Change & The New OMA

People say that they hate change. But it’s not true.

We love babies, weddings and graduation. We love new homes and cars and retirement.

Everyone loves positive change that we control, but we get stressed when other people make us move.

So most of us avoid asking for change. We know it threatens people. Asking for change means we want something better, or different.

Change & The New OMA

The OMA started renovation this spring: a new group of Board members, a governance retreat/renewal and then a major strategy planning session. Now the hard work begins.

Change means we find new and better ways to act. It means we work in concert.


Change interrupts usual workflow. We stop doing some things, start doing others and redefine ourselves in the process. Change is scary.  If it isn’t, it probably isn’t real change. Continue reading “Change & The New OMA”

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Governance Renewal – Ask Why Before How

Action expresses priorities – Ghandi

Every doctor has seen or done something horrible to an old, dying patient.

Armed with good intentions, we spot a gasping 95 year old and jump into action. We snap open a laryngoscope blade, hoist her jaw into the air and shove in a tube to relieve her “upper airway obstruction”.

Our technical prowess is matched only by our moral purity. But we accomplish something grotesque and wrong.

Doctors must learn to identify sick patients and how to resuscitate them. But these skills cause harm if doctors do not learn what comes between diagnosis and treatment.

Before treatment, we must ask: Why?  

Purpose Before Process

A governance expert entertained a large group of doctors in Toronto this weekend. He summarized a graduate textbook on board governance in 40 minutes, for a group who had very little board experience.

It was brilliant, funny and almost useless. Continue reading “Governance Renewal – Ask Why Before How”

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The OMA is on Fire

In 1880, doctors got together and built a house called the OMA. It was a small house with a big living room and magnificent doors that were always open.

The house helped doctors. That was its only purpose.

Over time, caretakers of the house found that friendship with power helped doctors. Soon the house was full of courtiers, with the doors closed. And soon after that, the doors stayed closed all the time.

The magnificent doors came to represent the whole building. They protected the building. It was their fiduciary duty.

Today, the OMA is on fire. Politicians lit the fire. But once the fire started, those in charge of the OMA ignored the smoke. In fact, many say that the caretakers could have prevented the fire altogether, if they had spent less time wringing their hands and courting power. Continue reading “The OMA is on Fire”

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How to Influence Council

influence councilLaugh tracks win debates.

Political talk shows, like Bill Maher’s, rely on cheers from the audience to boost the host’s views.

Applause directs viewers what to think. No one wants scorn for being out of line with what Bill Maher thinks.

Groups of doctors are no different. We think that we are thoughtful and deliberate, but applause changes doctors’ opinions, just like everyone else.

Influence Council

Almost 300 doctors will take a biannual pilgrimage to a giant basement in Toronto for the Ontario Medical Association Council meeting this weekend. Council delegates will consume tables of carbs and coffee listening to the OMA Board Report and other issues.

Delegates must sift hours of noise for buried scandals. Big issues can slip by in seconds. When delegates find something, they need to speak up. They need to convince the basement mob to think differently. Continue reading “How to Influence Council”

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Dangers of an Executive Committee

Executive CommitteeIndiana Jones and the Last Crusade pivots around Indiana Jones’ relationship with his father.

During the first half of the movie, Indiana treats his dad with a mix of frustration and programmed obedience.

At one point, Indie sits with his dad and asks why they never talked.

Indie says that his dad taught him that he was less important than people who had been dead for 500 years. His dad insists that he was a great father: He gave his son independence.

The conversation heats up, and Indie’s dad finally closes his book. He leans back and says,

Okay, I’m here. What do you wanna talk about?

He stares at Indie: see the picture above.

Indie is at a loss for words. I….I don’t know, he says.

His dad says, Well alright then. We’ve got work to do!

Indie drops the topic, his dad stays convinced that he was a good father, and the movie continues.

Board & Executive Committee

We find Boards everywhere: hospitals, banks, medical associations and athletic clubs. Not all groups have Boards, but we all belong to groups governed by Boards. If we want our groups to perform well, we need to know a bit about the Boards that run them. Continue reading “Dangers of an Executive Committee”

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Caring Versus Care

cassie-campbell-pascallMany athletes start second careers as broadcasters. Viewers love to hear from someone who spent time doing what others can only talk about.

Every profession has pundits and players: people who do and others who just talk. Even those who actually do what they love to talk about, sometimes confuse talking with doing.

Care versus Caring

Most doctors notice when they spend time away from clinical care. They feel out of touch. Physician leaders often insist on a few hours each week to spend with patients, to remember why healthcare exists.

If doctors feel ungrounded after only a few days away from patients, imagine how bureaucrats and politicians must feel? Continue reading “Caring Versus Care”

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Disruptive Takeover & Medical Associations

uber_drivermusic_imageToronto taxi licenses peaked at $360,000 in 2012. Three years later, licenses sold for $118,235.

Today, taxi plates go for less than $100,000.

Uber found a way to lower rates, offer better access and collect customer feedback with each ride.

Uber disrupted the taxi industry. Netflix did the same with movie rentals.

Airbnb entered the ‘hotel’ business without owning a single hotel room. It now has a larger market cap than Hilton and Marriott. Luxurious monopolies create irresistible targets for disruptive takeover. Continue reading “Disruptive Takeover & Medical Associations”

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Identity Crisis – Whose Side are We On?

luke skywalkerWhether in war or the Super Bowl, anyone who tries to cheer for two opponents gets called a traitor by both.

Serious opponents wrestle over fundamental differences.  Dreamy relativists dismiss debate and sing, “Why can’t we be friends.”

Although peace costs less than war, sometimes you must pick a side and fight. Peace-brokers risk becoming irrelevant to both sides, after the war ends. Those too eager for peace could incite civil war in their own ranks.

That’s not to say we should never call a truce. Calling a truce means, by definition, that there are two sides. You cannot deny differences and hope to win favour with both opponents.

Identity Crisis

Doctors are not on the same team as government. Politicians are on their own team. As soon as their interests do not align with ours, doctors often lose. Continue reading “Identity Crisis – Whose Side are We On?”

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Crisis of Trust – Doctors Vote No

harry-potter-philosophers-stoneOrphans make great fiction. Harry Potter leads a long list with Tom Sawyer, Anne of Green Gables and Oliver Twist.

Children need someone to trust. They cannot be children and fight the world at the same time. Abandonment is held with universal disdain.

Doctors feel abandoned. Over 61% voted No to a tentative deal that promised cuts and underfunding for 4 years.

The Wynne government has squandered money for medical services, by gambling on windmills and pension plans. Health Minister Hoskins makes a point of belittling doctors for working hard in the system his government created, while every other public union gets contracts, with raises.

Doctors feel abandoned by government.

Many doctors feel the same about the Ontario Medical Association (OMA).

No one can accuse the OMA of bargaining in bad faith. The OMA was determined to promote the 2016 Tentative Physician Services Agreement and spared no expense in advertising.

Robocalls, personal phone contact on the weekends, slick campaign ads by email, video interviews, dozens of roadshows, tele-townhalls, local medical meetings, letters to the editor and a massive social media campaign pushed doctors to vote Yes.

No one knows, but people guess it cost between $1 million to $3 million. This ignores hours of OMA staff time, as other work got put on hold.

The OMA has never tried so hard to convince their members to ratify a contract.

And that’s the problem.

The board endorsed the New Deal. It was wise to share it with members. But endorsement morphed into promotion and desperate advocacy.

Desperation creates blindness and drives odd behaviour. Superior Court Justice Perell ruled that the OMA Board’s Executive Committee had “abused the authority provided to it” and created an “unhelpful, unclear,  unbalanced, and unfair” voting process.

Perell called the Exec “sneaky”.

Addendum: One physician leader insisted that Perell called the “OMA” sneaky. Legal opinion did not back up that statement, although it is not 100% clear. Regardless, whether Purell referred to the Exec, the whole Board or the OMA writ large, his comments are damning. We must get on and face the fact that the comments exist and stop blaming people for drawing attention to them. 

We must not judge too quickly. Passionate beliefs make people double down and pour in more energy, precisely when they should step back. Double or nothing seems logical at the worst time.

A wise friend said that, People with weak arguments hold the bitterest resentment for those who do not support them. People with strong arguments do not need endorsement. Their case stands on its own merit.

The OMA bet everything on promoting a Yes vote and lost doctors’ trust in the process. Many of us might have made the same mistake.

Crisis of Trust

Warren Buffett said, “It takes 20 years to build a reputation, and 5 minutes to ruin it.” It takes years of effort, sacrifice and principled behaviour to earn the trust that creates lasting change.

Doctors need someone to watch their back, so that they can focus on patients. Doctors cannot provide care with one hand on their sword.

Many believe that the massive No vote is a vote of non-confidence in the OMA.

How to Rebuild Trust

Healing starts with taking other people’s beliefs seriously, regardless of our opinions about those beliefs.  Denying a crisis of trust guarantees more failure.

For leaders, staff opinion must trump leadership ‘facts’. When staff members firmly believe that leadership betrayed them, leaders cannot fix it by proving their staff has no right to feel that way. Leaders win trust with behaviours and outcomes, not arguments and facts.

Doctors know this. When grieving parents attack us, it does not help to debate the best way to resuscitate a dying toddler. We want to run away when lawyers show up, but that is exactly the time to engage with compassion.

Leaders must deal with beliefs and emotions before process and projects. We must take the accusations of our most passionate critics with utmost seriousness.

If government is a reckless, absent parent, then the OMA must be the dependable one. The OMA must win the right to be trusted. It can be done. But it will be costly, in many ways. We need the courage and humility to start.

The OMA must prove to doctors that it values its members before anything else; that it will never abandon them. That might require painful sacrifice. But it’s essential. Orphaned doctors do not provide great care.

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Crisis Management for Doctors – 7 Tips

hurt lockerAs a rule, Keep your mouth shut works almost everywhere. Most things get worse when we speak.

However, silence can cause trouble, too. Even a pause can be deadly:

Who do you love most: me, or my sister? 

Mom, was I a surprise pregnancy?

If we want safety, silence offers the best protection. It makes sense to hide and keep really quiet, when danger prowls – but not for leaders.

Doctors must lead. And leaders need to speak; precisely when everyone else is sliding down in their seats around the table.

Leaders must say something, even when there is nothing perfect to offer. Silence does nothing for a team. But we have to be careful, too: empty platitudes can come across like ‘Get Well’ cards at a funeral.

Medical Politics Thriller

If this were a spy thriller, Ontario sits at the point in the story when a bomb has just been found under the parliament buildings.

Helicopters circle. People run around screaming, and a sweating bomb tech, in safety gear, extends a shaking set of snips towards a jumble of wires.

Will he cut the blue wire…or the red one?

If you Google crisis + leadership, millions of results pop up like:

 These offer great advice. But doctors need something a bit different.

In Ontario, leaders have stepped forward from all sides: within the establishment, without, and in between. For all leaders, here are 7 tips:

Crisis Management for Doctors

1) Be cool – Lighting our hair on fire comes naturally for some. The heat and smoke releases energy and feels good, I suppose. Resist the urge, no matter how much better it makes you feel.

Everyone who looks to your reaction feels much worse when you lose control, even with an audience of one.

2) Avoid the simplistic – Us against them wins on a football field, but not with large groups. Black and white works well until kindergarten.

Oversimplifying complexity might seem to add sanity for a moment, but it never leads us out of a crisis.

3) Keep making friends – Fights during Thanksgiving dinner often leave deep, irreparable scars. Remember whom you are fighting with.

You may need to see them for your heart attack next week.

4) Forgive more – People make dozens of mistakes every hour, at their best. Under duress, we make many more. Itemized lists of all the ways other people messed up, acted poorly, or otherwise disappointed us rule out reconciliation.

Do not assume maleficence, when ignorance explains behaviour well enough.

5) Plan for the future – Force yourself to imagine life after this crisis has past. Even if things do not work out in your favour, this crisis, too, shall pass.

Your response will shape your experience of life afterwards.

6) Stop and think – Surviving the next minute blocks out all other thought in a crisis. We need more time to reflect, at the exact moment when there isn’t time to breath.

Stop. Think. Take 10 minutes to read. Pseudo-dementia comes from cognitive overload.

7) Remain positive – I think it was Dee Hock, founder and CEO of Visa, who said something like, “The times are too tough, and the outlook too dire, for negativity.

We need hope the most, when hope seems most unreasonable.

Crisis and Silence

Trauma and crises are not all bad. Birth is traumatic, violent even. Full lives have very few dull moments. Dreams of peace and quiet come true only for the most heavily sedated, on locked wards.

The excitement in Ontario will pass, eventually. We will go back to working together, sharing patients, and finding ways to work with others to improve our healthcare system. But during a crisis, many people find it safer to clam up and keep silent.

We need people to offer reasons for hope, no matter which direction this turns. Silence is not an option in crisis management.

Photo credit: The Hurt Locker

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