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CMA PolicyBase

Policies that advocate for the medical profession and Canadians


15 records – page 2 of 2.

Physician recruitment and retention programs

https://policybase.cma.ca/en/permalink/policy10163
Last Reviewed
2018-03-03
Date
2011-08-24
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC11-24
The Canadian Medical Association calls for adequate resources and coordination for the development, implementation and ongoing evaluation of physician recruitment and retention programs.
Policy Type
Policy resolution
Last Reviewed
2018-03-03
Date
2011-08-24
Topics
Health human resources
Health systems, system funding and performance
Resolution
GC11-24
The Canadian Medical Association calls for adequate resources and coordination for the development, implementation and ongoing evaluation of physician recruitment and retention programs.
Text
The Canadian Medical Association calls for adequate resources and coordination for the development, implementation and ongoing evaluation of physician recruitment and retention programs.
Less detail

Principles for health system governance

https://policybase.cma.ca/en/permalink/policy10320
Last Reviewed
2019-03-03
Date
2011-10-23
Topics
Health systems, system funding and performance
  1 document  
Policy Type
Policy document
Last Reviewed
2019-03-03
Date
2011-10-23
Replaces
Regionalization (Update 2001)
Topics
Health systems, system funding and performance
Text
Principles for Health System Governance This policy provides principles and recommendations for developing, implementing and evaluating health system governance models such as regionalized health care for the purposes of delivering high quality care to patients. Since the 1990s, health care systems in many countries including Canada have been searching for more effective health system governance models to accomplish a variety of health policy objectives. These objectives include funding health care based on population health needs and improving service delivery integration. In Canada, most provinces and territories moved to a regionalized model of health system governance during the 1990s. This "regionalization" approach involved both decentralizing and centralizing specific elements of the health care system. Decentralizing involved moving planning, budgeting and decision making authority from the provincial or territorial level to certain regional bodies. Centralizing involved moving the planning and governance of health care and medical services from individual institutions or agencies to a regional body. In terms of the delivery of health care services, centralization often occurred through the consolidation of several programs into a single program for a region and through the merger and closure of individual institutions. Since 2003, several provincial governments initiated new changes to their approach to health system governance ranging from vertical integration involving a range of health agencies under a single board (e.g., Quebec) to the creation of boards that oversee the delivery of care for larger portions of a jurisdiction or even the entire jurisdiction itself (e.g., Alberta Health Services). Many of these new models involve an arm's length authority governed by an appointed board that is mandated to manage and integrate the operations of the health system across the province/territory while leaving the ministry of health to set the overall plan and priorities for the health system as well as set standards and monitor outcomes. No doubt, governments will continue to search for an ideal health system governance and delivery model as part of an effort to develop "high performing health systems". Examples of high performing health systems exist at all levels such as at regional levels within countries (e.g., Jonkoping, Sweden) or at the client group level (e.g., US Veterans Health Administration). Health system governance models, such as health regions or health agencies, must have an overall goal of ensuring the delivery of high quality, timely and accessible care to its citizens. The Institute for Healthcare Improvement's (IHI) Triple Aim concept identifies three objectives for health systems: improve the health of the population; improve the health care experience for patients; and improve the value for money spent on health and health care. Many previous health system reforms have not resulted in improved care for patients. The CMA's 2010 action plan, Health Care Transformation in Canada: Change that Works. Care that Lasts, calls for patient-centred health care that puts the patients and their families' interests first. From the health provider perspective, previous regionalization efforts have raised several issues of concern, including whether these models translate into improved delivery of care for patients. There is also concern with the prospect that new models will limit provider involvement in health system governance and that health human resource planning will be localized when mobility of labour transcends local borders. The CMA is committed to playing a positive role in the debate on the future of health care reform in Canada. It recognizes that health system governance models are subject to change. However, this CMA policy on health system governance identifies fundamental principles that should guide any model under consideration. These guiding principles draw upon previous CMA work starting in 1991 with its Working Group on Regionalization, leading to its Language of Health System Reform report. Guiding principles Patient-centred: Any consideration of governance models must begin with an overall goal of providing patient-centred care-seamless access to the continuum of care in a timely manner, based on need and not the ability to pay, that takes into consideration the individual needs and preferences of the patient and his/her family, and treats the patient with respect and dignity. Defined objectives: The development and implementation of health system governance models/strategies must begin with a clear statement of objectives. The objectives should reflect the changes that need to be made to the health care system to address specific problems and, whenever possible, must be defined in measurable terms so that health system governance policies can be evaluated. Accountability/authority: Aligning accountability and authority is essential to effective and sustainable high performing health systems. Accountability is affected by the degree of authority and the scope of responsibilities (i.e., planning, administration, organization and funding of health care services) transferred to the governing units (e.g., regions). Who is accountable, and for what, need to be defined. There needs to be a clear statement of the roles of government, governing boards, physicians and all health care stakeholders. Physicians have a unique contribution to make and their views should be taken into account in any restructuring of the health care delivery system. Needs based planning/Responsive to regional needs: The definition of the region(s) or sub-regions should reflect the natural, socio-political and geographic divisions of the population. Once regions are defined, the health care needs of the population served by regional units should be determined through epidemiological studies, input from communities and other needs assessment. In addition to local planning, there is also the need for broader based planning to address medical and scientific research, new technologies and procedures. Regional health needs can vary requiring flexible delivery models. Credentialing that meets jurisdictional standards should be maintained at the regional level in order to effectively respond to regional needs and issues. Informed choice: Any form of health system governance should not restrict patients' mobility between providers or regions, physicians' mobility between and within regions, or physicians' choice of practice setting by limiting employment to community health centres or other forms of group practice. Participatory democracy Both patients/public and providers should be involved in determining governance models and participating in the ongoing governance of health systems. If providers are to be encouraged to get involved, they need to have ready access to the planning and administrative skills needed to participate effectively and make a valuable contribution to management and leadership. Three key areas in which providers must become knowledgeable and involved include governance and credentialing, health care needs assessment and health economics. Clinical autonomy: Physicians have a responsibility to advocate on behalf of their patients to ensure the availability of needed care. This responsibility should not be hindered by a physician's practice setting, mode of remuneration or paying agency. Evaluation: Evaluation protocols must be built into health system governance models at the outset, and the results of evaluation must be used to "fine tune" and improve the strategies. These protocols should address cost effectiveness, population health status, patient access to health care services and the interests of government, the profession and the public. Standards for reasonable access: Certain areas and cultural groups do not have the same level of access to health care services as the national norm. All health system governance models should address these shortcomings to ensure that the entire population of any given region has reasonable access to primary, secondary and tertiary care. Balancing access and affordability: One of the implicit objectives of new models of health system governance appears to be achieving both control over health care costs and redirecting expenditures from health care to community and social services. Governing authorities must be careful to maintain a balance between access to health care services and affordability allowing for a variety of methods to achieve this (e.g., internal markets). They must also maintain a comprehensive accounting of the cost of implementing any new model. Balancing curative with preventive and sustaining care: All health system governance models must support not only the system's ability to provide curative care but also an ability to provide effective preventive and sustaining care. Governance models should ensure funds can be allocated toward a comprehensive approach to care as well as allow for models of care that support all three functions. Support for medical education and research: Policies and structures of health system governance models need to acknowledge and foster the role of medical education and research in the health care system. Governance of medical teaching and research should reside within the academic health sciences centres. These centres should be assured of adequate financial and human resources and of access to cross regional patient populations and to community teaching sites in order to provide adequate learning and research opportunities. Recommendations With regard to the development, implementation and evaluation of health system governance models, the CMA recommends that: * advocacy on behalf of patients and physicians be maintained irrespective of any regional administrative boundaries; * governments ensure that the introduction of new models of health system governance do not interfere with clinical autonomy and professional freedom in the context of the physician/patient relationship; * governments, health governing authorities and institutions ensure that physicians, through their professional associations, are included in the development and revision of practitioner/medical staff bylaws and appointment policies; * family physicians, on the basis of their education, training and skills, are reaffirmed as the preferred point of entry into Canada's health care system; * governments ensure that catchment area under the governing authority be defined in a way that is sensitive to the political, cultural and geographic circumstances of the population and recognizes established patterns of the demand for, and the provision of, health care; * governments ensure that the introduction of new governance models does not interfere with reasonable access by the population to medical services at the primary, secondary and tertiary levels; * leadership be provided to help ensure that the development, implementation and evaluation of health system governance models are based on clear, measurable objectives; * governments develop and maintain national standards for access to high quality health care, medical education and research, irrespective of regional boundaries; * governments ensure that programs and policies under any form of health system governance be designed and implemented in a manner that supports key principles of medical education and research, including: - the governance and resources required for medical teaching, both in the academic health sciences centres and in appropriate community based sites throughout the province or territory, - academic health sciences centres' responsibilities for providing secondary and tertiary care to catchment populations that cut across regional boundaries, and - the need for academic physician resource plans to ensure a critical mass for teaching and research; * governments give priority to mechanisms to protect the mobility of patients and physicians when developing and implementing programs under any new health system governance model; and * the medical profession work with governments to develop: - clear role, responsibility and accountability statements for government, health system governing boards, health care providers and consumers, - mechanisms to ensure that governing boards have broad representation and meaningful input from the community, including physicians, and that regional boards be recruited through a clearly specified appointment or electoral process, - guidelines for use by communities to assess their health care needs and to provide assistance, as required, with the conduct of such assessments, - protocols and procedures for evaluating health system governance initiatives, - mechanisms to ensure adequate and appropriate physician input into operational aspects of regional planning and coordination of health care services, and - processes under any health system governance model ensure adequate opportunities for research, education (including continuing medical education) and training of physicians consistent with national standards.
Documents
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Process improvement methodologies

https://policybase.cma.ca/en/permalink/policy10204
Last Reviewed
2018-03-03
Date
2011-08-24
Topics
Health systems, system funding and performance
Health human resources
Resolution
GC11-47
The Canadian Medical Association will work to identify how funding can be used to support physicians and physician groups who wish to learn about process improvement methodologies, participate in process improvement initiatives, and become physician champions of such methods and initiatives.
Policy Type
Policy resolution
Last Reviewed
2018-03-03
Date
2011-08-24
Topics
Health systems, system funding and performance
Health human resources
Resolution
GC11-47
The Canadian Medical Association will work to identify how funding can be used to support physicians and physician groups who wish to learn about process improvement methodologies, participate in process improvement initiatives, and become physician champions of such methods and initiatives.
Text
The Canadian Medical Association will work to identify how funding can be used to support physicians and physician groups who wish to learn about process improvement methodologies, participate in process improvement initiatives, and become physician champions of such methods and initiatives.
Less detail

Standardized perioperative efficiency and quality performance indicators

https://policybase.cma.ca/en/permalink/policy10186
Last Reviewed
2018-03-03
Date
2011-08-24
Topics
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC11-50
The Canadian Medical Association supports the development and adoption of standardized perioperative efficiency and quality performance indicators to: - establish performance targets, - track progress, - pursue continued improvements against those targets.
Policy Type
Policy resolution
Last Reviewed
2018-03-03
Date
2011-08-24
Topics
Health systems, system funding and performance
Physician practice/ compensation/ forms
Resolution
GC11-50
The Canadian Medical Association supports the development and adoption of standardized perioperative efficiency and quality performance indicators to: - establish performance targets, - track progress, - pursue continued improvements against those targets.
Text
The Canadian Medical Association supports the development and adoption of standardized perioperative efficiency and quality performance indicators to: - establish performance targets, - track progress, - pursue continued improvements against those targets.
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Standardized perioperative efficiency and quality performance indicators

https://policybase.cma.ca/en/permalink/policy10187
Last Reviewed
2018-03-03
Date
2011-08-24
Topics
Health systems, system funding and performance
Resolution
GC11-51
The Canadian Medical Association supports the mandatory reporting of standardized perioperative efficiency and quality performance indicators.
Policy Type
Policy resolution
Last Reviewed
2018-03-03
Date
2011-08-24
Topics
Health systems, system funding and performance
Resolution
GC11-51
The Canadian Medical Association supports the mandatory reporting of standardized perioperative efficiency and quality performance indicators.
Text
The Canadian Medical Association supports the mandatory reporting of standardized perioperative efficiency and quality performance indicators.
Less detail

15 records – page 2 of 2.