Advocacy, Models of Care and Outcomes: the COA's new focus

Marc J. Moreau, M.D., FRCSC
President, Canadian Orthopaedic Association

It continues to be a great honour to serve as the President of the Canadian Orthopaedic Association. My wife Barb and I were privileged to represent our country at the annual meetings of the orthopaedic associations of the English Speaking World. Canada is held in high esteem and members from every country we visited came out and thanked us for our participation in their meeting. However, our work was still cut out for us upon returning to Canada.

In 2001, the COA Board held a Strategic Planning (SP) meeting from which several changes resulted. The committee structure was revamped and the National Standards Committee was brought to the fore. Dr. Cy Frank facilitated that meeting and we were fortunate to have him back again as part of the presidential line for our 2007 Strategic Planning meeting. Ms. Deb Starzynski, an accomplished facilitator, was hired to direct us through the process.

Dr. Marc J. Moreau

The first step was to gather members of the Board and a couple of guests for a two-day meeting. Each participant was asked to submit an "Environmental Scan" ahead of time: a picture of the main issues that each member of the SP team thought were important to the specialty and the Association. All of the issues were collated and separated into broad lines. Before long it was possible, with the aid of our facilitator, to outline three areas of focus: 1) Advocacy, 2) Models of Care, and 3) Outcomes. Participants chose one of these areas to study in detail. Each area was defined, issues specified, and solutions proposed. It was evident that in order to be successful, one needed to start out with small successes, so each group mapped out some modest gains that could be accomplished.

Advocacy was a key theme described in the membership survey. The important elements to be considered were tied to communication, by building up partnerships especially at the provincial level. A presence by the presidential line at all the provincial meetings was thought to be very important. This could be immediately accomplished and easy to implement. Showcasing the web site and developing an Advocacy section online and in the COA Bulletin would raise the profile of the need for an Advocacy role in the COA. Down the line, the hiring of a lobbyist may be necessary as is done by our partners to the south (AAOS).

Models of care are focused on the patient and facilitate life for the orthopaedic surgeon. Best practices of care will be defined, integrated, and the goal will be to train and support doctors to become managers of models. Some of the actions suggested include: 1) the endorsement of physician assistants, 2) closer examination of nurse practitioners and advanced practice physiotherapists and 4) cataloguing available HR services (podiatry, chiropractic, osteopathic, etc.).

The final group directed its attention towards promoting care that was outcomes driven. The establishment of outcome tool kits (set of measurables) for each subspecialty group will be forthcoming. Support for the Canadian Joint Replacement Registry is very important as impetus - participation in this project is decreasing, yet its relevance is increasing. The direction of part of the Annual General Meeting will be towards outcomes research by the subspecialties and instruments such as questionnaires will be developed and showcased in the COA Bulletin and on the web site.

The Strategic Planning meeting was instructive and incentive-building and a method of forward thinking. A half day "report card" session will be held next year at the Mid-Winter Meeting.

I would personally like to thank the Board, Doug Thomson, and Trinity Wittman for their commitment to the process and Deb Starzynski for her leadership. We hope to see the three-pronged approach bring success, continuing new membership and a renewal of interest in the organization.