Training: The Health Care System

Last post, we talked about how access to and the management and delivery of health care services are informed by policy. In today's post, I move the conversation forward to talk about another part of the health care system: training.

When you walk into a health care facility, be it a hospital, clinic, or other place where health is assessed, disease diagnosed and care delivered, you would expect that those who are performing these activities are qualified to do so—that they are trained—and that the medical opinion or treatment they provide can be trusted and is appropriate for your care. Like other human pursuits, not everyone is compelled to deliver care: While some enjoy the challenge of providing direct care to patients—getting into the "action" and being up-close and personal—others prefer to work in the background, supporting those who are on the "front-line" of care delivery. But where do they get their training? And how are they kept to a high-standard so that you, the patient, are not receiving wildly different diagnoses or care between the same type of health care provider?

Most universities and colleges offer degree and diploma programs with a focus on the health sciences, with some technical schools offering programs exclusively within the health sciences or within a specific discipline of the health sciences. All of these institutions would hire as teaching staff former and current health care delivery professionals, and specifically those who have earned an advanced degree (Master or Doctorate.) Some of these institutions (often universities) partner with a health care delivery facility, like a hospital, to conduct research and develop new methods in providing care, usually with the focus of making health care delivery safer and more effective. But not all of these training institutions are equal, even though the core of what they are teaching is, for the most part, consistent. There are some institutions that "stand out" when compared to others for the quality of the education they provide and the research that they perform, and while this does not imply that other institutions are not educating their students well, a common standard is needed to make sure that students leaving those schools are, at a basic level, trained to provide safe and effective care.

In Canada, these standards are often provided by regulated professional health colleges—legislated but independent organizations with a mandate to certify health professionals within their chosen disciplines—who work to develop criteria that graduates have to meet before being able to serve patients. Once a graduate demonstrates that they are able to practice safely, they are then "licensed" by the college to do so, and often only for the province in which they plan to work in. These same colleges discipline or provide remedial steps to their members if it is found that they have engaged in wrongdoing (non-criminal) or if it becomes apparent that a member's practice is falling short of the accepted standard of practice for their discipline. If a member has continually failed to meet professional expectations as defined by the college, that member will have their license to practice revoked, making it extremely difficult to practice again. In the United States, the licensing of health care professionals is managed by state governments, and an application must be made to a state’s health department, followed by an approval, before being allowed to deliver care to patients in that state.

During training, a health professional is often given the opportunity to explore different aspects of the health care system to determine which health care delivery area is a good fit. For example, a nursing trainee may first practice in an emergency room—a fast paced and emotionally charged environment with little certainty of the kinds of health challenges that will be encountered day-to-day—and compare that experience to another section area by training there afterwards, like a surgical care unit, where care delivery expectations are more consistent, and where patient outcomes can be more predictable. For those who would appreciate the former of the two care delivery environments, being able to try each environment first helps draw the right kinds of personalities to the right care delivery areas, even though the underlying clinical discipline needed to practice in either area is the same.

Now, to tie this conversation all together: Without the support of training institutions and professional regulatory and compliance bodies, a health care system will struggle with hiring qualified and competent clinical professionals who will be able to practice within the health system and deliver the right kind of care when needed.

Next, we talk about "people"—that is, the larger conversation about "who works where and why" within the health care system, expanding our conversation beyond training.


People: The Health Care System

Health Policy: The Health Care System