Efficient and effective reform of Canada’s health care system cannot occur without the active and willing participation and leadership of physicians. Physicians must work with others to change the structural, cultural, and political environment if we are to accomplish that goal. In addition, physicians’ own views of leadership must change, along with the mindsets of system managers, members of other professions, and providers in pursuit of this aim. A number of challenges exist: capacity challenges, mindset challenges, collaborative leadership challenges, educational challenges, and alignment challenges. However, none of these is insurmountable.
The purpose of this white paper is to stimulate dialogue and action: to facilitate the development of an environment that will create the energy and commitment needed for physicians to take charge of their own future — on their own and in collaboration with their partners in the health care system. For transformation of the Canadian health care system to be successful, physicians must play a central role in planning and implementing change. This necessitates collaborative and distributive leadership in cooperation with other groups, such as citizens, administrators, politicians, and allied health care professionals, particularly because of the current fragmentation of the system at many levels.
As a profession, physicians have a unique and central role to play in service delivery, and, in most instances, they are paid directly by government rather than health care service delivery organizations. Currently, the processes and methods dedicated to creating and supporting physician leaders, i.e., education, mentorship, and professional leadership development, are disorganized, episodic, and limited in scope, if they exist at all. When changes in service delivery are expected, physicians must develop a critical mass of knowledgeable and effective leaders to ensure they are partners in the process.
Governments, administrators, and physicians themselves at all levels must formally recognize the role of physicians as leaders. Steps must be taken by all groups to ensure that the scope and breadth of physician leadership needed to effectively transform the health care system exist. To that end, a philosophy and infrastructure supporting the creation of meaningful physician engagement and leadership must be built.
This paper is the first step toward systematically and strategically improving physician engagement and leadership in the Canadian health care system. The process begins with an argument for and articulation of the goal. However, that in itself is not enough. Such a change requires broader systemic engagement of partners who agree on the challenges and the solutions. We recommend actions to stimulate structural, cultural, political, and personal change. Those actions must be informed by a broader dialogue about whether they are appropriate and, more important, how to make them work. The goal is to generate energy to improve physician leadership at all levels and make physicians true partners in efforts to achieve meaningful large-scale change.
What physicians should do
We recommend that physicians, individually and collectively:
1. Explore and challenge their personal mental models and the world views that restrict them from (a) engaging in the health care system and (b) realizing their potential as leaders.
2. Be willing personally to participate in and champion efforts by colleagues to understand the reform agenda within their provincial health care system and the implications for their own area of responsibility.
3. Take advantage of opportunities provided by colleagues, fellow professionals, health organizations, regions, and governments to participate in reform initiatives, especially patient-safety and quality-improvement initiatives.
4. Take steps to negotiate appropriate working conditions for physicians in a reformed health care system.
5. Become active champions for, and partners in, physician engagement and physician leadership development.
What health care service organizations should do
We recommend that health care organizations, including hospitals, primary care agencies, health regions, and long-term care organizations, either individually or collectively:
6. Measure the current level of engagement of their physician population, both those working in house and those working in partnership as independent contractors.
7. Gather data and information about the current state of physician leadership in their organization to understand roles, responsibilities, remuneration, time allocation, and contracts and determine a base line for improvement.
8. Make changes in organizational structure and design, jointly advocated by the organization and physician representatives, to alter policies and practices toward involving physicians in informal and formal leadership roles.
9. Engage in projects to ensure that the organizational culture is conducive to facilitating and supporting the engagement and leadership of physicians.
10. Use informal and formal communications approaches to ensure that physicians are aware of organizational issues and priorities and are able to respond and provide feedback on such issues.
11. Identify potential future physician leaders and ensure their mentorship and development.
What provinces and medical associations should do
We recommend that provincial ministries and medical associations take steps to:
12. Initiate negotiations to develop an enabling policy framework that formalizes and supports regional and organizational efforts to realize effective physician leadership and engagement.
13. In the absence of an appetite in both parties to enter into such negotiations, build trust as a first step toward an increased willingness to negotiate.
14. Work with universities and health research agencies, both provincially and nationally, to identify best practices; either conduct or gather research on the impact of various models of physician leadership and engagement; and share that knowledge widely with potential partners.
15. Publicize the benefits of meaningful physician engagement and leadership by explicitly recognizing those benefits.
16. Provide financial support for physician leadership development and remuneration for physicians in leadership roles.
What Canada should do
We recommend the following actions at the national level:
17. The Government of Canada and Health Canada are encouraged to endorse the recommendations of the Advisory Panel on Healthcare Innovation and, in the spirit of human resource development, instill in the national innovation hub strong support for physician leadership development and engagement.
18. The Canadian Society of Physician Leaders is encouraged to develop a national strategy, in partnership with other national physician organizations, such as the Canadian Medical Association and others, to coordinate their existing resources and new efforts to help provinces and regions increase physician engagement and leadership capabilities across Canada.
19. The Canadian Medical Association should develop a policy statement that recognizes the importance of physician leadership in health care reform and, through its subsidiary, Joule, reform and expand its existing efforts to increase physician leadership.
20. The Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada, provincial colleges, and medical schools across the country should expand their efforts to embed leadership development in formal medical education and professional development curricula and explore options, such as the Royal Australasian College of Medical Administrators, to recognize physicians who move permanently into formal leadership roles.
We hope this white paper will stimulate national, provincial, regional, and local conversations to identify and implement actions that will generate greater physician leadership in the area of health care reform.