UBC DEPARTMENT OF OBSTETRICS GYNAECOLOGY GOVERNANCE GEOFF CUNDIFF

UBC DEPARTMENT OF OBSTETRICS & GYNAECOLOGY GOVERNANCE GEOFF CUNDIFF, PROFESSOR & HEAD ANDI MARTIN ADMINISTRATIVE DIRECTOR

THEY REALLY PLAN TO TALK ABOUT SOMETHING AS BORING AS GOVERNANCE? GEOFF CUNDIFF, BORE US TO DEATH ANDI MARTIN YAWN, HO HUM DIRECTOR

DOES GOVERNANCE MATTER? WHY DOES GOVERNANCE MATTER? • Form Follows Function In Reality, ……. • Function Follows Form Oh and by the way, …. . • Funding Follows Form too

SO WHAT IS THE DEPARTMENT’S FUNCTIONS? • Education • Research • Clinical Care

EDUCATIONAL PROGRAMS • Undergraduate Program • Reproductive Block • Year 3 Clerkship • Electives • Graduate Program • Postgraduate Programs • Obstetrics & Gynaecology Residency • Fellowships • • Gynaecologic Oncology Maternal Fetal Medicine Reproductive Endocrinology and Infertility Pelvic Pain and Endometriosis Family Planning Female Pelvic Medicine and Reconstructive Surgery Reproductive Infectious Disease • Practicing Physicians • Continuing Surgical Education Program • Fred Bryans Masters Teachers Program • D. A. Boyes Society Meeting

DEPARTMENTAL EDUCATIONAL PROGRAMS UBC Senate Graduate Studies Council Fo. M Faculty Health Profession Cte Undergrad Med Education Postgrad Med Education Dept. Prgm Cte Faculty Development Dept. Adv. Training Pgms Graduate Programs

UBC DEPARTMENT OF OBSTETRICS & GYNAECOLOGY Clinical Excellence Efficient Education Knowledge Development and Translation

The two "Death Valleys" of the clinical translational continuum Steven Reis, University of Pittsburgh and Harold Pincus, Columbia University; Adapted from CIHR.

UBC DEPARTMENT OF OBSTETRICS & GYNAECOLOGY BREADTH OF RESEARCH Basic Research • Placental Physiology • Genomics • Gyn cancers • Endometriosis • • Tumour markers Immunology Androgen action PCOS Clinical Research • • • Prenatal diagnosis Preeclampsia Vaccine therapy Colposcopy Minimally invasive surgery • Management of mesh complications • Pelvic Pain • Sexual dysfunction Health Research • Maternal morbidity • Neonatal morbidity • Performance indicators • Cancer prevention • Competency based education • Faculty Development

WHERE DOES OUR RESEARCH HAPPEN?

UBC DEPARTMENT OF OBSTETRICS & GYNAECOLOGY: REGIONAL ACADEMIC SITES St. Paul’s Hospital UBC Hospital Vancouver General Hospital B. C. Women’s Hospital

Lion’s Gate Hospital Royal Columbian Hospital Richmond Hospital Surrey Memorial Hospital

UBC DEPARTMENT OF OBSTETRICS & GYNAECOLOGY: PROVINCIAL ACADEMIC SITES

UBC FOM DISTRIBUTED SITES • Vancouver/Fraser Program • • • University; UBC (Simon Fraser) Educational Programs: Undergrad, Grad, Postgrad Research: Full Spectrum • Island Medical Program • • • University; University of Victoria Educational Programs: Undergrad, Grad, Postgrad Research: Limited full spectrum • Northern Medical Program • • • University; University of Northern British Columbia Educational Programs: Undergrad, Grad Research: limited full spectrum • Southern Medical Program • • • University; UBC Okanogan Educational Programs: Undergrad Research: Limited

FOM LEADERSHIP STRUCTURE Dean Fo. M Executive Vice Dean Regional Assoc Deans Advisor Council Northern Med Prgm Exec Assoc Dean Education Island Med Prgm Exec Assoc Dean Research Southern Med Prgm Exec Assoc Dean Partnerships Dept Heads

TRI-PARTIDE MISSION Departmental Mission re ty Ca Quali on tigati Inves tion Educa

PROVINCIAL HEALTH AUTHORITIES

THE HEALTH AUTHORITIES • Interior Health • Southern Medical Program • Thompson Cariboo Shuswap, Okanagan, Kootenay Boundary and East Kootenay • Fraser Health • Vancouver Fraser Medical Program • Fraser North, Fraser South and Fraser East • Vancouver Coastal Health • Vancouver Fraser Medical Program • Vancouver, Richmond, North Shore/Coast Garibaldi • Vancouver Island Health • Island Medical Program • Vancouver Island, the islands of the Strait of Georgia, and the mainland communities north of Powell River and south of Rivers Inlet • Northern Health • Northern Medical Program • Northwest, the Northeast and the Northern Interior • Provincial Health Service • Works with the five regional health authorities to plan and coordinate the delivery of provincial programs and provide highly specialized services across the province

WHAT ABOUT ST. PAUL’S HOSPITAL? Mo. H IH VCH PHC St. Pauls FHA NHA IHA Providence Health Care • Has independent Board • Independent Credentialing Mt. St. Joseph Brock Farney • All Funding flows through VCH

WHAT ABOUT WOMEN’S HOSPITAL? Mo. H BC Cancer Agency BC Center for Disease Control BC Children’s Hospital Geographical HAs PHSA BC Women’s Hospital BC Mental Health Service Perinatal Services BC BC Provincial Renal Agency BC Transplant Agency Cardiac Services BC BC Emergency Services Providential Health Services Agency • Has independent Board • Independent Credentialing • All Funding flows from Mo. H

VCHA Maternity Sites Obstetrician Surgeon FP Surgeon Family Physician Midwife

ISSUES: SYSTEMIC • Effective Model of Quaternary Maternity Care ~120 -150/yr ~10 -12/yr BCWH • Obstetrics • Gynaecology • Neonatology • Perinatology • Adult Medicine MOU VGH • Obstetrics • Gynaecology • Trauma • Neurosurgery • Oncology MOU SPH • Obstetrics • Gynaecology • Cardiology • Nephrology • Surgery • ICU • Imaging

GOVERNANCE STRUCTURE REGIONAL DEPARTMENT OF OBSTETRICS & GYNAECOLOGY Regional Department Head Regional Executive Committee Site Head Rural Rep Site Head PRH BCWH LGH VGH RH SMH SPH SGH PHSA VCHA PHC

MOH PHSA VCHA HAMAC BCWH MAC Regional Department Head Regional Executive Committee Site Head Rural Rep Site Head PR H BCWH LGH VGH RH SMH SPH SGH PHSA VCHA PHC

MOH PHSA Perinatal Services BC VCHA HAMAC BCWH MAC Regional Department Head Regional Executive Committee Perinatal Coordinating Council Site Head Rural Rep Site Head PR H BCWH LGH VGH RH SMH SPH SGH PHSA VCHA PHC

HEALTH AUTHORITY GOVERNANCE Regional Governance structures differ by HA • Vancouver Island Health • No Department of O&G • OB is in the Department of Maternity • Gyn is in the Department of Surgery • Fraser Health • Regional Maternity Program • Separate Regional Departments of Obstetrics and Gynaecology • Interior Health • No regional departments • Kelowna and Kamloops functionally separate • Northern Health • No regional departments

HOW DOES UNIVERSITY GOVERNANCE DIFFER FROM HEALTH AUTHORITIES? University Fo. M • Collegial Rule Health Authority • Corporate Rule • “Department Chair” • “Department Head” • Parallel structures • Academic structure • Administrative structure • Relationship to Physicians • Academic faculty = employees • Clinical faculty = vendors • Medical staff structure • Programmatic structure • Relationship to Physicians • Academic faculty • Clinical faculty = vendors

UBC ACADEMIC GOVERNANCE PRIOR STRUCTURE Fo. M Full Faculty Exec Cte Dept Heads Cte Research Cte Grad Education Cte Health Professions Cte Undergrad Med Education Cte Postgrad Med Education Cte Professional Education Cte

UBC ACADEMIC GOVERNANCE NEW STRUCTURE Fo. M Faculty Exec Cte Dept Heads Cte Research Cte Graduate Education Cte Health Professions Cte Undergrad Med Education Cte Postgrad Med Education Cte Professional Education Cte

UBC ACADEMIC GOVERNANCE NEW STRUCTURE Fo. M Faculty Exec Cte Advisory Dept Heads Cte Research Cte Graduate Education Cte Health Professions Cte Undergrad Med Education Cte Postgrad Med Education Cte Professional Education Cte

UBC ACADEMIC GOVERNANCE NEW STRUCTURE Fo. M Faculty Where decisions are approved Faculty Exec Cte Advisory Dept Heads Cte Research Cte Graduate Education Cte Health Professions Cte Where decisions are made Undergrad Med Education Cte Postgrad Med Education Cte Professional Education Cte

UBC ADMINISTRATIVE GOVERNANCE Dean Fo. M Dean’s Exec Cte Dept Heads Cte Information Technology Cte Facilities and Capital Cte Occupational Health Cte Organizational Development Cte Finance Cte

ROLE DEFINITIONS UBC Academic Roles • Department Head • Responsible for the planning and delivery of mandate • Division Head • Responsible for the mandate at Division level • Program Directors • Responsible for the planning and delivery of specific educational program HA Operational Roles • Regional Head • Responsible for manpower planning and quality of care for all sites • Associate Head • Regional Head with academic deliverables • Site Head • Responsible for manpower planning and quality of care for one sites

MULTIPLE AND COMPETING PRIORITIES

PROBLEMS WITH THE EXISTING STRUCTURE • Clinical services are not coordinated • Academic goals • Educational sites do not align with • Clinical structures • Departmental structures • Research occurs in silos • Dilution of faculty effort • • Poor engagement Duplication Lack of coordination Frustration

HOW DO FACULTY GET PAID? Mo. H Mo. E HA $ GPO $ MSP $ UBC BCWH VCH PGME $ Academic Faculty Clinical Faculty

GOAL: ALL FLYING IN THE SAME DIRECTION

THE IDEAL GOVERNANCE STRUCTURE Mo. H Board AHCN CEO VGH UBC Dean Dpt Med Dept Surg Dept O&G Dept Ped BCWH PHC RCH SMH

THE IDEAL GOVERNANCE STRUCTURE Mo. H Board AHCN CEO VGH UBC Dean Dpt Med Dept Surg Dept O&G Dept Ped BCWH PHC RC H SMH

DEPARTMENTAL GOVERNANCE STRUCTURE EDUCATION GEN DIV GYN ONC DIV REI DIV GYN SPEC DIV MFM DIV PHSA VCHA PHC FHA VIHA NHA IHA

PERSONAL CONSIDERATIONS • Most faculty members work within multiple governance structures • When asked to serve on a committee or leadership role consider the strengths and weaknesses and what can realistically be accomplished. • When you are frustrated by lack of success in pushing for change, you may be pushing in the wrong place.

QUESTIONS? ?