CEO Update:
strategic planning

Doug Thomson
CEO
Canadian Orthopaedic Association

Late in 2007, the COA's Board of Directors went through a strategic planning exercise that yielded three priority areas for concerted action: advocacy, models of care, and outcomes.

Capitalizing on the momentum generated by the initiative, COA President Dr. Peter O'Brien has instituted monthly teleconferences with the Executive Committee aimed at establishing goals, objectives and milestones for advocacy, models of care and outcomes. And while that might sound a bit lofty and high-concept, there has been real progress on the ground. Here's a brief overview of past and upcoming activities in our three strategic domains.

Advocacy
Our 2007 membership survey identified advocacy as a top priority, and, by extension, the need for improved communications and enhanced partnerships, particularly at the provincial level.

All politics is local, as the saying goes. Thus, throughout 2008, one member or another of the COA Executive Committee made a point of attending most provincial association meetings to help the national organization stay on top of local issues.

Podiatry quickly emerged as a hot issue. Legislation in Manitoba and Saskatchewan appears to expand podiatrists' scope of practice, allowing them to perform procedures using public resources that historically have been the domain of general and sub-specialist orthopaedic surgeons. With podiatry schools in Alberta, Manitoba and Quebec starting to generate graduates, scope of practice for podiatrists has become a point of contention in Ontario.

Thanks to the leadership of Drs. Tim Daniels and Johnny Lau, the COA released its position statement on orthopaedic care and podiatry (available on the COA web site) and made a presentation to the Health Professions Regulatory Council (HPRAC). We cautioned the Council against an expansion of podiatry's scope of practice without first establishing:

• detailed standards of care;

• education and CME requirements;

• ongoing assessment of competence;

• medico-legal coverage; and

• a regulatory body to oversee these important issues.

In order to provide a solution to the problem, the COA and the OOA commissioned a foot and ankle care model that would encompass some of the elements from across the country that have been successful in reducing wait times for hip and knee arthroplasty.

Our work on this file is on-going, and I look forward to keeping the membership informed of our progress.

Last June, the COA Board approved an internal communications strategy that in the short term sought to:

• improve the COA's "newsgathering" capacity;

• help COA members develop focus and clarity on the priority issues facing the profession;

• build consensus on possible types of engagement with decision-makers to change the status quo.

The following month, the COA hired Dennis Jeanes as the COA's Manager of Communications and Advocacy. Since then, Dennis has been busy providing support for a variety of strategic initiatives (podiatry, health human resources, continuing professional development, professional ethics), as well as developing position statements and COA Bulletin articles.

Lastly, the COA also has engaged the services of a consulting firm in government relations to facilitate our interactions and contacts. Recently we met with Assistant Deputy Minister of Health Karen Dodds about funding for the Canadian Joint Replacement Registry. And though ADM Dodds wasn't very encouraging of our quest for designated funding, we will try to meet with other Health Canada bureaucrats who are more directly involved with the Registry.

Models of Care
For the last year or so, Dr. Cy Frank has been representing the COA as part of Bone and Joint Canada's efforts to develop a model of care Toolkit. In late March, Bone and Joint Canada will convene a two-day forum to present a draft national model of care for hip and knee replacement, where representatives from across the country, and across all areas of health care, will gain insights in how to use the Toolkit. Then they will draft an implementation plan, outlining strategies for managing change and identifying key indicators for data collection.

Outcomes
Dr. O'Brien leads this group, which has been focussing its attention on promoting care that is outcomes driven. In January, the Outcomes group posted on the COA web site a set of outcomes measures for specific sub-specialties.

Currently the Outcomes group is strengthening its relationship with the Canadian Joint Replacement Registry in a bid to increase participation rates in the Registry and bring it more in line with the global standards associated with the best-managed registries. Participation rates in Canada have been decreasing at a time when there is increasing public and governmental interest in the benefits of a well-run registry.

As always, I welcome the comments and ideas from members on any aspect of COA business. Fell free to send me your comments to: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

The Outcomes Toolkit as well as the position statement on orthopaedic care and podiatry are available in the 'Health Policy' section under the 'Member Services' tab on the COA web site: www.coa-aco.org