This article originally appeared in the Winter 2022 issue of the Ontario Medical Review magazine.
New nimble structure giving physicians greater voice
The Ontario Medical Association’s massive governance transformation is progressing, and OMA members will soon recognize they have greater opportunities to get their voices heard, Dr. Veronica Legnini, chair of the OMA General Assembly Steering Committee, said in a recent interview.
For the past 18 months the association has been laying the foundation and beginning concrete work on its new structure, she said.
The overhaul has so far seen the identification and recruitment of the new General Assembly Steering Committee, which oversees the work of the General Assembly.
Additionally, the three panels of the General Assembly have been formed which examine issues and policy, compensation and advocacy. Working groups have also been recruited to flesh out and develop actionable evidence-based recommendations to implement these priorities.
Meantime, the delegates to the Priority and Leadership Group have been in position for more than a year. This group of 125 hail from each section, district and fora. Each delegate helps identify the member-driven priorities for the OMA, successfully doing so in 2021 and 2022.
Dr. Legnini hopes that as the process unfolds, OMA members will see the changes result in greater nimbleness and responsiveness on the part of their association.
“Transformation is only successful if members benefit,” said Dr. Legnini, a family practitioner in Kingston. “It can be really challenging in this messy middle part of transformation where you haven’t quite seen the end product. You know the tweaks that need to be made, and there’s work still to be done. Maintaining that positive energy for change is really the trick.”
The new OMA governance streamlines the organization’s structure, defining more clearly the roles of the General Assembly and the board. The board has been pared from 26 directors to 11. And the General Assembly has created a workflow to tackle and act on issues of particular interest to members.
The General Assembly structure is coming together, Dr. Legnini said. The panels each are working on two assigned priorities generated from member ideas.
“One of the panels is far enough along that they have just finished the recruitment for their first working group — the people who will really get to the brass tacks of the assignment,” she said.
The OMA is now seeking more ideas for the next set of priorities for panels to tackle.
“The average member is going to be able to submit an idea… If there is enough support behind that idea, it may be selected for further review,” Dr. Legnini said. “The General Assembly will take the top five and do a deeper dive… If an idea is selected it gets sent to the panels.”
She acknowledges that members may sometimes struggle to connect the work of the OMA with the daily reality of their work lives. But she says the priorities panels are tackling can be game changers for physicians. For example, one of the priorities of the Issues and Policy Panel is centralized requisitions for imaging and lab testing, like blood tests, and that would have a massive impact on physicians’ work lives.
“My biggest pet peeve lately is forms, and how every program and every diagnostic imaging centre has its own forms… I just think how lovely it would be if they had to accept any form from any place, or there was this provincial standard for forms.”
Another panel is tasked with finding ways to reduce delays in patient care, a priority that affects not just caregivers, but everyone, she said.
The OMA’s General Assembly met in person at the beginning of October 2022, giving delegates an opportunity to hear from leaders in the transformation process about progress to date. It was also a chance to give feedback on the work underway and to network.
While much of the transformation has unfolded as expected there is still work to do.
“It can be really challenging in this messy middle part of transformation where you haven’t quite seen the end product. You know the tweaks that need to be made, and there’s work still to be done. Maintaining that positive energy for change is really the trick.”
— Dr. Veronica Legnini
Dr. Legnini said the work of networks under the new structure still must be clarified. These groups associated with areas of practice — academic, diagnostic, medical, primary care, regional and surgical — take the place of the previous assemblies.
“We want to make sure that we retain everything good that there was about the former assemblies and troubleshoot in advance anything that didn’t work... There’s a lot of work that’s been done previously that I think we can use to grow. That’s the next piece of the puzzle.”
How often the networks meet, their final structure and what kind of support they would need are on the table.
Dr. Legnini said governance transformation is hard work, and she praised her colleagues who keep coming back to address problems every day, doing the “nose-to-the-grindstone” work.
“They’re there for the right reasons. They’re there for the system. They’re not there for themselves, that’s for sure.”
The initial work of the panels has involved some of that nose-to-the-grindstone work just in terms of determining the scope of the priorities being tackled.
Reporting on progress resulting from the OMA’s governance transformation are, from left to right, Dr. Veronica Legnini, chair of the General Assembly Steering Committee; Dr. Michael Finkelstein, chair of the Issues and Policy Panel; and Dr. Lisa Salamon, chair of the Advocacy Panel.
Dr. Michael Finkelstein said the Issues and Policy Panel he chairs took about three months to scope out its first assigned priority, data support for work and health human resources, to the point where it could be sent to a working group.
The panel brought in economist Arthur Sweetman, Ontario Research Chair in Health Human Resources from McMaster University, who is an expert in the field, to help the panel determine the scope of how best the OMA can contribute to solving the human resources crisis developing in health care.
Dr. Finkelstein, who is deputy medical officer of health for Toronto Public Health, said it is important OMA members recognize his panel isn’t focused initially on the solutions to those health human resources problems.
“We felt that for solutions to be actionable they need to be in areas where there is influence from the OMA’s perspective. We felt that determining how people are getting into practice and then how people are leaving practice would be two important areas from a health resource perspective for action to be taken.
“How can we keep people in practice longer? Do we have an idea of who’s leaving? That would be important to try to determine… Same thing for people coming into practice… Are they coming from other countries? Are they getting training in other parts of our country?”
The OMA has data already available on how many physicians are in practice and how long they have been in practice. Dr. Finkelstein said there are a number of other organizations and information sources, such as the Ontario Physician Reporting Centre, which is operated out of McMaster University, with other crucial data to help with the human resources issue.
Identifying those information sources and collaborating with them will be part of the working group process, he said.
The 30 top candidates from across the province, winnowed down into a six-person working group, are about to start work on the priority. Dr. Finkelstein said he hopes a report can go to the board in spring 2023.
The second priority for the Issues and Policy Panel is centralized lab requisitions for imaging and lab testing like blood work. If work on narrowing the scope for that issue proceeds at the same pace as the first priority, a working group on requisitions should be struck early in the new year, Dr. Finkelstein said.
“While you’re speaking to the patient, or just afterwards, you realize you need to ask for a test. Wouldn’t it be great if it’s somehow integrated into your workflow with the patient’s chart on your EMR?”
— Dr. Michael Finkelstein
While the scope of that priority hasn’t yet been determined, Dr. Finkelstein said it may include a focus on how to integrate requisitions with electronic medical records.
“While you’re speaking to the patient, or just afterwards, you realize you need to ask for a test. Wouldn’t it be great if it’s somehow integrated into your workflow with the patient’s chart on your EMR? That I think offers a substantial potential to lower the administrative burden of practice.”
The Advocacy Panel’s two priorities are sweeping. The first is reducing delays in patient care and the second is developing a health human resources strategy, including a portable license that is time-restricted to underserved areas.
Panel chair Dr. Lisa Salamon, an emergency physician at Scarborough Health Network and Sinai Health, explained at the October General Assembly meeting, how ideas were synthesized to reduce delays in patient care priority.
“Many ideas came to the Priority and Leadership Group in 2021. From those, three really discussed wait times. Two were around surgical care — one about protecting surgical beds and the other one about using community-based settings to perform surgeries. And the third idea was to focus on greater access to outpatient palliative care.
“The Priority and Leadership Group combined these ideas to get to the root cause of delays in patient care.”
Dr. Salamon said the panel isn’t redefining policy but focusing on how the OMA will approach advocacy related to the priority.
“Our next priority will be to tackle the comprehensive health human resources strategy identified by the PLG group in May. And, as part of this, we were urged to consider portable licenses would be part of the solution for getting underserviced areas more care.”
— Dr. Lisa Salamon
The panel met with an expert in patient flow, a community-based practitioner in the north and OMA teams involved in government relations and surgical backlog.
“Our next priority will be to tackle the comprehensive health human resources strategy identified by the PLG group in May,” Dr. Salamon said. “And, as part of this, we were urged to consider portable licenses would be part of the solution for getting underserviced areas more care.”
The Compensation Panel, chaired by Dr. Robert Dinniwell, a radiation oncologist at the Walker Family Cancer Centre, Niagara Health, is dealing with two priorities identified in 2022: restructuring negotiations to optimize constituency group engagement and revamping OHIP eligible rejected claims process to compensate for 1) OHIP eligible patients with rejected claims for any type of OHIP-insured care, and 2) urgent, non-deferrable care for uninsured patients.
“This is such an important panel because we keep top of mind the needs of physicians and work to further optimal alignment of the services we provide with funding,” Dr. Dinniwell said. “It is a privilege to work together with such an amazing team of physicians and OMA staff on this panel. As the larger governance transformation advances, our work through this panel has now begun in earnest and there’s so much more to do.”
The General Assembly heard in October that the panel has met with the OMA’s negotiation consultant. And the panel also met with representatives of the Alberta and Saskatchewan medical associations to find out how uninsured services are dealt with in those provinces.
The compensation panel must also align with the negotiations review, which is underway and affecting the group’s timeline, the General Assembly was told.
Dr. Legnini said the final test for governance transformation and the work of the General Assembly will be when working groups complete work, panels approve the recommendations and results are reported to the board for action and the General Assembly is updated on progress.
Timelines aren’t hard and fast for the completion of recommendations from the panels. The amount of time required depends on each priority. It could take a year and a half to three years to develop recommendations because of their strategic nature and scope.
Updates on work will be provided at PLG and General Assembly meetings as well as in communications to the broader membership.
Dr. Legnini said once a priority has yielded actionable results, the assembly will be able to say to members: “You came to us with this idea. This is what it’s going to look like on the ground. What do you think of your child?”
Katherine Kerr is an Edmonton-based writer.