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governance_panel_edmonton_caep_05_28_15_(1)[1].pptx
- 1. Towards Better Governance Modelsfor Academic Units/Depts of EM CAEP working group / panel Academic Symposium 2015 “Once you have three people working together – you have a governance problem whether you want one or not. It might be a simple agreement on a napkin but it’s governance”
- 2. Governance Panel Members: DavidPetrie, Chair (Dalhousie U) Jim Christenson, Leadership Working Group Chair (U British Columbia) Ian Stiell, Academic Section Executive Chair (U Ottawa) Gordon Jones (Queens U) Anil Chopra (U of Toronto) Shannon MacPhee (Dalhousie U) Michael Schull (U of Toronto) Alecs Chochinov (U of Manitoba) Margaret Ackerman (McMaster U) John Tallon (U British Columbia) Jennifer Artz (CAEP) Kelly Wyatt (CAEP)
- 3. WHAT ARE THEBEST MODELS FOR UNIVERSITY EM GOVERNANCE AND ADMINISTRATION? • To define effectiveness as an outcome of an emergency medicine academic program. • To describe current governance and administration models and relate them to the overall effectiveness of the academic unit. • To point out variability and gaps across Canada and determine best models to develop, sustain, and grow strong academic programs.
- 4. Terms of Reference: a)Researching the topic including environmental scans of Canada and U.S., literature review, and interviews of experts. b) Creating recommendations for Canadian Academic EM units, c) Presenting the recommendations at the CAEP 2015 Academic Symposium, d) Publishing the recommendations in CJEM.
- 5. Overview: • What isGovernance? • Two separate but related levels of governance in dept/unit’s of EM • Why is governance important in the context of Academic Emergency Medicine? • If governance is a means to an end, what is the purpose of an Academic Unit / Department of Emergency Medicine and how does that impact governance? • What do we know about governance in Canadian EM dept/units across Canada? • Questions to reflect upon re your own situation (handout 1). • What are the essential elements of good governance in this context? • Towards better governance at the Unit/Dept level (handout 2). • Why become a full academic department (handout 3). • Recommendations
- 6. Proposed Flow ofpresentation: • Intro/Background/Framing - Petrie (10 min) • Recommendation 1 • Recommendation 2 • Discussion Handout 1 • Environmental scan survey results • Importance of good “internal” governance - Petrie (5 min) • Discussion Handout 2 • Recommendation 3 • To be, or not to be, a Department - Chopra and Chochinov (15 min) • Discussion Handout 3 • Recommendation 4 • Summary Petrie et al • Recommendation 5 and 6
- 7. Definition of Governance: •“The complexity of governance is difficult to capture in a simple definition”. • “The need for governance exists anytime a group of people come together to accomplish an end”. • Governance determines who has power, who makes decisions, how other players make their voice heard and how account is rendered. http://iog.ca/
- 8. Who makes whatdecisions, and how; at the Unit/Dept level and at the FoM/University level?
- 9. Inter-dependent aspects ofUnit’s effectiveness: Leadership Funding Governance
- 10. Governance is aMeans to an End: Research Education Leadership Governance Funding Patient Care Population Outcomes “The vision of the CAEP Academic Section is to promote high- quality emergency patient care by conducting world-leading education and research in emergency medicine”.
- 11. Tripartite Mission: Research,Education, Patient Care:
- 12. Provincial Government DoH,DoE Health Authority, Hospital Clinical Chief University, FoM Academic Chair Accountabilities to ultimate Payer(s) / Public Chair/Chief as agent of Hosp/FoM. Hospital privileges/ academic promotion Purpose/Mission: Clinical Care, Education, Research Individual MDs and constituent programs Affiliation agreement vs single AHSC Legitimacy Voice Legislation Bylaws Membership agreements
- 13. Provincial Government DoH,DoE Health Authority, Hospital Clinical Chief University, FoM Academic Chair Accountabilities to ultimate Payer(s) / Public Chair/Chief as agent of Hosp/FoM. Hospital privileges/ academic promotion Purpose/Mission: Clinical Care, Education, Research Individual MDs and constituent programs Affiliation agreement vs single AHSC Legitimacy Voice Legislation Bylaws Membership agreements
- 14. Provincial Government DoH,DoE Health Authority, Hospital Clinical Chief University, FoM Academic Chair Accountabilities to ultimate Payer(s) / Public Chair/Chief as agent of Hosp/FoM. Hospital privileges/ academic promotion Purpose/Mission: Clinical Care, Education, Research Individual MDs and constituent programs Affiliation agreement vs single AHSC Legitimacy Voice Legislation Bylaws Membership agreements
- 15. Provincial Government DoH,DoE Health Authority, Hospital Clinical Chief University, FoM Academic Chair Accountabilities to ultimate Payer(s) / Public Chair/Chief as agent of Hosp/FoM. Hospital privileges/ academic promotion Purpose/Mission: Clinical Care, Education, Research Individual MDs and constituent programs Affiliation agreement vs single AHSC Legitimacy Voice Legislation Bylaws Membership agreements Business Manager
- 16. 5 Principles ofGood Governance: 1. Legitimacy and Voice • Participation, consensus orientation 2. Direction • Strategic Vision 3. Performance • Responsiveness, Effectiveness, Efficiency 4. Accountability • Accountability and Transparency 5. Fairness • Equity and rule of law
- 17. Governance as Leadershipmodel: Chait, Ryan, Taylor, 2005. Governance as Leadership “We don’t think about or debate governing; we just do it”
- 18. Governance as Leadershipin EM: Who makes what decisions, and how? • Fiduciary • Stewardship of tangible assets (financial and legal obligations) • Accountability to senior organizations, payers, partners, stakeholders • Accountability to individual members and constituent interests • Strategic • Set the Unit/Dept’s course and priorities (Mission, Vision, Values) • Deploy resources accordingly (trade-offs, incentives) • Generative (adaptive) • Frame problems and make sense of ambiguous situations • Evolve, adapt, respond to uncertainty and changing environments
- 19. Two Inter-dependent waysto view Governance in Academic Depts/Units of EM: 1. Dept/unit in relation to “internal” programs/EM physicians? • See handout 2 re “Top 10 aspects of good internal governance”. • What does the CAEP academic section survey tell us? • How well is your own Dept/unit doing? 2. Dept/unit in relation to the Faculty of Medicine/University? • See handout 3 re “Why become an Acadmic Department”. • What does the CAEP academic section survey tell us? • How well is your own Dept/unit doing?
- 20. Two levels ofgovernance in Academic EM: Two levels of governance impacting Unit/Dept performance “Full” Academic Department Status within University, Faculty of Medicine Division, section, or no status within University, Faculty of Medicine Good Governance of “Internal Affairs” A B Challenged Governance of “Internal Affairs” C D
- 21. Don’t just doit; think about it
- 22. Recommendation # 1: Alongwith leadership and funding, governance can have an important impact on Academic Unit / Departmental policy development and decision making. Therefore, governance should not be taken for granted. There should be a deliberate approach to governance structures, processes and improvements. See Handout # 1
- 23. Recommendation # 2: Notwo Academic Units / Departments are the same; the ideal governance structure for any given Unit/Dept should be aligned with the local institutional bylaws, organizational cultures, and relative emphasis the Unit/Dept puts on the tripartite mission of academic medicine (patient care, research, and education). See Handout # 1
- 24. EM Status andDepartment vs Other: 8; 47% 4; 24% 3; 18% 2; 12% Status of EM Within the 17 medical Schools Full Department Division/Section Joint Department with FM No Status
- 25. Division/Section of EMaffiliations: Surgery Not Specified Family Medicine (FM) Pediatrics Medicine 0 1 2 2 3 Section / Division Affiliations (n = 4)
- 26. Division of EMaffiliations: N = 3 Divisions (1 Section) Medicine Surgery Family Medicine Pediatrics A FRCP CCFP-EM PEM is with Peds B FRCP CCFP-EM PEM is with Peds C FRCP, CCFP-EM? PEM is with Peds
- 27. Sources for financialsupport across the 17 medical schools University Ministry of Health / Alternate Funding Plan Practice Plan Hospital 17 10 7 6 Sources of Support Number of Medical Schools
- 29. Directors and AssistantDirectors 16 Funded Clerkship Directors 2 Funded Clerkship Assistant Directors Clerkshi p 5 Funded Electives Directors 1 Unfunded Elective s 3 Funded “Other” Directors Other UG 17 Funded Program Directors 10 Funded Assistant Program Directors 1 Unfunded CCFP- EM 14 Funded Program Directors 10 Funded Assistant Program Directors 1 Unfunded RCPSC- EM 11 Funded Off-service Directors Off- service
- 30. Directors and AssistantDirectors: Education Scholarship 4 Funded Directors 1 Unfunded EM Educati on 4 Funded Directors EM Scholar ship 8 Funded Directors 1 Unfunded CPD
- 31. Research and Support 14Funded Directors Research Director 13 Funded Resident Research Facilitator
- 32. But what doesthis say about the best models for University EM governance (at both “levels”): 1. Legitimacy and Voice • Participation, consensus orientation 2. Direction • Strategic Vision 3. Performance • Responsiveness, Effectiveness, and Efficiency 4. Accountability • Accountability and Transparency 5. Fairness • Equity and rule of law
- 33. Recommendation # 3: Internalgovernance structures govern the relationship between the Academic Unit / Department and the constituent academic programs, and the individual physicians. While modifying to local contexts, Academic Units/Depts should consider implementing the “top 10 list” of governance principles in their design. See: Top 10 elements of a Good Governance Plan for Depts/Units of Emergency Medicine (Handout # 2).
- 34. Recommendation # 4: Divisionsand Sections of Emergency Medicine should seek to become Academic Departments as a means to develop, sustain, and grow strong academic programs (provided that careful analysis suggests mutual benefits to Emergency Medicine and the mission of the Medical School). See: Why should EM be an Academic Department (Handout # 3)?
- 35. Why should EMbe an Academic Department? • Chochinov and Chopra: 10 - 15 minutes dialogue on • Why full academic dept status is important and how it has made a difference • Why academic performance is the real issue (and full academic dept status may not be necessary for that)
- 36. How to becomea Department of EM?
- 37. How to becomea Department of EM? 1. Build the respect and reputation of EM over time (especially in research and education) but also, in day-to-day clinical care 2. Articulate a vision of improved patient/population outcomes fostered by excellence in EM education and research (when/where ever possible) 3. Understand the culture of the institution(s) 4. Know the criteria and process of application at your institution 5. Understand the priorities and values of the Dean and the CEO of the Health Science Centre - align the prospective Dept’s with these 6. Build coalitions (Especially with the Chair of Medicine, Surgery, Family Medicine, and Pediatrics) – emphasize mutual advantages of departmental status
- 38. Recommendation # 5and # 6: • The CAEP Academic Section should organize and support a consultation service to provide experience, analysis, and advice to Chairs/Heads because there is no “how to” blue print for an Academic Unit / Department to construct, implement, and improve their governance (at both levels). • Many of the leadership/governance/funding issues and challenges facing academic emergency medicine across the country have similar patterns and drivers (even if contexts and details may differ between Universities). The Academic Chair/Heads should establish a formal and regular forum for meeting and sharing experiences/approaches to common issues.
- 40. Example Executive Committee: • UniversityHead/District Chief • 2 Site Chiefs (major teaching hospitals) • 3 Academic representatives • 2 elected members • + Chief Operating Officer
Editor's Notes
- #9 The larger the circle the better the individual aspect of each. The more overlap of the circles the better the integration and coordination of the three.