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.

The following ideas come from a blend of research and personal experience. I cannot cite sources for each idea, just note that many come from other authors. After each idea, I try to apply it to the OMA, in italics.

NB: Adjust these ideas to fit your position in your hospital, clinic or organization. Still, the ideas hold for everyone everywhere.

For example, your change efforts will look different depending on who reports to you, if anyone.

Middle management will apply these ideas differently than a CEO.

And a Board Director will play a different role, too: You cannot direct operations, but you can and should ask hard questions.

Dream Big

Pick a vision that people can understand.

We chose “Everyone seen within 1 hour,” in our emergency department. People laughed out loud, when they heard it. They stopped laughing when we hit 1 hour, 12 months later. At every success or failure, we circled back to our dream.

What’s our big dream at the OMA? Is it big enough that people will think we are a bit crazy for trying?

Find Your Moral Compass

Identify the high ground.

In our emergency department, our central value was, “Treat everyone like family.” We fought against any process that privileged patients did not have to endure. We wanted everyone to get outstanding service and care.

Once you identify your high ground, stake it out. Own it. When you get attacked, point your team back to why you are all on this journey.

What is the high ground for the OMA? Is it serving members, or something else? Do all our current projects fit with our dream and moral compass?

Prepare for Resistance

As soon as you start change, you will get attacked. People who never spent one millisecond thinking about your work before will descend in flocks to peck at your attempt to change.

People often resist change because they benefit from current dysfunction. Your change efforts WILL make life worse for some people. Dogcatchers go unemployed when all the dogs have new pens.

Who will resist change at the OMA? Who will attack from the outside? How can we prepare?

Build a Great Team

Some people will never like what you are doing. Some will threaten to leave. Help them do so. You only want people around who are 100% committed to the vision.

Find flexible people, those comfortable with ambiguity.

Some people are wired to work as switch operators on train tracks. For them, life must be crisp and clear. They lose their minds with any hint of ambiguity. They travel through life on one track or another.

These kinds of people are great for running a system after it’s built. Do not keep them around for renovations. Ask them back when it’s done.

When you identify great people, spend time nurturing them. Hunt for true leaders; they are rare. Train them to scale up your efforts.

No one wants a wage slave. Employers want passion, enthusiasm and excellence. These things are never bought. People offer them voluntarily, or not at all. It is not easy to ask volunteers to change.

The OMA has some outstanding staff: dedicated, expert people. Are we supporting them? Are they free to perform? Do we need to recruit more? What are we unable to do because we lack trained staff to do it?

Embrace Ambiguity

Change is messy. Kitchen renovations mean plates stacked on tables and towels tossed in boxes. Dust and muddy footprints are so intolerable for some people that they move out until after the work is done.

Can we cope with change at the OMA? Can we handle good enough while working towards something better? Will we use parliamentary process to block change?

Be Relentless

Seriously. You need to be relentless in a positive way.

Attacks on the ethics, logic or wisdom of your vision must be confronted. Every tiny jab that undermines the vision must be addressed. You must not tolerate eye rolling, distraction or other passive aggression.

Are we ready to be relentless about change at the OMA? Do we have the energy for it? Are we prepared?


Own your own performance.

Business schools talk about an internal versus external locus of control. People who blame something outside themselves for their bad performance have an external locus of control.

These people rarely adopt positive change.

People with an internal locus of control refuse to blame other people or external events for their performance. They adopt SMART goals and push toward targets, relentlessly.

Show people that you care about performance by holding them accountable to meaningful targets. Help them. Give people the tools they need to excel.

Do we have measurable goals that reflect our vision? Is member satisfaction our primary target? Do we have an internal or external locus of control?


John Kotter has some brilliant parables about change. My favourites are,

BuyIn: Saving your good idea from being shot down, and

Our Iceberg is Melting: Changing and succeeding under any conditions.

90 minutes well spent.

Courage and Change

Change makes us feel uncomfortable, a bit nervous. That is good; it helps us empathize with those we are leading through change.

In the end, people change. Change starts with individuals. Do we have the courage to try something different ourselves?

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5 Replies to “Change & The New OMA”

  1. The ‘ new and improved’ OMA may well have its ‘ dreams’ ….but what really matters are the levelling dreams of the social justice warriors within the government and from within their advisors in the ivory towers, from within our own profession and from within the media.

    They already have a good team and will not tolerate resistance, they have proven to be relentless , they have their vision and their target is the much loathed medical profession which they have every intention of puttng in its place.

    This has nothing to do with health care, it has everything to do with power.

    1. ” Focused advocacy” implies that the OMA will have the ability to influence the political class and the health care bureaucracy in a manner to the advantage and benefit of the members of the medical profession and their patients (or will if be ” client”?) .

      The political class have and will look after its own interests.

      The health care bureaucracy and its ‘ experts’ have and will look after their own interests.

      The interests of the government and of the bureaucracy and their advisors are not the interests of either the grassroots medical profession or of their patients….the government and its bureaucracy hold a firm grip on the levers of power, the medical profession is powerless and does not have the power to influence them, only the deluded think that they have such a power.

      The OMA will be directed and it, in turn, will direct the widgets to do the government’s bidding and to take responsibility for any negative consequences of governmental decisions whilst giving credit for any positives ( if any) to the government.

  2. It is easy for the OMA to put OUR money where it’s mouth is…..
    The NEW OMA should do the RIGHT thing…de-rand the profession and make it once again voluntary.
    Is it afraid of THAT change ??

  3. The number one issue that affects the majority of docs is relativity. I completely respect,and am greatful for, what Shawn, Nadia and all the grassroots people have done to shake up the old boys and girls club of the OMA. But now the real work begins. Until all the new guard can explain why radiologists make 800, 000 to a million a year, while internists, neurologists, and the whole slew of groups that keep this system afloat at 3 am, get paid 1/4 to 1/3 of that, while having to actually spend all day fending off the disgruntled patients complaints, then NOTHING will have changed. Until that happens, its just the same old leadership too scared to do what is clearly fair. Shawn, you are talking the talk, but now we need to know if its
    real. Please tell me how the money pot distribution is fair. If you say it is, then nothing has really changed, and you would have to convince the vast majority of the profession why it is fair. If you say it’s not, then perhaps re-read your own words above and tell us how the OMA leadership plans to dream big, find its moral compass, handle the resistance to relativity change, and own its performance. Until ALL doctors are treated fairly by both the government AND the OMA, the dream remains the same old passive aggressive mediocre daydream the OMA has foisted upon us for over 2 decades.

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