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FALL 2007 |
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E
X E C U T I V E D I R E C T O R ' S M E S S A G E
Medical by-laws
review opportunity to reform system
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Jonathan Carpenter Photo |
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The restructuring of
regional health authorities over the last couple of years has not been
without stresses and strains.
The medical care system in our province is at an important crossroads.
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By Rob Ritter |
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The restructuring of regional health
authorities (RHAs) over the last couple of years has not been
without stresses and strains. Organizational change rarely occurs
without some level of disruption and uncertainty. While it is not
possible to predict precisely how much longer it will take before a
desirable level of equilibrium is achieved, the months ahead promise
to be as challenging as those of the recent past. But transitional
periods, such as the one we find ourselves in today, can also be
highly therapeutic and foster improvements to the status quo.
While a positive and cooperative
disposition by the stakeholders is one vital determinant to future
success, so too is the need for effective communication processes. I am
referring here specifically to proper roles and functions of entities
such as the “medical advisory committee” (MAC) and the “medical staff
association” (MSA).
Cost-effective medical care delivery
requires strong and continuous collaboration between physicians and RHA
administrators. The MAC and the MSA are forums through which physicians
can consult with one another in an orderly and comprehensive fashion so
that they can offer the best advice to the decision-makers.
Unfortunately, most physicians today are becoming increasingly cynical
about the MAC and MSA. They feel that their collective voice is only
given lip service through these forums. This perception has led to
growing physician complacency which, in turn, has caused further erosion
of the consultative processes within the health care delivery system.
The absence of an appropriate arena through which physicians may channel
and address important issues will precipitate fragmentation and discord.
Recently in our province, we witnessed
several examples of what happens when pressures build up and the
mechanisms intended to address issues are not functioning properly. The
intense expressions of concern by individual physicians channeled to the
media or political arenas about urology services and radiology reporting
delays were desperate pleas for action, motivated by concern for
patients. They were driven by a perception that nobody was listening to
or responding to their concerns. No doubt, the public outcry to these
issues will prompt responsive action and something will ultimately be
done. But is there a better way? The answer is yes.
The solution lies in the hands of three
key stakeholders – government, the health authorities and physicians
(collectively and individually). First, there must be an acknowledgement
by all parties that current processes are not operating as they should
and there is a need for change. Secondly, each stakeholder must
recognize and demonstrate a willingness to contribute to a shared
solution.
Health Minister Ross Wiseman has made a
commitment to ensure that there will be meaningful dialogue with
physicians before the current draft medical by-laws are put into effect.
This approach sets the right tone for constructive change and it is in
the context of this exercise that reforms to the current MAC and MSA
ought to take place. How can each stakeholder contribute to the common
effort?
The health care system has been stuck in a
“reactive” culture, responding to crisis situations. Government needs to
create an environment that will foster a shift towards a “proactive”
mindset. This can begin with a couple of practical steps. First, it must
be recognized that the work of “clinical chiefs” requires dedicated time
and effort. Addressing matters such as quality assurance, managing
precious technical, financial and professional resources, and problem
solving complex issues should not be relegated to nights or weekends as
an add-on to a full clinical workload. The clinical chiefs are the
backbone of the MAC and the caliber of advice that administration
receives from the MAC will be governed by the quality of input from
those physician leaders.
Second, in order for committees such as
the MAC and MSA to be productive they need basic moral, technical and
resource support. The RHA can contribute in practical and meaningful
ways. Sufficient administrative and clerical support is needed to ensure
that the work of these committees is carried out in a business-like and
productive manner. Clearer guidelines are needed to define the roles and
relationships between the RHA, MAC and MSA. Most important, the RHA must
demonstrate in tangible ways that the advice of physicians is taken
seriously and acted upon.
The responsibility to make sure that the
medical care delivery system is functioning properly rests not only on
the shoulders of the government and the RHA. Each individual physician
has an inherent obligation to serve as an activist to strengthening the
medical delivery system. The MSA can and should serve as a clearinghouse
to air issues and develop solutions that can be referred to the
decision-makers. Intra-professional collegiality and coordination is
crucial because more often than not, the action of one group will impact
on others.
The medical care system in our province is
at an important crossroads. The coming weeks and months will provide an
opportunity for government, the regional health authorities and
physicians to develop by-laws that have the potential of strengthening
our business practices. Given the enormity of challenges that the health
care system faces, it is incumbent on all of us to get it right. The
NLMA, for our part, will work diligently to that end.
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