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.
Many groups of doctors have come to help with the blaze. Some want to tear down the house, but most want to rescue the building.
The magnificent doors, locked for years now, need to be breached to fight the blaze. The historic society insists the doors were hung democratically and in accordance with the bylaws. Without the doors, anyone could walk in and take over.
The doors, in many ways, are the OMA house. Without the doors, the house might cease to exist to others in power. We must not touch the doors, especially not now!
Let us focus on the cause of the fire. We must put our energy into fighting the villains who caused the fire. The fire is not the issue.
OMA Response
The past Presidents have come to the rescue of the Executive Committee. They gloss over performance and insist that the Exec stands on a solid, democratic process.
Every year, each member of the Executive stands for election.
Every year, the whole Board reviews the performance of each Executive member.
And every year, the Board can throw out a scoundrel, if one ever exists.
Never mind the fact that the Board has never thrown out anyone from the Executive procession. Past Presidents who polish the patina of democracy completely miss the point:
The Exec stands as a magnificent governance structure that blocks rescue efforts. It exists despite governance experts saying that it should not.
Elections for the Executive committee do not change the fact that the Exec must be radically changed and shrunk.
If the OMA ever hopes to function well, the Exec must change. The Board must modernize.
The OMA is in flames, and rescue begins with renovating the Board, starting with the Exec.
Board Serves the OMA, not Doctors?
A number of seasoned Board members have lectured me, and many others, in conversation and personal emails, that the Board exists to protect the OMA.
The Board does not exist to serve members. It exists to serve and protect the OMA. If a decision looks good for the OMA, but not for members, the Board must put priority on what is good for the OMA.
This nonsense might explain why the OMA has rankled doctors recently. Like all nonsense, it takes more time to correct than the gibberish deserves.
The Board existing to serve the OMA, before members, is like saying that those who row a lifeboat exist to maintain the integrity of the lifeboat, before saving drowning sailors. We must not compromise the lifeboat. The boat is sailors’ only hope!
Or it’s like saying that those who oversee a storehouse of food, during a famine, exist to keep the food safe, never mind the starving people. We must keep the stores dry and sound. The wailing people must not distract us from protecting the food!
The Board of the OMA exists to govern the OMA, which exists to serve members. There is no reality in which the OMA can stop serving members: first, foremost and in all things.
To be clear, ‘serving members’ means doing what is good for members, as defined by members. Serving members means adding value for members.
If the OMA stops serving members, it has lost any reason to exist. A Board that protects an OMA that does not serve members has lost the right to govern.
Any Board that puts the health of the OMA before the OMA’s mission to serve members has completely lost sight of why it is there.
(See Glenn Tecker’s comment, governance expert, below. Brilliant!)
The Board must serve members, die trying, or resign.
Barrier vs Portal
The Exec stands resolute, like magnificent doors, while the OMA burns. Doctors do not want this to happen.
The Board knows what needs to be done but insists that things are not that bad. They say that it’s only 25 members of council calling the meeting.
Never mind that member satisfaction has never been so low.
Never mind that 5 different MD groups oppose the OMA.
Never mind that most doctors would leave the OMA, en masse, if they were allowed.
The Board must let members help put out the fire. This Special Meeting of Council is just one fire brigade.
The Board sees the meeting as a band of villains at the gate. They are not. They are the volunteer fire department that has come to help the Board do what the Board could not do on its own.
The Board needs to remember why the OMA was built in 1880. The OMA exists to serve members. That’s it. Let’s hope doctors can put out the fire before there’s nothing left of the OMA.
Thank you Shawn for this Parable. I look forward to reading your blogs and am always impressed by both your insight as well as your ability to express that insightfulness. I agree that most of us make up the impromptu brigade of firefighters and hope that when the house is razed we can raise a new one.
Thanks Sandra!
Renewal is coming, whether anyone wants it or not.
Sure appreciate you reading and sharing a comment!
Shawn
As always, Shawn, a blog that shines a light on the truth of the matter. Thanks you for this.
Thank you, Marie-Claire!
I hope doctors all know about your blog, too. Please feel free to share another comment with a link to your last post!
Cheers
Shawn
A primary difference between non profit and for profit boards is the nature of the organizations they lead. The fiduciary responsibility of boards of for profits is to the value of a share. The fiduciary responsibility of the board of a non profit is to its mission. Since the mission speaks to the good of the members and the public they serve, the fiduciary responsibility of the board of a non profit is to the interests of those populations. The duty of loyalty in a non protection board is about subordination of personal and constituency self interests to the best interests of the organization and it’s mission. This should never be misinterpreted as a call to subordinate the interests of the membership to the interest of the association as a corporation.
Wow!
Glenn,
Thank you SO MUCH for offering this comment. People who have read this blog for years will recognize your name from other posts. For those who do not: Glenn Tecker is an international expert and published author on board governance, organizational function and just about everything that goes into making an organization work well.
I will re-post your comment on the FaceBook thread, too. Brilliant. Just brilliant.
Great to hear from you!
Best regards,
Shawn
^^^What he said
Perfect.
Well said!
I’m glad I’m sick today or else I would have missed this post. Your analogy is almost right. Its the profession that is on fire and the OMA exec is fiddling while it burns. I and others have tried to get the OMA to change direction with the most palatable suggestions, they ignored us. A new and more focussed direction for the OMA? Quashed because doing an electronic poll was “too expensive” and yet they found money to hire an outside agency to poll only what they wanted to be polled. They are following the old approach with the same old advisors and will get the same old result. The only solution we can find is to reject the exec. We are doing it using OMA by-laws and procedures. The response so far? Past presidents issuing mass e-mails, sudden personal attacks on the movers and dirty tricks. We are our own worst enemy. If we can unite and take meaningful job action we will be too powerful and essential to brush aside and be attacked by Government. Incidentally do you think as I do that bill 87 was thrown out there to be a bargaining chip in negotiations? We shouldn’t bite this bait, better to address that in the courts rather than give up leverage at the bargaining table.
Great point, Ernest.
You are right, of course. This mess could have been much smaller — much of it avoided altogether.
You ask about Bill 87 as a bargaining chip. I respect the intelligence of the political class, but I don’t know if they come up with all the complex attack plans we attribute to them. I thought 87 was a way to deal with an activist’s approach to regulated professions. The process stinks, but some of the things in the bill we could all support.
I hope you feel better soon! Thanks for taking time to read and share a comment here.
Talk soon,
Shawn
Everything is unfolding as you predicted in your previous blog post. That is how predictable the insulated unaccountable upper echelon of the OMA is…even more so when you have been on the inside and see EXACTLY how it works.
A very interesting situation could arise at this meeting. What might happen if the motion of non confidence passes BUT the other motions garner more than 50% + yes vote BUT not the 66.7%+ required???
Very sad that it was so easy to predict!
You ask a great question about the motions, Paul. I suspect that if the non-confidence motion passes, the Board will call a recess and make some decisions of its own. At least that’s what should happen. The other option would be for the Exec to voluntarily resign. Having said this, given what we’ve seen over the last few years, I would not be surprised if we end up in the scenario you describe.
Thanks for sharing a great comment!
Cheers
Shawn
An excellent article—one day , historians will sift through the ashes of the Ontario health care system to carry out a post mortem as to what happened….what happened was that power hungry ideologues , having promised a perpetual supply of free golden eggs to the citizenry , slit open the belly of the abused goose that laid the golden eggs, killing it.
I always love your analogies, Andris!
I worry that, since change from the reigning mythology seems so hard, things will get worse and worse and end with a crash. We could avoid the crash. We could take action now. We could admit that no one in the world copies our system, that no population entrusts their health to a state monopoly anymore. The only reason we survive so long – like a perpetual dust-devil twirling and twirling – is because people with means can get care in the USA or with executive health services. Those with the power to change the Medicare myth have no interest in doing so; it would only hurt their political support.
I hope you and I are wrong. Maybe someone like Brad Wall will convince voters that innovation can help; it does not mean people dying in agony.
Thanks for sharing!
Shawn
Shawn
I so appreciate your use of analogies to help clarify/objectify complex issues.
It is also so helpful to be reminded of the governance /mission of not for profit membership based organizations ( thank you Glenn) .
Let us hope this governance true north guides all at the Special Meeting today and ,of course , moving forwards .
Jane
Jane,
Thank you so much for taking time to share some encouragement! I think we all hope for a stronger, better OMA as soon as possible. I’m sure things can change and improve if we have to courage to try.
Enjoy your day and thanks for all you do for doctors in Ontario and beyond!
Talk soon,
Shawn
Shawn,
Thank you for your insightful blogs. You grasp the reality of the situation within the confines of the system. I am hopeful that through conflict comes resolution and enhanced awareness.
Thanks Deborah!
With the non-confidence vote passing today, I sure hope the Board gets the message. Council is not happy with the Exec’s performance, but Council has no hate for any particular individual. The Board should have recessed after the non-confidence vote and asked for resignations.
Healing will come! I fear that this wound will require a few more debridements yet.
Great hearing from you.
Best regards,
Shawn