviews (peer and interprofessional) 12

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INTRODUCTION The College of Midwives of Ontario’s Quality Assurance Program is a requirement set out in the College’s Quality Assurance Regulation (O. Reg 669/20). The Quality Assurance Program is defined as a program to assure the quality of the practice of the profession and to promote continuing evaluation, competence and improvement among the members. An important part of the College’s Quality Assurance Program is the Professional Development Portfolio. The Professional Development Portfolio, informed by midwives and approved by Council, is designed to encourage and support midwives to continually engage in self-assessment, continuing education, and professional development. The Professional Development Portfolio is comprised of a self-assessment, continuing education, and professional development activities and a declaration of completion every three years. This document describes the Professional Development Portfolio, how midwives will meet their Professional Development Portfolio requirements, and the College’s process for reviewing midwives’ participation in the Professional Development Portfolio portion of the Quality Assurance Program.

PARTICIPATION Completing the Professional Development Portfolio (Appendix A of this document [to be attached once finalized]) is a requirement for all midwives registered in the General, Supervised Practice, Transitional, and Inactive classes. All Midwives must submit evidence of a completed Professional Development Portfolio three years after they become registered with the College and every three years thereafter. The number of peer reviews required is based on the length of time a midwife is registered in the General class during their three-year reporting cycle. More information about this is found in the section Participate in case reviews (peer and interprofessional). Midwives who experience barriers to participating in, or reporting on, their Professional Development Portfoli0 can be accommodated to the point of undue hardship. Midwives who are unable to participate in, or report on, their Professional Development Portfolios can apply for an exemption (see Exemptions).

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MAINTAINING RECORDS Midwives are required to keep their Professional Development Portfolio (i.e., Self-Assessment, Learning Plan, and Case Reviews in the formats specified by the College), as well as any supporting documentation for their CE/CPD activities for the previous two reporting cycles. This means a midwife submitting their Professional Development Portfolio will still retain their two previous Professional Development Portfolios but may discard any records prior to that. Midwives may be asked to submit their Professional Development Portfolio to either the College or an assessor as part of the College’s Professional Development Portfolio review (see below) or a peer and practice assessment. There is always the possibility that a midwife’s Professional Development Portfolio will be reviewed by the College, therefore it is essential that they are complete. A complete Professional Development Portfolio is one where the following is evident:

• Learning Plans and Reflections are descriptive • The required number of peer case reviews have been attended and documented • Supporting documentation about CE/CPD activities are maintained by the midwife

(e.g., evidence of course completion, references for journal articles reviewed). Since the Professional Development Portfolio is designed for midwives to stay engaged in the midwifery profession by participating in ongoing learning, midwives may want to keep their records for their own files to document the changes to their practice throughout their professional careers.

REPORTING CYCLE Midwives are required to report on their Professional Development Portfolio every three years, by October 1 of their reporting year (i.e., midnight on September 30). A midwife’s reporting year is determined in the following way:

A midwife’s first reporting cycle begins on the date of their first registration renewal or the third October after initial registration with the College. This means completion of the first Professional Development Portfolio for midwives is likely to be longer than three years. For example, if a midwife registers on July 7, 2019, their first renewal will be on October 1, 2019. Thus, the midwife’s first Professional Development Portfolio report will be due on October 1, 2022.

A midwife’s reporting cycle does not change if they change classes. This means that a midwife’s reporting cycle will always be three years from the date of their first registration renewal or the third October after initial registration with the College and does not go on hold if they register as inactive. Only activities a midwife participates in during their reporting cycle Professional Development Portfolio cycle are eligible as reportable activities. Any Professional

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Development Portfolio activities completed between the date of submission and the actual submission deadline cannot be carried forward to the next reporting cycle.

SUBMISSION TO THE COLLEGE All reporting midwives will be required to submit a declaration of completion in the Member Portal of the database by the reporting deadline. Falsely declaring completion of the Professional Development Portfolio is an act of professional misconduct. Should a midwife submit a declaration of completion for the Professional Development Portfolio and a College review of their records finds they do not have the supporting evidence to demonstrate completion, the midwife may be referred to Inquiries, Complaints, and Reports Committee (ICRC) under s. 80.2 of the Code.

COLLEGE REVIEWS Each year, 20% of reporting midwives will be selected by the College to have their Professional Development Portfolio reviewed for completion. Midwives who have been selected for a College review will have 30 days to submit their Professional Development Portfolio and any supporting documentation. Professional Development Portfolios must be submitted on the College’s template. Supporting documentation includes certificates, diplomas, conference proceedings, and other forms of documentation that demonstrate participation in learning activities when such evidence exists. Not submitting the required records for review is considered non-compliance. Details about non-compliance are described below.

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COMPLIANCE Midwives submitting a declaration only Midwives who submit their declaration of completion and are not randomly selected for review are considered compliant with the Professional Development Portfolio requirements.

Midwives selected for review Midwives who submit their declaration of completion and are randomly selected for review and submit complete CE/CPD records by the assigned deadline are considered compliant with the Professional Development Portfolio. Midwives who are considered compliant will receive a notice of compliance.

NON-COMPLIANCE Midwives who fail to submit a declaration Midwives who do not submit a declaration of completion or who are selected for review and do not submit a completed Professional Development Portfolio will receive a notice of non-compliance and must pay an administrative fee pursuant to Article 11 (9) of the College’s Fees and Remuneration By-Law. Midwives marked non-compliant may make a written submission regarding their non-compliance to the Quality Assurance Committee (QAC) within 30 days of receiving the notice. Submissions will be reviewed by a panel of the QAC.

Outcome of non-compliance Following a review of a midwife’s documents, a panel of the QAC may make the following decisions: Take no Action The panel may choose to take no action Peer and Practice Assessment The panel may order the midwife to undergo a peer and practice assessment. The midwife will bear all costs (not more than $2,500) for the peer and practice assessment pursuant to Article 7(2) of the College’s Fees and Remuneration By-Law.

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Remediation After considering the assessor’s report of the peer and practice assessment, the QAC may choose to do one or more of the following, listed in subsection 80.2 (1) of the Health Professional Procedural Code:

• Require individual midwives whose knowledge, skill, and judgment have been assessed and found to be unsatisfactory to participate in specified continuing education or remediation programs (SCERP).

• Direct the Registrar to impose terms, conditions, or limitations (TCL) for a specified period to be determined by the Committee on the certificate of registration of a midwife.

o where the midwife’s knowledge, skill, and judgment are assessed and found to be unsatisfactory;

o if, following a SCERP and reassessment, the midwife’s knowledge, skill, and judgment is still deemed to be unsatisfactory; or

o if the midwife does not comply with the direction to participate in, or successfully complete a SCERP

• Disclose the name of the midwife and allegations against them to the Inquiries, Complaints and Reports Committee (ICRC) if the QAC is of the opinion that the midwife may have committed an act of professional misconduct or may be incompetent or incapacitated.

EXEMPTIONS Midwives who are unable to meet their Professional Development Portfolio requirements due to exceptional circumstances such as illness, parental leave, or disability leave can be granted an exemption from any, or all, of the program requirements under Section 4 of the Quality Assurance Regulation. A full exemption means the midwife has no reporting obligations for the entire three year Professional Development Portfolio cycle for which the exemption was requested. A partial exemption means the midwife will complete some, not all of the Professional Development Portfolio requirements for the three year reporting cycle. Midwives must apply for an exemption at least 15 business days prior to their reporting deadline by submitting an Exemption Request form. The Exemption Request form is designed to facilitate the request and not to pose a barrier for those midwives who have experienced barriers to completing their Professional Development Portfolio requirements. If the exemption is not warranted, the midwife will be considered non-compliant with the Professional Development Portfolio if they remain unable to meet the requirements.

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CONFIDENTIALITY The Code has special confidentiality requirements that protect information gathered by the College as part of the Professional Development Portfolio. The purpose of these special confidentiality requirements is to encourage midwives’ candid participation in the program. According to the Code (s. 83), information that midwives provide to the College as part of their Professional Development Portfolio is confidential and cannot be shared with other committees such as the Registration Committee. This means that midwives can be forthright in their Professional Development Portfolio knowing that the QAC generally cannot share this information.

There are, however, exceptions to the confidentiality provisions and the QAC can disclose information to the ICRC under the following circumstances:

• if the QAC is of the opinion that the midwife may have committed an act of professional misconduct or may be incompetent or incapacitated

• if the midwife knowingly gave false information to the QAC.

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PROFESSIONAL DEVELOPMENT PROGRAM COMPONENTS Midwives in Ontario have a professional responsibility to ensure that they are competent to practise. At entry to practice, midwives’ competence is assured by the entry to practice requirements but maintaining competence requires ongoing learning. The Professional Development Portfolio is designed to support midwives maintain competence by encouraging ongoing learning through self-assessment and participation in continuing education and professional development activities that include self-reflection and attendance at case reviews. The following components of the Professional Development Portfolio are designed to support midwives maintain competence.

1. Self-Assessment Self-assessment is “… the ability of a health worker to reflect on his or her own performance strengths and weaknesses to identify learning needs, conduct a review of his or her performance, and reinforce new skills or behaviors in order to improve performance.”1

The self-assessment built into the Professional Development Portfolio is designed to assist midwives identify their learning needs and can serve as the foundation for creating their Learning Plan.

Unlike other components of the Professional Development Portfolio (e.g., case review reports), the self-assessment is designed for the midwife only and will not be accessible to, or reviewed by, the College.

Although midwives are only required to complete and report on completion of their self-assessment every three years, annual completion is recommended as a way of continually assessing their knowledge and skills related to the standards of the profession.

1 Bose, S., Oliveras, E., & Edson, W. N. (2001). How can self-assessment improve the quality of healthcare. Operations research issue paper, 2(4), 1-27. Page 4

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2. Continuing Education and Professional Development

There are two sections that must be completed in this part of the Professional Development Portfolio:

i. Develop and complete a Learning Plan ii. Participate in case reviews (peer and interprofessional)

i. Develop and complete a Learning Plan Midwives will develop a Learning Plan based on areas that have been identified as in need of updating or expanding. These areas, or learning needs, can be identified in a number of ways including the self-assessment, issues brought up during a peer case review, challenges during a client interaction, or a breakdown in communication with another health care provider. Any area of a midwife’s professional life that requires extra attention can be a learning need. These identified learning needs then become learning goals which will form the basis of the Learning Plan. Midwives may benefit from asking colleagues for information and feedback about this part of the Professional Development Portfolio. A minimum of one learning goal will be met per year. Setting one learning goal per year means midwives can select short term goals to be met the first year and long-term goals to be met in years two and three of their reporting cycle. In the Learning Plan, midwives will be asked to demonstrate how they will meet their learning goals, dates for expected completion and the ways in which those goals will be achieved. There should be at least one learning activity for each goal and some goals will require different types of activities. Goals should be SMART which is an acronym for: • Specific – what it is you want to learn • Measurable – quantify the goal

• Attainable – make sure the goal is achievable and realistic • Relevant – make sure the goal is relevant to your practice of midwifery • Time-limited – put a time limit on the goal so it doesn't go on indefinitely More information on SMART learning goals is included in the Learning Plan section of the Professional Development Portfolio.

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The College does not specify the types of learning goals required. Midwives are encouraged to choose goals that include technical skills and non-technical skills. Technical skills are tangible skills that can be objectively measured, such as measuring a blood pressure or performing the maneuvers in a shoulder dystocia. Non-technical skills are the cognitive and social skills that complement technical skills such as having an informed choice discussion with a client about the benefits and risks to a clinical intervention or coordinating the care and assigning tasks during an emergency. Non -technical skills tend to be more difficult to define, so the College is sharing the following table with examples of non-technical skills2 that could be included as a learning goal or as activities in a Learning Plan.

Non-technical Description

Communication The exchange of information, feedback or response, ideas and feelings

Teamwork The collection of skills required to work in a team (e.g., conflict resolution)

Leadership Directing and coordinating the activity of team members, encouraging them to work together, assessing performance, assigning tasks, developing team knowledge, skills and abilities

Situation awareness Knowing what is going on around you

Decision making The process of reaching a judgment or choosing an option, sometimes called a course of action to meet the needs of a given situation

Managing stress and fatigue

A particular relationship between a person and the environment that is appraised by the person as taxing or exceeding their resources and endangering their well-being

2 Flin, R., & O'Connor, P. (2017). Safety at the sharp end: a guide to non-technical skills. CRC Press.

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Participate in activities that meet the chosen learning goals Midwives are required to meet their learning goals by identifying and participating in learning activities. Midwives should choose learning activities that meet their own individual learning style as well as activities that are delivered in a way that meets their goal. Some learning goals may require only one learning activity. For example, attending a fetal health surveillance workshop may be all that is required to meet a learning goal about intermittent auscultation. Other learning goals will require more than one activity. For example, a reviewing the recent literature about communication methods and attending a communication workshop may be required for a learning goal about communicating in emergency situations. Examples of learning activities that can be used to meet learning goals

• Participating in workshops, webinars, teleconferences • Completing courses • Reading recent primary research studies or reviews • Developing protocols and practice guidelines • Teaching, mentoring, precepting • Research, project work, publication, presentation • Reflecting on feedback and keeping a practice journal • Active participation in a relevant College or Association board, council or committee • Undertaking relevant undergraduate or graduate courses • Participation or certification in quality assurance/improvement committees • Peer mentoring.

Note: Participating in an obstetrical emergency skills program, a neonatal resuscitation program, and a cardiopulmonary resuscitation program are continuing competencies required for registration and so cannot be used as a learning activity for meeting a learning goal.

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Reflect on learning After all learning activities are completed, midwives must engage in a reflection of their learning. Reflection involves drawing on the activities that were undertaken to understand how they met the learning goals. Reflection is a deliberate and structured process of drawing on past events to understand what has happened and … is the basis of reflective learning and reflective practice3. More information about reflective learning and practice can be found in the Learning Plan section of the Professional Development Portfolio.

ii. Participate in case reviews (peer and interprofessional) Case reviews are formal gatherings to discuss specific clinical cases with the goal of learning. The learnings from clinical scenarios should be applicable to midwifery practice. For the purpose of the Professional Development Portfolio, case reviews must be held with at least two midwifery practice groups or among a group of interprofessional colleagues. Each year, midwives who are registered in the General, Supervised Practice, or Transitional class for 12 months or more are required to attend four case reviews per year of registration in the General, Supervised Practice, or Transitional class for a total of 12 case reviews attended over the three year cycle. This means that midwives registered in the General, Supervised Practice, or Transitional class for less than three years report on fewer case reviews. The requirement for attending and obtaining evidence of attendance at case reviews is specified below (please note that the time registered in General, Supervised Practice, or Transitional class need not be consecutive). Midwives who are registered in the General, Supervised Practice, or Transitional class for less than 12 months of the reporting period are not required to participate in, or obtain evidence of, attendance at case reviews. This part of the program was designed to address the barriers to attending peer case reviews that may be experienced by midwives who are not associated with a clinical setting attending case reviews as well as the limited relevance for inactive midwives working only in non-clinical roles. An important component of any case review is establishing parameters around conducting the review. The College does not specify the details of how to conduct a case review, however it is expected that case reviews be conducted in accordance with a framework that is agreed upon by the participants. There are numerous resources that can be used to provide guidance to midwives about participating in case reviews. More information on conducting and tracking participating in case reviews is included in the case review section of the Professional Development Portfolio. Note that case reviews conducted as part of the College's Professional Development Portfolio are distinct from quality of care reviews conducted at hospitals and birth centres pursuant to the Quality of Care Information Protection Act, 2016 (QCIPA); however, midwives may count their attendance at QCIPA reviews toward satisfying the required case reviews for the College's Professional Development Portfolio. QCIPA contains specific rules relating

3 Andre, K., & Heartfield, M., & Cusack, L. (2017). Portfolios for Health Professionals. Third edition. Elsevier Australia.

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to quality of care reviews and what information from QCIPA meetings and reviews must be protected as confidential.

Confidentiality of case reviews Midwives have both legal and ethical responsibilities to protect the confidentiality and privacy of clients' personal health information. For more guidance, see to the Personal Health Information Protection Act (PHIPA), 2004 and the College’s Guide on Compliance with the Personal Health Information Protection Act, both available on the College’s website. Unless a client has provided their express consent4 to disclose their personal health information as part of a case review, midwives should remove all client identifiers from cases that are presented. This may require modifying details about the client, health care providers, and anyone else with information that is discussed. In some situations, some of the extraneous details of a case should be changed to protect the client’s identity. It should be made clear at the case review that all identifying features of the client have been removed or changed. The information discussed as case reviews should be treated as confidential and midwives should not disclose information learned at a case review unless required by law. More information about reporting obligations can be found in the College’s Guide on Mandatory and Permissive Reporting. Questions about the Quality Assurance Program’s Professional Development Portfolio can be directed to the Quality Assurance Department at [email protected].

4 Express consent is an unequivocal expression of consent that is direct and clear. It can be given orally or in writing (Guide to the Health Care Consent Act)

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mailto:[email protected]


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College of Midwives of Ontario Registrar & CEO Quarterly Report October 6, 2021

REGISTRAR-CEO QUARTERLY REPORT

REPORT TO COUNCIL – October 6, 2021. Submitted by: Kelly Dobbin The Registrar-CEO Quarterly Report assures Council that the College operates effectively and achieves its strategic goals, and that the Registrar performs in accordance with the expected duties outlined in Council’s Governance Policies. The Registrar-CEO is accountable for the College’s performance in six main areas:

1. Strategic Leadership and Direction Setting 2. Development and Achievement of Goals 3. Reputation and Relationship Management 4. Financial Accountability and Management 5. People and Organizational Leadership 6. Council Governance and Engagement

1. Strategic Leadership and Direction Setting Laboratory and Specimen Collection Centre Licensing Act (LSCCLA) Appendix B of Regulation 682, under the Laboratory and Specimen Collection Centre Licensing Act (LSCCLA), permits midwives to order limited and specified laboratory tests in Ontario. Since 2010, the College has made numerous efforts to make changes to this regulation, first by requesting additional test to be added to the list in Appendix B, and more recently, in January 2018, to formally request that Appendix B be rescinded and that midwives be given broad authority to order laboratory tests in accordance with the midwifery scope of practice. In addition, the College has met with the Ministry to discuss amendments with respect to point-of-care testing. To date, the College has not been successful in achieving these changes. On September 1st, 2021, the Ministry posted to its Regulatory Registry its intention to modernize the regulatory framework of the LSCCLA. While they have not posted a revised draft regulation for review, the Ministry is seeking feedback on the following proposed general changes:

• to proclaim amendments to the LSCCLA, made under the Protecting Patients Act, (PPA) 2017 (Schedule 3), into force.

• to revoke Reg. 682 and Reg. 683 and replace them with a new consolidated regulation to support the proclamation of amendments made to the LSCCLA. The proposed new regulation would include provisions that apply to both labs and specimen collection centres. It would modernize the lab licensing framework in Ontario by streamlining regulatory requirements, while maintaining public protection, reducing administrative burden for licensed labs and licensed specimen collection centres, and ensuring alignment

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with health system priorities.

The Ministry is accepting feedback until October 16th, and we will use this opportunity to bring forward the College’s previous requests for change. Ontario Physician and Surgeons Discipline Tribunal (OPSDT) On September 1st, 2021, the College of Physicians and Surgeons of Ontario (CPSO) launched the OPSDT website to highlight the role of the College’s Discipline Committee and its structural arm’s length relationship to the College as “a neutral and independent body committed to holding fair, transparent and efficient hearings and making timely, understandable and well-reasoned decisions”. The name change from Discipline Committee to Tribunal is a laudable rebranding effort, demonstrating to the public that the Tribunal operates outside the interests of the College. While the Tribunal operates within the current parameters of the RHPA (whereby a panel must be comprised of three to five members where at least two public members of Council appointed by the Lieutenant Governor, and one is a professional member of Council) one important change to highlight is that all Panel chairs are appointed adjudicators with legal training and sufficient knowledge of legal proceedings and case law to eliminate the need for the panel to obtain Independent Legal Counsel (ILC). Information regarding upcoming hearings and past decisions can be found on the new OPSDT website. 2. Development and Achievement of Goals

Equity, Diversity, and Inclusion On April 1, 2021, “Equity” became one of the College’s six interrelated guiding principles that define how we strive to work as an organization, shape our culture and our relationships with the public, midwives, and partner organizations. In adding Equity as a guiding principle, Council acknowledges the importance of diversity, equity and inclusion in our work and relationships with partners. While the College has made efforts in recent years to improve equity, diversity, and inclusion in our work, we have not yet done so in a systematic manner with clearly identified outcomes. At its last meeting, the Executive Committee provided input on a draft Equity, Diversity, and Inclusion Roadmap, a high-level document outlining a sustained commitment to implement systems to effectively identify, remove, and prevent inequities in our work and our relationships with the public, midwives, and partner organizations. Staff will incorporate the Executive Committee’s feedback and will review again at its November meeting in advance of bringing to Council for final approval. On September 9th, HPRO and the Office of the Fairness Commission (OFC) co-hosted a webinar on Collecting Race-Based Data. College staff were in attendance and learnings from the session will inform our work as we commit to collecting and analyzing Human Rights Code based data to identify systemic inequities to be effectively addressed.

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https://opsdt.ca/


In the summer of 2020, Health Profession Regulators of Ontario (HPRO) initiated a working group to address anti-BIPOC (Black, Indigenous, People of Colour) racism, and other forms of inequity and justice, in health profession regulation. Dr. Javeed Sukhera was consulted to commission a report to inform the work in the sector. The working group has received the report and met on September 21, 2021, to discuss its findings and recommendations. Once the report is finalized, its findings and recommendations will be incorporated into our work. Office Of the Fairness Commission On April 1, 2021, the Office of the Fairness Commissioner (OFC) launched its new Risk-informed Compliance Framework (RICF). The first year of the framework will serve as a transitional period during which the OFC will review the historical performance of each regulator and place them in a provisional compliance category. We are pleased to report that the OFC has determined that the College of Midwives of Ontario should be assigned a “full compliance” provisional rating. This means that we have successfully implemented each of the compliance recommendations that the OFC has issued, additional recommendations were not identified, and other criteria have been met. For comparative purposes, the provisional compliance categories that the OFC has allocated to the 39 regulators over which it has jurisdiction are as follows: 32 were assigned full compliance; 4 were assigned substantial compliance; and 3 fell short of compliance. 3. Reputation and Relationship Management

International Midwifery Pre-Registration Program (IMPP) The International Midwifery Pre-registration Program (IMPP), the College’s third-party assessment and bridging program, is not currently offering a pathway to registration for Internationally Educated Midwives (IEM). The College has a duty to assess foreign trained midwives’ qualifications and skills to determine eligibility for registration. The lack of a third-party program means that the College is currently unable to fulfil this duty. The College had anticipated a change to the program in or around 2023 and had begun to evaluate its options for ensuring the delivery of a sustainable program by that time. The sudden and unexpected pause of the program has significantly shortened our timelines. Accordingly, the College must work quickly to mitigate the risk of not having a program in place to assess IEMs. To date, the College has met with senior leadership at Ryerson University Continuing Education (where the IMPP is housed) to discuss their plans. At present we know that they will not deliver the program this year (2021-22). They may be able to deliver the program in September 2022 while exploring the development of a new program by 2023. The College has also met with an assessment and bridging consultant to determine the viability of developing an assessment program delivered by the College. While the contract for proposal development falls under our expert line in our current budget, any program development costs would require Council to adjust the 2021-22 budget and allocate sufficient funds for that project.

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We expect to have a proposal by early October 2021, including projected costs to develop, administer and maintain a program at the College. The College plans to meet with other stakeholders in the sector, including the Office of the Fairness Commission, as we move forward in determining the best way forward to ensure fair and timely access to the profession. The Registration Committee will be briefed on this issue at their next meeting and will be responsible for undertaking the work to bring a new program (a new program at Ryerson, the College’s own program, or another solution) forward to Council for approval. COVID-19 The College continues to actively monitor the pandemic as it relates to the health profession regulatory sector and midwives in particular. To protect clients from harm and increase safety of midwives practising the profession, we have strengthened our messaging on our website and have increased our social media posts regarding vaccinations against COVID-19. Vaccines play an important role in protecting the most vulnerable—particularly those from communities who have been disproportionately impacted by COVID-19. This pandemic offers midwives an opportunity to lead by example. By getting vaccinated, midwives can help relieve the strain on our health-care system while supporting the health, safety, and wellbeing of their clients and communities. The College strongly encourages all eligible midwives to get vaccinated unless contraindicated. 4. Financial Accountability and Management Statement of Operations & Financial Statements A Q1 Statement of Operations was approved by the Executive Committee at its last meeting and is presented under the Executive Committee’s report to Council for your information. The College’s 2020-2021 Annual Report and approved Financial Statements (attached to this report) have been submitted to the Minister of Health, Hon. Christine Elliott, as per our requirements under s.6 of the Regulated Health Professions Act. 5. People and Organizational Leadership Staff Leadership Program The College has implemented a new leadership development program to support employees interested in career growth. The College recognizes that opportunities for career growth within

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the organization are limited due to its small size and this initiative is an effort to compensate for that fact. The program is available to employees that meet the following criteria:

• Have been employed with the College for no less than 18 months • Met expectations in all areas on their last Performance Appraisal • Are not in management positions

Employees accepted into the Leadership Development Program participate in the design of a personalized program in consultation with the Director of Operations. The program includes:

• 10 hours of coaching with a reputable leadership/career coach approved by the Director of Operations

• Mentorship with a member of the College’s leadership team • Three relevant leadership focused courses offered through a reputable institution approved

by the Director of Operations (of no less than 10 hours of class time each) • Attendance at seminars/conferences/stakeholder meetings with their mentor/other College

personnel to both grow their network and access opportunity • At least one presentation opportunity where the participant will represent either the College

to stakeholders (including members), or their program area to Committee or Council when more appropriate

Employees use their annual professional development benefits to cover the costs of courses. Coaching costs will be covered by the College up to $250/hour for 10 hours. It should be noted that employees can choose other paths besides this program by utilizing the professional development benefit that is available to all employees. The policy can be read in detail in the Staff Operations Manual saved in BoardEffect (Policy #8.10.2). 6. Council Governance and Engagement Council Members We are pleased to welcome recently elected professional members of Council, Alexia Singh and Hardeep Fervaha. Council orientations for our two new members are scheduled for September 29th and will be reinforced by the Governance Orientation/Re-orientation Training scheduled for all Council members on the October 5th Training Day. We say goodbye to professional Council members Jan Teevan and Maureen Silverman at this time. Jan has served a total of nine consecutive years on Council and Maureen has served three consecutive years. We recognize their significant contributions to the College over the years through their engagement and pursuit of good governance. We will miss your involvement and wish you all the best in your future endeavours. Non-Council Committee Members

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A call for professional and public non-Council committee members has been made. To increase the diversity committee members, the College encourages midwives from Indigenous, Black, and racialized communities, marginalized communities, rural communities, as well as midwives who are internationally educated, or practising in expanded, collaborative and/or community health team models to apply for committee membership. Due to the past success of hosting webinars for midwives interested or having questions about serving on Council, Council Chair, Claire Ramlogan-Salanga, and Council Coordinator, Zahra Grant, will host similar “lunch and learn” for those interested in committee work. One session will be reserved for midwives from Indigenous, Black, or racialized communities.

Attachments:

College of Midwives of Ontario Annual Report 2020-2021

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COLLEGE OF MIDWIVES OF ONTARIO

Annual Report 2020/21

Delivering Missionon our

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interest.

COLLEGE OF MIDWIVES OF ONTARIO PAGE 02

regulates more than 1,000 midwivespractising in Ontario. We ensure thatmidwives meet high standards, and act when risks are identified.

The College of Midwives of Ontario

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98% 97% 92%of midwives fulfilled theirCollege quality assurance

requirements

of midwives renewed theirCollege registration by the

deadline

of midwives required to submitan active practice report met

the requirement

64

184

New midwives registered in 2020/21

Inquiries received andresponded to by ourpractice advisor


The College by the Numbers

1,064Registered

midwives in Ontario

51

Mandatory and otherreports received by the College.

195Class change

applications processed

of reports received by theCollege were acted upon.Almost 11% resulted in a

formal investigation.

Complaints eligible for AlternativeDispute Resolution that proceeded

with consent of all parties

0 Reports of unauthorizedpractice were made to theCollege

5

62 100%

Complaint mattersreceived

45Complaint matters closed by the Inquiries, Complaints, and

Reports Committee

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From the professional barriers facing racialized midwives in Ontario, to the inequities experienced by Indigenous, Black, and racialized clients, there are many ongoing harms that both health regulators and midwives must be mindful of as we proceed in this work.

In drafting our strategic plan this year, the College made a critical addition to our guiding principles—we've included equity as a core consideration. How we actively demonstrate our commitment to equity will now serve as a key metric when we evaluate our ability to deliver on our mission.

2020/2021 also saw the College take important steps with anti-racist education and training for staff, improvements to our HR processes, and exciting new sector partnerships to build upon our shared capacity to create change.


Looking to the future, the College will continue to reporton our progress as we proactively identify and removeinequities present in our work. We are committed tobeing accountable as we proceed, and to partner withothers so that we may collectively advocate for change.

This work is not about checking the boxes, or fixing asingle problem—it is the long and challenging processof becoming advocates for social equity and justice.

Whether you are a midwife, a regulator, or a member ofthe public, I hope that you too see a role for yourselfwithin this work. The College welcomes yourparticipation—and your feedback.

Please reach out should you have any questions,concerns, or ideas. Building an equitable healthcaresystem will truly require all of us.

Letter from the Chair

The College’s mandate is to regulatemidwifery in the public interest. To do so effectively, we must commitourselves to eradicating racism as itintersects with our sector.

Claire Ramlogan-Salanga, RMChair, College of Midwives of Ontario

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I am similarly proud of the College's staff, Council, andcommittees, who rose to the challenge and delivered onour mission. You'll read about how we shifted strategies toprovide accessible services to midwives and the publicthroughout this report.

Despite the many hardships of the past twelve months, I’mending this year with feelings of optimism. Seeing midwivesand clients do their part to protect one another and preventthe spread of COVID-19 bolstered my faith that we willeradicate this virus.

Likewise, I am so pleased to see a marked increase inengagement and enthusiasm from midwives in theCollege's activities. Whether they ran for College Council,voted in elections, or shared their feedback with us throughsurveys, their contributions will surely strengthen the workthat we do.

This year, the College's Council approved an ambitiousstrategic plan that will drive our work through 2026. I amconfident its activities will enhance the capacity of midwivesto provide safe and effective care, and will foster greatertrust between the public and the profession. You can findour plan on page 14.

Also included in this Annual Report is an in-depthperformance analysis of our impact in four key areas.Through qualitative and quantitative data, we willcontinually use our new Performance MeasurementFramework to chart our successes and identifyopportunities for improvement.

The College, Council, and committees will apply the lessonsthat we’ve learned over this most arduous year. I have nodoubt that by working together, we will continue to swiftlyadapt to whatever the future holds.

Kelly DobbinRegistrar and CEOCollege of Midwives of Ontario

It has been a challenging year on so manylevels. I wish to share my thanks andadmiration to everyone who practisedmidwifery, instructed students, or otherwisesupported the profession and the publicduring 2020/21. In a tumultuous time, you'veprovided care and support to thousands.


Letter from the Registrar

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We've offered timely and accurate information on the pandemic bydirecting visitors to reputable sources via our website's COVID-19 FAQand social media accounts.

We held our first digital discipline hearing in 2020 after consulting withother colleges to determine best practices. We found that conductingthe hearing virtually enabled more members from the profession andthe public to attend. College Council meetings continue to be heldonline, and remain open to the public.

Through remote classrooms visits, we've continued to work with ourmidwifery education partners and their students. We've addedworkshops into their curriculum to inform students of their regulatoryobligations and better prepare them for entry to practise.

The College is committed to keeping midwives and the public equippedwith information and resources on the issues that affect them—no matterwhat the circumstances.

In response to the pandemic, the College translated our operations andmaterials into a digital context in 2020/21. Along the way, we've learnedvaluable lessons and new techniques on how we can make ourinformation more accessible long after the pandemic is over.

COVID Info and Resources

Remote Meetings

Visiting Midwifery Education Programs.


Staying Connected During COVID

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Regulatory PolicySuitability to PractiseOpenness and AccountabilityGood Governance.

As the regulator of midwifery in Ontario, the College has important goals toachieve. We work to ensure that midwives possess and maintain theknowledge, skills, and behaviours to provide safe, ethical and effective care,and we take swift action when risks are identified.

To meet these critical outcomes, we must continually evaluate ourperformance and publicly report on the execution of our core functions.

The College created a voluntary Performance Measurement Framework in2019 to ensure we remain effective in our mission. Its standards measure ourperformance in four domains that seek to provide a balanced picture of allfunctional areas of the College:

We are pleased to announce that we have fully met 15/20 of our standardsfor 2020/2021, and that we've identified a course of action to improve uponour 5 partially met standards.

Measuring our Performance


Measuring our Annual Performance

15 Standards Met 5 Standards Partially Met

Over the following pages, you'll learn about how the activities within thesefour domains serve the College's mission and mandate, how we assess ourperformance, and how we are committing to continual improvement in theyears to come.

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Regular and purposeful engagement isundertaken with stakeholders, midwives, andthe public throughout the policy makingprocess

Policy decision-making is open and transparent

Regulatory Policy

PAGE 08

Community Consultation. We met with the Association ofOntario Midwives, the Midwifery Education Programs, theInternational Midwifery Pre-registration Program, and others, toensure clarity and consensus behind our findings and approach.

Regulation is proportionate to the risk of harmbeing managed

Regulation is evidence-based and reflectscurrent best practice

The College has the authority to develop regulations for registeredmidwives in Ontario. We take a rigorous approach to policy-making thatincorporates stakeholder engagement and a thorough evaluation ofrisk, evidence, and impacts. This ensures we don't choose regulation asthe default solution—only when non-regulatory options are unable todeliver the desired results.

The College proposed four policy initiatives in 2020/21: StandardsReview – Phase 2, Clinical Currency, New Registrant Conditions, andRequirements for Issuance and Ongoing Requirements for classes ofRegistration.


All Four Standards Met

Surveying Midwives. We surveyed midwives to learn how wecould support them to develop confidence and competence asthey transition to independent practice, and about their practiceenvironments to understand if there is a need for additionalstandards or guidance to support positive work environments.

Our 2020|2021 Performance Successes:

Risk Assessment. Impact assessments were conducted for allnew regulatory initiatives to ensure actions were based onevidence of risk and proportionate to the risk being managed.

Evidence-based. All policies, standards of practice, and otherguiding documents that were approved by Council or acommittee involved a thorough literature review.

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Suitability to Practise

The College works to ensure that Ontario midwives are qualified, skilled,and competent in the areas in which they practise.

To do so, we register qualified midwives, set requirements forcontinuous education and professional development, and investigatecomplaints and reports about midwives’ competence, professionalconduct, and fitness to practise.

Applicants and non-practising midwivesdemonstrate suitability to practise before they arepermitted to practise midwifery in Ontario

Midwives continually demonstrate suitability topractise

Reports made the College about the professionalmisconduct, incompetence or incapacity of a midwifeare acted upon

Complaints made to the College about theprofessional misconduct, incompetence, or incapacityof a midwife are acted upon

Risk of harm to the public by individuals illegallypractising midwifery is managed appropriately

All Five Standards Met

Registration. All applicants who entered/re-entered practicedemonstrated that they met all entry to practise requirements.

Quality assurance. All midwives were required to meet ongoingrequirements and action was taken in cases where they didn’tmeet the requirements.

Investigations. All complaints filed with the College wereinvestigated.

Alternative Dispute Resolution (ADR). All complaints that wentthrough ADR met the eligibility criteria.

Assessing risk. Risk assessment is built into into our complaintsand reports processes, and informed every decision.

Reports of concern. All concerning information—includingmandatory reports and concerns from midwives and othersources—that came to the College’s attention was acted upon.

Areas to improve: We wish to better demonstrate that thedecision to launch a formal investigation in response to a reportor concern is proportionate to the risk of harm caused to currentor potential clients. We are developing a tool to simplify riskassessment and bring greater consistency in decision-making,and will implement it in 2021-2022.


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Transparency and accountability are among the College's corevalues. We seek to serve the public interest by providing timelyaccess to information about our decision-making, and by publiclyreporting on the execution of our regulatory functions.


Openness and Accountability

Clients and the public have access to information tounderstand what it means to regulate in the publicinterest and how the College makes decisions thataffect them

Public register provides access to information aboutmidwives

The investigations and hearings process is fair,transparent, timely, consistent and focuses onpublic protection

Midwives and midwifery applicants have access toinformation and guidance to understand Collegerequirements

Registration processes are fair, transparent,impartial and objective

All Five Standards Partially MetInformation Sharing. We offer detailed information on ourcomplaints and investigations processes, and work to ensureclients can access our Sexual Abuse Prevention Program.

Resources. We provide midwives with all relevant standards,by-laws, and guiding documents.

Mandate: We clearly state our mandate of regulating in thepublic interest.

Brochures: We provide clients with clear expectations throughour "What to Expect from Your Midwife" brochure, available inEnglish and French.

Regular Updates. We seek to update the public register in atimely manner to reflect midwives' changes in registration classor committee decisions.

Consistent Outcomes. We use risk assessment tools to ensuregreater consistency in decision-making.

Practice Advice. We offer advice to midwifery clients and thepublic through our Practice Advisor.


Areas to improve: See next page. of 128

Openness and AccountabilityOpenness and Accountability

Informing the Public. While we are clear at communicating ourmandate, there is less information available to the public aboutthe College’s core functions—registration and quality assurance—and how we regulate midwives to ensure suitability topractise. There is also limited information on the website aboutthe governance arrangements that are in place to ensureregulatory integrity and objective and impartial decisionmaking.

We do not currently engage directly with the public to measuretheir understanding of the College’s public protection mandateand our decision-making and to assess the overall accessibilityof College information.

Updating the Public Register. Our assessment found some outof date information in the register. We must make every effortto ensure that the information provided to us by midwives istimely and complete.


Setting Timelines. Timelines for our investigations procedures,registration processes, and for resolving matters that go to ourICRC and Registration committees are required to benchmarkour performance. We will present our benchmarks forinvestigations in the 2021-2022 annual report.

Surveying the Profession. We will survey midwives andmidwifery students to track their perceptions of the College sowe can better understand the impact of our work and how wecan communicate more effectively with them.

In designing our 2021-2026 Strategic Framework, theCollege reviewed the results of this annualperformance evaluation—including our need toimprove performance in the domain of openness andaccountability.

Our framework's third strategic priority is "Buildingengagement and fostering trust with the public andthe profession," with goals and metrics that weredrawn from the gaps identified on this page.

You can read more about our strategic framework onpage 14.

Where we will improve:

Ensuring Success

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Governance

The College is overseen by a Council of up to eight midwives elected bythe profession, and up to seven public members appointed by thegovernment. Council sets the College's strategic direction, and they holdstaff accountable for fulfilling our mandate and duties.

We continually evaluate our governance structures to ensure effectivefunctioning, to preserve a high degree of regulatory integrity, and to helpus achieve decision-making that is objective, impartial, and avoidsconflict of interest, bias, or improper influence.


Council meetings are open to the public, and Counciland committee decision-making is transparent andaccessible to the public.

There are systems in place to protect the independenceof Council and committee decision makers from anyinterests other than the public interests

Council is structurally separated from inappropriatestakeholder or other influence to support regulatoryintegrity

There are systems in place to ensure that Council andits committees fulfill their duties professionally andethically

Council regularly evaluates its effectiveness to ensureimproved leadership, better decision-making andgreater accountability as well as more efficientCouncil operations

Collectively, Council and its committees have adiversity of skills and experience tailored to thefunctions of the College and are appropriately trainedto ensure robust decision-making

Education. All candidates running for election must complete ourgovernance education modules.

Code of Conduct. All Council and committee members havesigned our code of conduct after receiving relevant training.

Standards for Candidates. Professional Council members areannually elected by their peers. There are requirements in placethat outline the eligibility to stand for election.

Orientation. A comprehensive orientation session is delivered in-person before the first meeting of Council. Both professional andpublic members are required to attend.

Expertise. All Council members undergo self-assessment andtraining to ensure Council has the collective expertise to provideoversight and strategic guidance to staff.

Evaluation. Council evaluated its overall performance through ananonymous survey, a Peer Review to assess individual membereffectiveness and help them bring value to their roles, and regularpost-meeting and training session feedback surveys.

All Six Standards MetOur 2020|2021 Performance:

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Elected Professional Members

Claire Ramlogan-Salanga, RM, ChairEdan Thomas, RM, Vice-ChairClaudette Leduc, RMLilly Martin, RMKaren McKenzie, RMIsabelle Milot, RMMaureen Silverman, RMJan Teevan, RM

Non-Council Appointed CommitteeMembers (Professional)

Sabrina Blaise, RMChristi Johnston, RMSarah Kirkland, RMAlexandra Nikitakis, RMMaryam Rahimi-Chatri, RMJessica Raison, RMKristen Wilkenson, RM

Standing Committees

Client RelationsDisciplineExecutive Fitness to Practise Inquires, Complaints, and Reports Quality Assurance Registration

Public Members

Donald Strickland, Vice-ChairPete AarssenSarah BakerMarianna KaminskaJudith Murray

Non-Council AppointedCommittee Members(Public)

Jill EvansSamantha HeiydtSally Lewis

College Council meetings are always open to members and the

general public. They are currently held by videoconference, and

access information can be found our website..

All committees provide quarterly and annual reports to Council.

Council materials are also posted on our website for the public to

review, along with the agenda and approved minutes.


Your College Council 2020-2021

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Entitled "Working with Midwives, Working for the Public,” the College's new strategic framework charts a bold yetresponsive vision for our future. We are confident that this focus will allow us to continue to grow and improve — bothas a regulator, and as a resource for midwives, midwifery students, and the public.

Regulation that enables the midwifery profession to evolve.Effective use of data to identify and act on existing andemerging risks.Building engagement and fostering trust with the public andthe profession.

Our Strategic Priorities

1.2.

3.

Clients and the public can be confident that midwives possessand maintain knowledge, skills and behaviours relevant to theirprofessional practice and exercise clinical and professionaljudgment to provide safe and effective care.Clients and the public can be confident that midwives practisethe profession with honesty and integrity and regard theirresponsibility to the client as paramount.Clients and the public can be confident that midwivesdemonstrate accountability by complying with legislative andregulatory requirements.Clients and the public trust that the College of Midwives ofOntario regulates in the public interest.

Key Outcomes We Expect to Achieve

1.

2.

3.

4.

Our Guiding Principles

These interrelated principles define how we striveto work as an organization, and shape our cultureand our relationships with the public, midwives,and partner organizations.

Accountability. We make fair, consistent anddefensible decisions, incorporating diverse andinclusive views.Equity. We identify, remove and prevent systemicinequities.Transparency. We act openly and honestly toenhance accountability.Integrity. We act with humility and respect andapply a lens of social justice to our work.Proportionality. We allocate resourcesproportionate to the risk posed to our regulatoryoutcomes.Innovation. We translate opportunity into tangiblebenefits for the organization.

COLLEGE OF MIDWIVES OF ONTARIO PAGE 05COLLEGE OF MIDWIVES OF ONTARIO PAGE 14

2021—2026 Strategic Framework

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On July 22, 2020, a panel of the Discipline Committee of the College of Midwives ofOntario found that Sandra Knight (the Member) engaged in professional misconductby practising the profession while the member is in a conflict of interest; engaging inconduct that would reasonably be regarded by members as conduct unbecoming amidwife; and engaging in conduct or performing an act or omission relevant to thepractice of the profession that, having regard to all the circumstances, wouldreasonably be regarded by members as unprofessional.

Publication Ban: The Panel made an order that no person shall publish, broadcastor in any manner disclose the name of the Client or the baby referred to during thehearing or in documents filed at the hearing, held July 22, 2020, or any informationthat would disclose the identity of the Client or the baby. The publication banapplies to the exhibits filed and to the Panel’s decision and reasons. Please note thatthis summary has been drafted to comply with the publication ban ordered by theDiscipline Committee and therefore some facts that could identify the Client or thebaby have been omitted.

The Facts: The Member admitted that she engaged in professional misconduct andthe Member and the College jointly agreed to the facts that were presented to thepanel. The allegations in this case involved a blurring of professional and personalboundaries. The Client contacted the Practice through the Practice’s online intakeform. The Client advised that she had recently learned that she was pregnant. TheClient indicated that she wanted to terminate the pregnancy, but she was advisedby other health care practitioners that she would not be able to do so. The Clientwas in a vulnerable position. The Member contacted the Client and arranged tomeet her at a coffee shop. They met on October 12, 2018. The Member informed theclient she was not there as a midwife but rather, a woman wanting to help anotherwoman in a time of need. The Client and the Member spoke for approximately 5hours. During the course of this meeting, the Member discussed various care andtreatment options, including midwifery, obstetric care and a Caesarean section. TheMember also offered to have a non-professional relationship with the Client.

After this meeting, the Member documented in a narrative note that she offered tostay on call for the Client as a midwife in the event anything urgent occurred sincethe Client had not had prenatal care since early September. The Member admitsthat it was unprofessional to meet the Client at a coffee shop and to discuss theClient’s pregnancy and care options in these circumstances.

Sandra Knight v. CMO On October 13, 2018, the Client contacted the Member and complained of pain. TheMember advised her to go to the hospital, but the Client refused to go due to pastnegative experiences. The Member then offered to pick her up and take her to thehospital, and the Client agreed.While at the hospital, the Member introduced theClient to the other midwife at the practice who would act as the primary midwife if theClient decided to enter midwifery care. The Client indicated that she would like tobecome a client of that midwife. That midwife was assisting another client in activelabour and was therefore unable to provide care to the Client at that time.

The Member provided midwifery care to the Client including: taking the Client’shistory, completing documentation relating to the Client’s care, including the OntarioPerinatal Record, ordering lab work,·prescribing medication to the Client, andspeaking to the obstetrician about the Client delivering the baby by plannedCaesarean section. On October 15, 2018, the Member documented in the Client’smidwifery chart that the Member would have a non-professional relationship with theClient and that the Member would no longer be involved clinically in the Client’s care.Thereafter, the Client was cared for by a different midwife at the Practice.

The Member acknowledges it was unprofessional to offer to have a non-professionalrelationship with a person in a vulnerable position who was requesting pregnancy-related care from the Practice and to later provide care, even if limited, to that Client.

Findings of Professional Misconduct: The Panel found the agreed facts supportedthe findings of professional misconduct. The Panel determined the Member was apractising midwife at the time of the events and as such the Member problematicallyblurred the line between acting as an individual and acting as a midwife in aprofessional capacity.

Firstly, had it not been for the Member being a midwife and working within amidwifery practice at the time, the Member would never have had access to theClient nor would they have been aware of the Client at all. In this respect, when theMember contacted the Client, the Client might have reasonably interpreted that theMember was acting as a midwife responding to her email and not as an individual.The Panel found this problematic and felt that the Member could have reasonablyanticipated that this involvement could cross boundaries since their involvement withthe Client came through their practice in the first place. The Panel also felt that theMember themselves understood that this could be problematic by initially attemptingto clarify to the Client that they were not acting as a midwife.

Discipline Committee Report

Findings of the College's Discipline Committee are made public inservice to accountability and transparency. There were two cases thatresulted in discipline in 2020/21, and their summaries are listed below.

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The Panel agreed that the Member acted unprofessionally in choosing to meet theClient at a coffee shop on October 12, 2018, rather than in their clinic or a moreprofessional setting. While the Member believed that this more casual and publicsetting was for the Client’s comfort and that this would also reinforce the idea that theMember was acting as an individual rather than as a midwife, the discussion that tookplace in the coffee shop was of a professional and private nature and should havebeen conducted in a suitable environment to protect the Client’s privacy and healthinformation. In discussing health care options with the Client at this time the Panelconcluded that the Member blurred the lines between being a private individual whoonly wanted to help, and being a member of a healthcare profession.

The Member’s offer to have a non-professional relationship with the Client put theMember in a conflict of interest right away and would reasonably be regarded by themembership and the public at large as unprofessional. Although the Client stated thatthey did not feel pressured by the Member’s conduct, the appearance to the publicmay be one of the Member taking advantage of a vulnerable client. The Panel wasconcerned that these actions led to the perception by the public that midwives areunprofessional or untrustworthy.

With respect to the care provided by the Member to the Client on October 13, 2018, thePanel concluded that this was a conflict of interest and thus constituted professionalmisconduct. The Panel determined that when the Member agreed to be on call for theClient subsequent to their meeting at the coffee shop, the Member was already inconflict of interest as midwifery community standard is that midwives are on call forpeople who are already in their professional care.

Thus, the Member offering to be on call for the Client in this case would be perceivedby the professional community and midwifery clients as the Member having taken onthe professional role for this Client while both parties were contemplating a non-professional relationship as well. It would have been more appropriate for the Memberat this time to have provided the Client with another midwife from the practice.

It was this on-call provision that led to the Member providing care to this Client onOctober 13th, 2018. Once the Member met the Client at the hospital and the Clientdecided to come into midwifery care, the Member should have recused herself andcalled in another midwife from the practice since the midwife who would ultimatelytake over care was unavailable at that time.

The fact that the Member had access to the Client’s chart and documented in thatchart on more than one occasion is problematic. An individual without a professionalrelationship with this Client would not have had access to the private healthcareinformation of the Client, nor would they be charting on the record.

Ms. Knight is required to appear before a panel of the Discipline Committee to bereprimanded, with the fact of the reprimand to appear on the public register ofthe College;The Registrar is directed to impose the following terms, conditions andlimitations on Ms. Knight’s certificate of registration:Within six months of the date of the Discipline Committee’s Order, Ms. Knight isrequired to successfully complete, at her own expense and to the Registrar'ssatisfaction, an individualized ethics and professionalism course that is pre-approved by the Registrar; andWithin two months of the date of the completion of the above-noted ethics andprofessionalism course, Ms. Knight is required to prepare and submit a 1,500-word paper, to the satisfaction of the Registrar, in which Ms. Knight demonstratesher reflection on the importance of establishing and maintaining professionalboundaries with persons in a vulnerable position; andMs. Knight is required to pay to the College costs in the amount of $2,500 within12 months of the date of the Discipline Committee’s Order.

The Panel did believe that the Member was trying to act in an altruistic and caringmanner and was not trying to take advantage of the situation. The Panelacknowledged that once the Client had decided to officially come into midwiferycare and had decided to have a non-professional relationship with the Member, theMember did take steps to remove themselves from the Client’s care and to ensurethat the Client was taken care of by others within their practice.

However, while this was appropriate to do, the Panel found that the Member shouldhave been more aware of the potential conflicts of interest and the blurring of theboundaries that could and in fact did take place.

PenaltyThe Panel accepted the parties’ Joint Submission as to Penalty and accordinglymade the following order:

The Panel concluded that the proposed penalty was reasonable and in the publicinterest. The reprimand, individualized ethics and professionalism course, andreflective paper serve the goal of specific deterrence and are rehabilitative in nature.In addition, the reprimand being posted on the public register of the Memberprotects the public interest and serves as a general deterrent to the membership.

The Panel considered that the Member had no prior discipline issues at the College;the Member cooperated with the College; the Member has acknowledged herbehaviour amounted to professional misconduct and accepted responsibility for heractions; and from the Agreed Statement of Facts, her intentions were perceived bythe Panel as altruistic.

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On March 5, 2021, a panel of the Discipline Committee of the College ofMidwives of Ontario found that Natasha Singleton-Bassaragh (the Member)engaged in professional misconduct by failing to meet a standard of theprofession; and engaging in conduct or performing an act or omission relevantto the practice of the profession that, having regard to all the circumstances,would reasonably be regarded by members as unprofessional.

The Client involved in this case delivered a baby girl who was stillborn. TheClient was a client of the Practice and the Member became involved when theClient contacted the Practice to report reduced fetal movement and theClient’s primary midwife was off call.

The Panel found that the agreed facts supported the findings of professionalmisconduct in that the care provided failed to meet the standard, in particularwith regard to the management of fetal movement.

The Member failed to conduct an in-person assessment of the Client whenthe Client reported concerns relating to fetal movement and failed to clearlycommunicate a plan to the Client and document a plan for an in-personassessment following a call related to concerns of reduced fetal movement.The Member failed to appropriately monitor fetal well-being and the fetalheart rate upon the Client’s admission to hospital and prior to transferringprimary care back to the primary midwife, including failing to conduct a non-stress test upon the Client’s admission and failing to auscultate the fetal heartrate in a timely manner.

The Panel was satisfied that the Member’s conduct noted above wouldreasonably be regarded by other members of this profession asunprofessional.

The Member is required to appear before a panel of the DisciplineCommittee to be reprimanded, with the fact of the reprimand to appear onthe public register of the College; The Registrar is directed to impose the following terms, conditions andlimitations on the Member’s certificate of registration:

PenaltyThe Panel accepted the parties’ Joint Submission as to Penalty andaccordingly made the following order:

1.

2.

a. Within three months of the date of the Discipline Committee’s Order,the Member is required to prepare and submit a 1,500-word reflectivepaper, to the satisfaction of the Registrar, regarding the managementof decreased fetal movement and the assessment of fetal well-beingin labour. b. Within six months of the Member’s return to practise, the Membermust participate in a chart audit with a College appointed auditor,subject to the following terms:

i. The Member must notify the Registrar in writing one week beforethe date that she returns to practise; ii. The auditor will review a minimum of five and a maximum ofeight charts, with care provided by Ms. Singleton-Bassaragh afterher return to practise referred to in paragraph (i) above, focusing onthe documentation and care surrounding the assessment of fetalheart rate, including any charts with reported decreased fetalmovement, if available; iii. The auditor will provide a written report to the Registrarregarding the outcome of the chart audit in a form and mannerapproved by the Registrar; iv. The Member is responsible for any costs or expensesassociated with the chart audit to a maximum of $1,500.

3. The Member is required to pay to the College costs in the amount of $1,500,to be in paid in 15 monthly instalments of $100.00, beginning one month afterthe date of the Discipline Committee’s Order and continuing every month untilpaid in full.

Natasha Singleton-Bassaragh v. CMO

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Opinion: The summary financial statements, which comprise thesummary statement of financial position as at March 31, 2021,and the summary statement of operations for the year thenended, and related note, are derived from the auditedfinancial statements of the College of Midwives of Ontario(the "College") for the year ended March 31, 2021.

In our opinion, the accompanying summary financialstatements are a fair summary of the audited financialstatements, in accordance with the criteria described in thenote to the summary financial statements.

Summary Financial StatementsThe summary financial statements do not contain all thedisclosures required by Canadian accounting standards fornot-for-profit organizations. Reading the summary financialstatements and the auditor's report thereon, therefore, is nota substitute for reading the audited financial statements ofthe College and the auditor's report thereon.

Report of the Independent Auditor on the Summary Financial Statements to the Council of the College of Midwives of Ontario

The Audited Financial Statements and Our Report ThereonWe expressed an unmodified audit opinion on the auditedfinancial statements in our report dated June 23, 2021.

Management's Responsibility for the Summary Financial StatementsManagement is responsible for the preparation of thesummary financial statements in accordance with the criteriadescribed in the note to the summary financial statements.

Auditor's ResponsibilityOur responsibility is to express an opinion on whether thesummary financial statements are a fair summary of theaudited financial statements based on our procedures, whichwere conducted in accordance with CanadianAuditing Standard (CAS) 810, Engagements to Report onSummary Financial Statements.

Toronto, OntarioJune 23, 2021

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Year End March 31

AssetsCurrent assets Cash and cash equivalents Accounts receivable Prepaid expenses

Capital assets

LiabilitiesCurrent liabilities Accounts payable and accrued liabilities Deferred registration fees

Deferred lease incentives

Net AssetsInvested in capital assetsInternally restricted for therapy and counselling Internally restricted for investigations and hearings Unrestricted

2021 $

3,189,6654,721

38,1933,232,579

108,6203,341,199

264,7301,155,4061,420,136

16,9081,437,044

99,875 16,000

300,0001,488,2801,904,155

3,341,199

2020 $

3,025,22115,06938,029

3,078,319 108,657

3,186,976

345,7771,115,5961,461,373

28,8391,490,212

93,74116,000

-1,587,0231,696,764

3,186,976

Statement of Financial Position

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Year End March 31

Revenues Registration fees Administration and other Government grant - project funding

Expenses Salaries and benefits Professional fees Council and committees Office and general Rent and utilities Quality assurance program Investigations and hearings Membership dues and fees Information and communications technology Government projects Amortization

Excess of revenues over expenses for year

2020 $

2,139,459104,350

78,0112,321,820

1,318,73273,17493,555

124,322184,795

26,711130,706

53,44274,56178,01136,285

2,194,294

127,526

2021 $

2,380,25752,10475,722

2,508,083

1,408,56378,499

120,271109,425192,042

23,49198,91355,84094,86375,72243,063

2,300,692

207,391

Summary Statement of Operations

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Basis of presentation

These summary financial statements are derived from the audited financial statements of the College ofMidwives Ontario (the "College") for the year ended March 31, 2021, which were prepared in accordancewith Canadian accounting standards for not-for-profit organizations.

Management prepared these summary financial statements using the following criteria:

The audited financial statements of the College are available to members upon request.

Note to Summary Financial Statements

(a) the summary financial statements include a statement for each statementincluded in the audited financial statements, except for the statements ofchanges in net assets and cash flows;(b) information in the summary financial statements agrees with the relatedinformation in the audited financial statements; and(c) major subtotals, totals and comparative information from the audited financialstatements are included.

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T: 416.640.2252 / [email protected]


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IN CAMERA The IN CAMERA session of the of Council meeting excludes the attendance of public observers pursuant to the Health

Professions Procedural Code of the Regulated Health Professions Act, 1991, section 7(2)(b).

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2020-2021 Council Members

Elected Professional Members

• Claire Ramlogan-Salanga, RM • Edan Thomas, RM • Lilly Martin, RM • Isabelle Milot, RM • Claudette Leduc, RM • Karen McKenzie, RM • Alexia Singh, RM • Hardeep Fervaha, RM

Appointed Public Members

• Marianna Kaminska • Judith Murray • Peter Aarssen • Donald Strickland • Oliver Okafor

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7

Policy Type: Governance Process

Policy Title: Council and Committee Member’s Role and Code of Conduct

Reference: GP5

Date approved: June 24, 2020; October 13, 2016; November 21, 2014

Council and Committee members make decisions in the public interest considering an understanding of the midwifery profession and environments in which it is practised. Council and Committees are committed to lawful conduct and commonly accepted business and professional ethics, including proper decorum, confidentiality and use of authority, when acting as Council and Committee members.

Accordingly,

1. Council members will serve on Council and on at least one statutory committee to which they are appointed.

2. Council and Committee members will support all of the decisions taken by Council and Committees.

3. Council and Committee members must prioritize the interests of the College. This accountability supersedes any conflicting loyalty to any specific interest group and membership on any other governing body.

4. Council and Committee members must avoid conflict of interest with respect to their fiduciary responsibilities.

a. There must be no conduct of private business or personal services between any Council and Committee member and the College except as procedurally controlled to ensure openness, competitive opportunity, and equal access to inside information.

b. Council and Committee members may not use their positions to obtain employment, with the College or its agents, for themselves, family members or close associates.

c. Should a Council or Committee member wish to be considered for employment with the College they must resign from Council or the Committee prior to submitting their application.

5. Council and Committee members cannot exercise individual authority over the organization.

a. Council and Committee members’ interactions with the Registrar or with staff must recognize the lack of authority vested in individuals except when explicitly Council-authorized.

b. Similarly, Council and Committee members’ interactions with the public, press or other entities must recognize the same limitations.

6. Council and Committee members will respect the confidentiality inherent in their role.

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8

Code of Conduct Acknowledgement for Council and Committee Members

I, ______________________________________ , acknowledge that I have read and understood and agree to comply with the Duties of Council and Committee member provisions in the by-laws as well as “Council and Committee Member’s Role and Code of Conduct”

_________________________

Signature

_________________________

Date

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Disclosure of Conflict of Interest

I undertake to comply with the conflict of interest provisions in the By-laws and to inform Council or a Committee of Council of any conflict of interest that may arise during the course of the coming year involving the undersigned.

To the best of my knowledge, I,

___________________________________________

a member of Council or a Committee of the Council of the College of Midwives of Ontario, currently

DO NOT have an actual or perceived conflict of interest.

DO have a conflict of interest (please explain)

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

_________________________________________________ Name (please print) Signature Date

9

*Please note your signed conflict of interest form may be appended to publicly available Council packages, as required in accordance to Ministry direction.

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Policy Type: Policy Title: Reference: Date approved:

Date revised:

Governance Process

Confidentiality and Disclosure of College

Information GP6

November 21, 2014

March 20, 2019

All Council and Committee members (“members”) will adhere to the confidentiality provisions as set out in the RHPA* and treat as confidential all sensitive information obtained or available as a result of their appointment/election to the College. All members will take all reasonable precautions to safeguard the confidentiality of such information.

Accordingly,

1. Members will sign a Statement of Confidentiality upon commencement oftheir term and annually thereafter.

2. All records (defined as any tangible information in any form, e.g.,document, recording, tape) obtained as a member will remain the exclusiveproperty of the College.

3. Members will maintain confidentiality of information with respect to allmatters that come to their knowledge in the course of their duties except asauthorized by the RHPA.

4. Other than in the course of completing documented duties, no member willremove any books, records, documents or property belonging to theCollege, from the College office. Any such property issued to a member inthe course of their duties will be returned to the College upon completion ofthe member’s term.

* Note: Common law also imposes fiduciary duties on Council members that include the obligation tokeep matters confidential.

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STATEMENT OF CONFIDENTIALITY

I have read and understood and agree to abide by the College’s Confidentiality and Disclosure of College Information policy.

I have read and understood and agree to abide by sections 36(1) and 40(2) and (3) of the Regulated Health Professions Act (the “RHPA”), which outline my duty of confidentiality and the consequences for a breach of confidentiality.

I understand that:

• all confidential and/or personal information that I have access to or learn through myaffiliation with the College is confidential

• as a condition of my affiliation with the College, I must comply with the Confidentialityand Disclosure of College Information Policy and related procedures

• my failure to comply may result in the termination of my affiliation with the Collegeand may also result in legal action being taken against me by the College and others.

I undertake to take all reasonable steps not to access, use or disclose without authorization any confidential and/or personal information that I learn of or possess because of my affiliation with the College, unless it is necessary for me to do so in order to perform my responsibilities or meet my legal obligations. I also understand that under no circumstances may confidential and/or personal information be communicated either within or outside of the College except to other persons who are authorized by the College or by law to receive such information.

If I believe that disclosure of confidential information or personal information obtained in the course of my duties is required by law (such as pursuant to a criminal proceeding), I shall notify the Registrar as soon as reasonably possible and as much in advance of the impending disclosure as possible so that the College may obtain legal advice with respect to the matter. In the event that I disclose or attempt to disclose any such confidential or personal information in breach of this statement of confidentiality, I understand that the College shall be entitled to enforce its legal rights to prevent the disclosure of the information by injunction or otherwise and may bring such further action against me as it considers advisable.

I agree that I will not alter, destroy, copy or interfere with this information, except with prior authorization and in accordance with the applicable College policies and procedures.

In the event that I have questions or concerns about any matter covered by this Statement or if I have concerns about confidentiality matters concerning the College, I will promptly contact the Registrar.

I have read and understood and agree to abide by the College’s Confidentiality and Disclosure of College Information policy.

I have read and understood and agree to abide the College’s Information Security Policy (for Council, Committee, and Working Group Members) and Privacy Code.

______________________ ______________________ Name (please print) Signature Date

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Expression of Interest Form

To assist the Executive Committee in making committee appointment recommendations to Council, please complete the below Expression of Interest Form. The Executive Committee will make its recommendations to Council in December based on your preference and in accordance with the Committee appointment guidelines:

1. Name: ________________________________________________________________

Term Year :____________________________________________________________________

2. Please indicate below at least two committees you are interested in. If you are interested in more than two appointments, please indicate in order of preference. If you are an elected member of the Executive Committee, please indicate at least one committee:

Committee Name: Preference (e.g. 1,2,3)

Client Relations Committee (CRC)

Discipline and Fitness to Practise Committees

Inquiries, Complaints and Reports Committee (ICRC)

Quality Assurance Committee (QAC)

Registration Committee

3. Are you interested in chairing a committee during the upcoming term?

Yes No

If yes, please indicate your first and (optional) second choice:

Committee 1st choice 2nd choice (optional

Client Relations Committee (CRC)

Discipline and Fitness to Practise Committees

Inquiries, Complaints and Reports Committee (ICRC)

Quality Assurance Committee (QAC)

Registration Committee

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I undertake to comply with the conflict of interest provisions in the By-laws and to inform

Council or a Committee of Council of any conflict of interest that may arise during the course

of the coming year involving the undersigned.


Edan Thomas ___________________________________________

a member of Council or a Committee of the Council of the College of Midwives of Ontario,

currently



________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Edan Thomas September 23 2020 _________________________________________________

Name (please print) Signature Date

*Please note your signed conflict of interest form may be appended to publicly available Councilpackages in accordance with the Ministry's College Performance Measurement Framework.

X

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___________________________________________




________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

_________________________________________________ Name (please print) Signature Date

9

*Please note your signed conflict of interest form may be appended to publicly available Council packages, as required in accordance to Ministry direction.

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_Hardeep Fervaha____________


!DO NOT have an actual or perceived conflict of interest.


________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

Hardeep Fervaha

September 20, 2021

___________________________________ Name (please print) Signature Date

*Please note your signed conflict of interest form may be appended to publicly available Council packages, as required in accordance to Ministry direction.9

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council meeting - cmo.on.ca

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