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Physicians at 2017 Fall RA learn more about leadership roles in new Saskatchewan Health Authority

Saskatchewan physicians caught a glimpse into the future of health care in the province during the 2017 Fall Representative Assembly (RA), held Nov. 3-4 in Saskatoon.

A “fireside chat” between Saskatchewan Medical Association (SMA) president Dr. Joanne Sivertson and Scott Livingstone, CEO of the Saskatchewan Health Authority (SHA), provided a chance for physicians to have their questions answered on the new health administration structure coming next month.

The SHA begins operations on Dec. 4, at which time the 12 current regional health authorities will be folded into a single health authority spanning the province.

Physicians attending the RA were engaged in the discussions with Mr. Livingstone, and in all aspects of the RA, noted Dr. Sivertson.

"This fall's RA was productive and timely," she said. "Saskatchewan's health system is facing many changes and physicians are demonstrating their willingness to step up and lead."

Dr. Sivertson began the session with Mr. Livingstone by asking a series of questions, after which the floor was opened to further questions.

Mr. Livingstone noted the new health structure will see physicians co-leading in four main areas, following models of high-performing health systems elsewhere. The goal is to have physician executives lead and build a succession plan so that the next SHA CEO will be a physician, he said.

The SHA’s work will only just begin on Dec. 4, he continued. It will take months and years to build and develop the system. A good working relationship has already been established between the SHA and the SMA, and the challenge will be to carry that forward through collaboration and compromise when needed, he said.

Many questions centred on the potential for centralized services at the expense of local needs. Mr. Livingstone responded that there will be community advisory networks, and there are no preconceived ideas on how these will function. He said zones will be created in which urban and rural regions are equal partners.

He added the SHA will not take a “cookie-cutter approach” as it builds the system. A distributed leadership model will see executives located all over the province. In response to a question on a stalled EMR project in one health region, he said profiles of each of the 12 health regions are being developed so that nothing is missed in the transition to a single authority. However, in the early stages there will be many initiatives that are not intentionally stalled, but will be in limbo.

"Members very much appreciated the opportunity to hear from Mr. Livingstone regarding his vision for the future and the role of the physician," Dr. Sivertson said.   

President’s address

Dr. Sivertson delivered her presidential address highlighting the top 10 things she has learned over the last six months of her presidency. These include:

Civility and collegiality: Saskatchewan is doing well compared to other jurisdictions and work must continue to foster relationships and keep them alive and flourishing.  

RMA visitors/function: The College of Physicians and Surgeons of Saskatchewan, the Saskatoon Health Region and the College of Medicine have made efforts to visit rural centres for information sharing, and the hope is to co-ordinate even more visits in the future.

There is a crisis in primary care:  It is less sustainable to practice as family physicians as overhead is going up and patients are expecting more.  Family physicians are not being paid appropriately and this has to be addressed going forward.

Redesign and new payment models:  There are difficult decisions ahead regarding redesign, but Saskatchewan is the ideal size to do this. Physicians are willing to consider alternative payments models.

Readiness for physician leadership in this province:  Saskatchewan is envied across Canada for its physician leadership.  However, physicians who move into leadership roles must be paid appropriately and their positions must be backfilled.

Minister of Health Address

Minister Jim Reiter addressed the assembly on Friday, Nov. 3, noting the political landscape is changing with the election of new leaders for the two main parties. He said such changes can bring about new agendas for the province.

He noted the pending establishment of the SHA, the importance the province has placed in physician input into the process of creating the SHA and beyond, and work the provincial government did to bring concerns physicians had over federal tax proposals to the attention of the federal government. Minister Reiter took several questions from physicians on a variety of topics, including: fee-for-service fee codes, modernizing the fee schedules, a lack of appropriate data for physicians, wait times for child psychiatry services in Saskatoon, medical education funding, and programs to promote patient accountability.

RA sessions

Provincial transition team update

Drs. Bruce Murray and Kevin Wasko provided an update on the transition team that has been planning the move to a single health authority. The two physicians have been members of the transition team, providing physician input into the process.

Dr. Murray said the new structure will revolutionize health care for years to come, adding “we feel we landed a transition that will serve us well.” He hoped a better structure will lead to a system in which patients are happy to receive their health care and physicians are happy to practise.

He added the team learned from the experience of other provinces that have created a single health authority and from high-performing systems that incorporate physician involvement and dyad leadership models.

Dr. Wasko noted physician executives will be paired as equals with a VP in four distinct areas. These jobs will be .8 positions, allowing for clinical work to continue. In response to a question, Dr. Wasko said these physician executive job descriptions were developed with input from the physician advisory network, provincial department heads and others, plus there were consultations with Medical Services Branch on the payment schedule.

Dr Wasko told physicians that their roles will continue after Dec. 4 as they are now, and but when new chiefs of staff are in place they will work with local physicians to address their concerns and issues.

Update and consultation on SMA’s draft 2018 – Strategic Plan

Dr. Sivertson reviewed the SMA’s strategic plan and the need for new directions for the association after the current plan expires at the end of 2017. Delegates broke into groups to pick the strategic priorities that most interested them.

"Physicians were tremendously engaged during discussions about the future direction of the SMA, particularly our role in fostering physician health and wellness," noted Dr. Sivertson.

Dr. Siva Karunakaran, SMA vice-president, told delegates that during the President and Vice-President’s Tour of the province during the fall, the most common themes were physician wellness, improving collegiality, remuneration for the work that physicians do, internal communications with each other both professionally and socially, and communications with the public.

Some of the main themes that emerged from the group session will be gathered discussed further this year and into 2018.

Health Informatics in Sask.: Update and your questions

Dr. Brandon Thorpe, chair of the SMA’s health information committee; Wilbour Craddock and Kevin Wilson, representing eHealth; and Aftab Ahmad, director of the Saskatchewan EMR program, led a session on information technology.

The presentations gave delegates an update heading into the establishment of the SHA. Work has been ongoing to establish a single identity for each user of health system technology, which would allow a user to sign in anywhere on any system with a single user name and password. However, Mr. Craddock said this system won’t be in place for most health system employees until March or April, 2018.

He said many applications will transition to the SHA on Dec. 4, but further models will be developed once leadership positions are in place after the launch date. The goal will be to work with clinical leadership to ensure the reliability and consistency of the flow of information across the health system.

Physician health and well-being

Ms. Brenda Senger, the SMA’s director of Physician Support Programs, told delegates that physicians in need of care often feel guilt when they accept care and shame that they needed it in the first place.

She gave an overview of the Physician Health Program, noting the number of contacts with physicians increases every year. The top issues raised are mental health and occupational.

On Saturday morning, an in-camera session was held to update delegates on negotiations with the provincial government.

A food bank drive was held in conjunction with the Fall RA. About $500 in cash and numerous food items were collected and donated to the Saskatoon Food Bank & Learning Centre.

News organizations attended parts of the RA. News coverage included the StarPhoenix, CTV, CJWW and CKOM.

The next Representative Assembly will be May 4-5, 2018, at the Hotel Saskatchewan in Regina.


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