Dissertation (Doctoral) Managing Conflict of Interest in Health Care: The Roles of Professionalism and Regulatory Colleges


Debra Lydia Catherine Zelisko


Self-regulation relies on professionalism, which entails the existence of a specialized body of knowledge, associated activities best evaluated by those possessing this knowledge, the expectation that professionals act on behalf of their clients, and the potential for harm if the activities are not carried out well (Bayles 1986; Cruess & Cruess, 1997; Freidson 1994, 2001). A conflict of interest (COI) occurs when conditions may unduly influence an individual’s behavior or ability to carry out his/her obligations (Thompson, 1993; Carson, 1994). In healthcare, COI may interfere with patient care, and erode trust, undermining self-regulation’s effectiveness (Thompson, 1993; Cruess, Johnston and Cruess, 2002; Tonelli, 2007; Haines & Olver, 2008).

This study examined how four Ontario-based regulatory Colleges addressed financial COI. Incorporating a nested multiple-case study, part one, a descriptive study examined which health professions were self-regulated in Canada. Part two, a multiple-case study examined four health professions’ Colleges in Ontario regulating: Audiologists and Speech-Language Pathologists; Nurses; Physiotherapists; and Physicians.

Part one’s results indicated differences amongst the provinces regarding legislative framework implementing self-regulation, and which health professions were granted self-regulation. Part two’s results indicated that the four Colleges had mechanisms in place to address financial COI, although the number of disciplinary hearings that related to financial COI was low, suggesting the number or importance of financially-based COI issues within these Colleges was low. It was also reflective of the disciplinary process which largely relies on complaints or concerns being submitted to the College.

The areas these Colleges perceived their members to have COI concerns could be related back to nature of work, work environment and remuneration. The Colleges viewed publicly-funded services as minimizing the risk for financial COI. The Colleges did not have oversight in determining fees, and pricing under any remuneration structure, nor did their mandates extend to non-professionally owned/managed businesses. Areas identified for further investigation to inform policy development included examining how accountability is maintained in areas related to financial COI for publicly-funded services. In addition, how Colleges might play a role in maintaining public interest and trust as profession-controlled markets are moving towards corporately-owned or controlled models warrants further study.


Raisa Deber