Allocution du président élu 2009

Prononcée le 6 juillet, à Whistler, en Colombie-Britannique, par Cy Frank, MD, FRCSC

Mr. Chairman, President O'Brien, fellow members of the COA, COA-members-to-be (those of you who are still in your training), honoured national and international guests, distinguished allied health professional partners and industry supporters of the COA, mentors, family, friends and colleagues from across Canada, Ladies and Gentlemen:

Bonjour à tous et un gros merci pour y être ce matin. J'aimerais parler à chacun d'entre vous aujourd'hui afin de faire un effort personnel sérieux de collaboration aux différents niveaux local, provincial et national. Si nous faisons tous un tel engagement à créer des réseaux efficaces d'excellence orthopédique dans chaque province, et qu'ils sont facilités par l'Association Canadienne d'Orthopédie, je crois que nous pouvons nous valoriser davantage.

It is a great honour and a personal privilege to address you as the 64^th president of this great national association - whose noble mission is to promote excellence in orthopaedic care and MSK health for all Canadians and to serve the needs of all Canadian orthopaedic surgeons in achieving those goals. Our COA executive is committed to achieving that mission together - through strategic (collaborative) initiatives, advancing advocacy, sharing innovative models of care that will improve surgeon efficiency and effectiveness and enhancing patient outcomes.

I would first like to recognize and thank Dr. Peter O'Brien for his tremendous service and leadership for the COA over the past year. Peter and Connie have been great role models and international ambassadors on your behalf while Peter's focused, thoughtful and highly effective common sense approach to successfully rolling out our most recent strategic plan here at home, I believe, has created the platform for even greater opportunities for all of us.

In terms of our Association status, I am pleased to report that over the past three years - the Association membership has grown with the addition of resident members and has stabilized at nearly 1000 active members. Orthopaedic surgery is slowly becoming a more attractive career for women with 23% of R1's in Canada now being female. We have outstanding dedicated staff (Doug, Trinity, Cynthia and Dennis) and, despite the economic turmoil of the world, our Association finances are stable and relatively predictable. We have strong relationships with many professional organizations and international partners, and our communications to our members have improved significantly via the Bulletin and Dispatch. Congratulations to Doug and his staff for these significant accomplishments.

Not surprisingly, we do have a number of concerns. The COA continues 'graying' with an average age now in the mid-fifties, we continue having difficulty showing value to members in Quebec; our COA staff continues to be inordinately consumed with running the Annual Meeting - reaching less than 1/3 of our members each year, and it is increasingly difficult to meaningfully advance our strategic plan with limited resources.

Musculoskeletal care remains disturbingly low on government agendas, our clinical resources are frustratingly rationed and we continue having difficulties getting 'MSK education' to become a higher priority in undergraduate curricula. Happily, we are making progress on many of these issues through the dedicated work of our committees, our provincial associations and our staff.

In terms of my priorities for this year, I recognize that time is precious so being practical and providing valuable services that are relevant to the full membership and 'doing more with less' will be our mantra. We will focus on relevant activities that address the concerns I've already noted, practice extreme fiscal prudence, try to do a small number of things well, and listen carefully to member feedback to do highest value things even better.

Notwithstanding my desire to convince you, in 15 minutes or less, that orthopaedic surgeons have a golden opportunity to lead sustainable patient-centered health care reform in Canada, I will instead concentrate on the one enabling change that I believe will underpin that outcome. What we need to focus on this year, in my opinion, is provincial and national COLLABORATION. COLLABORATION is an extremely powerful word to me - probably the most powerful word I know - describing how I believe that every person here, as individuals and as groups, can achieve their personal goals and, in fact, the COA itself can be successful in achieving its mission. Best practices can be identified and shared where they exist, or they can be created through collaborative action.

Those who know me well will know that that word certainly describes my personal philosophy and strong belief that we have a lot to learn from each other and that together - if we truly collaborate with one another and with others in our health care system - listening, learning and identifying 'best practices' in whatever we are trying to do - we can achieve a lot more than we can alone. That is true in every area of interest to people in this room today.

As I will discuss briefly, my experience has been that carefully considered profession-wide integrated collaborations - identifying best practices and collaborating among and between groups internally, combined with carefully considered collaborations with our partners and stakeholders can drive sustainable excellence in clinical care, all areas of education, all types of research, and even in administration and advocacy. Solutions based on a collective wisdom will be better supported and thus, be more sustainable. There are only two significant 'cautions' to collaboration that I believe need to be flagged, and I will do so at the end of this speech, after I highlight what I believe to be the strong base of opportunity for even better orthopaedic collaborations in Canada right now.

First, let me provide a brief definition of what I mean by collaboration. That great 2009 collaborative web resource known as Wikipedia defines the word 'collaboration' as: a recursive process where two or more people or organizations work together in an intersection of common goals - for example, an intellectual endeavor that is creative in nature - by sharing knowledge, learning and building consensus. According to Wikipedia, effective collaboration does not require leadership and can sometimes bring better results through decentralization and egalitarianism. In particular, it notes that "teams that work collaboratively can obtain greater resources, recognition and reward when facing competition for finite resources." Nothing could be more relevant and more important, in my opinion, for the COA in 2009-2010. Trust me when I say that orthopaedics can lead all surgical and medical disciplines in Canada in optimizing our resources and getting what we need for all of our patients if we were all truly committed to driving models of care and improving patient outcomes combined with effective advocacy as a national collaboration.

Is this definition of collaboration or its potential value to us in Canadian orthopaedics a foreign concept to anyone here? Certainly not! While I know you are all strong individuals, you are also already effective collaborators with many others in your daily lives. Whether you recognize it or not, you have to be strongly collaborative in your functioning as a clinical team leader. I'm certain that you collaborate with other surgeons within your orthopaedic units and you also collaborate with a number of other physicians, health professionals and allied professionals in the care of every patient. I'm equally sure that you do so willingly, since you recognize that effective teamwork is best for every one of your patients.

At this point, I would like to distinguish collaborations from employer-employee relationships or 'passive interactions' since, as I will reinforce, I believe that true collaboration is NOT a 'passive process' and it is not one-way. It is aimed at achieving some mutual benefit. Over time, at a minimum, if you choose your collaborations wisely, I guarantee that you get as much, or more, from each collaboration than you give. Each partner is better and everyone around them can win. Trust me - magic can happen.

With that introduction, let me reinforce the fact that I think that we are, as a profession, already quite highly collaborative and in many ways we are already leading all surgical and most medical disciplines in advancing useful collaborations locally, provincially and nationally. I will highlight the fact that there are many established opportunities for us to build on in the COA. I also want to highlight the fact that there are a few existing major drivers of collaboration at work in our orthopaedic lives that we should recognize as discrete opportunities to be crystallized and enhanced. These include clinical and academic professional subspecialization (clinical, research and education) and how health care is organized and funded in Canada - with provincial structures dominating. Let me expand on these themes and emphasize where I think we have the greatest opportunities.

Over my practice life, areas of clinical interest, otherwise known as 'subspecialty interests' have unquestionably, in my opinion, become the biggest driver of new and heretofore unexpected clinical and academic collaborations among otherwise 'non-aligned' groups of our surgeons between hospitals, cities and increasingly, even nationally. These collaborations, facilitated by a few leaders, have led to the formation of a number of increasingly strong subspecialty societies within the COA - with common interests in subspecialty-specific topics of interest in care, research and education. COTS, COFAS, MANUS, and a number of other societies are becoming models of collaboration within the COA that need to be fostered, featured and facilitated. I recognize the potential importance of these types of networks and their value to the COA both clinically and academically. Integrating and bringing them into the centre of our COA activities while focusing on how they can add value to the majority of our members who do NOT have such subspecialty interests is a major opportunity for the COA. Doing this in a way that everyone wins must be our goal and I think that is achievable!

The second major driver of collaboration has been how health care in Canada is organized with provincially-driven structures of health care administration, policy, funding and provider compensation. Whatever you think about the administrative moves from what was almost pure hospital-based care 25 years ago, through so-called "regionalization" to the province-wide administrative experiment in Alberta right now, these moves have created huge opportunities for significant new collaborations for all of us. In these environments, well organized specialty groups, such as ours, can potentially thrive to make effective 'business cases' for improving access, quality and cost-effectiveness of patient care as a group.

I know that this type of intra-provincial networking has been happening within orthopaedics in Quebec and Ontario for many years and more recently, in every other province and region. I think that even within the past three years that virtually all of our provincial associations have grown in potential value for their members and are now providing unprecedented opportunities to drive change in orthopaedics within each province.

Depuis plus de quinze ans, j'ai eu l'honneur d'être professeur invité dans presque tous les programmes orthopédiques au Canada. Ce que j'ai vu et retenu est que tous les programmes partagent une chose en commun - ils sont basés sur un fort sens de collégialité et de collaboration professionnelles, cliniquement, tant en recherche qu'en éducation. De toutes les régions du Canada, c'est au Québec que l'engagement à cette collaboration locale et provinciale est le plus fort. Je crois que nous pouvons en apprendre beaucoup de nos collègues du Québec sur la création de réseaux efficaces de collaboration aux niveaux local et provincial.

We can learn a lot from our colleagues in Quebec. They have a sense of community and collaboration in Quebec that we should aspire to create in every province! In my opinion, this type of collaboration is a key to the sustainability of our health system in Canada - sharing rather than duplicating and collaborating on solutions. I believe that this pattern of developing increasingly strong, vibrant and collaborative provincial orthopaedic associations - with significant ability to influence health care agendas as advocates of appropriate care for orthopaedic patients and for effective new models of care (with evidence) - is an important national pattern that the COA needs to foster. At the same time, we need to simply get them to collaborate with each other in identifying best practices in each of our strategic aims.

We know this can be done as we already have some early examples of success. Bone and Joint Canada, led by Jim Waddell and Hazel Wood has, over the past year, brought together committed clinical and administrative orthopaedic teams from nearly every province to identify and share current best practices in hip and knee arthroplasty. Similarly, the Canadian Joint Replacement Registry is successfully compiling useful clinical information that will also benefit patient outcomes. Very few other clinical groups have such a government-supported resource at their fingertips.

If we can build on these initiatives, for example by getting 100% buy-in to each of them, it will have very powerful clinical and policy consequences.

There are, of course, two other forces within our country that have driven important collaborations within orthopaedics that should be recognized: education and research. Whether in academic centres or not, we alternate between teaching and learning from each other and we do the same with our allied health professional colleagues. We actively collaborate in self-improvement through CME and we are beginning to discover and share best practices and innovations in improving educational outcomes in surgery. While the COA has outstanding educational experts and have been driving outstanding PGME and CME activities, I think that there are still collaborative gains to be made in UME and patient education in particular. We are already doing this but I think we can do more.

In the 'research world', which I know the best, I would say that 'collaboration is essential' for success. What can the COA do to facilitate research? Using the same strategies I've already alluded to, the COA can support networks in doing research by linking researchers with collaborating surgeons in the 'real world'. What are now called 'comparative effectiveness trials' of entire care pathways are potential ways of more rapidly defining 'best practices' in real life and they are areas where a country like Canada, with national standards and well developed clinical networks, can shine. With a bit more facilitated collaboration, Canada can also lead the world in doing practice-altering comparative effectiveness trials in ALL areas of orthopaedic care. I would sure like to see that happen!

The last area where orthopaedic collaborations are critical and where I think we could do much better is in the area of advocacy and linkage to health care administration. I think that we would all agree that strong linkages between surgeons, administrators and policy people are critical - but I doubt that very many people here have thought of these relationships as COLLABORATIONS. While these interactions, over my practice lifetime, have been much more adversarial that collaborative, I can assure you that it would be in our best interests to change that paradigm.

So as promised, just before closing, let me highlight the only two major pitfalls that I can see in the process of collaboration of like-minded individuals: the pitfall of potential fragmentation and the pitfall of burn-out. In my experience, strong collaborations can create great satisfaction and great productivity due to focus and unity of purpose. What comes with that, however, is a strong sense of independence, and also, it seems, causing some potential loss of insight that they are still part of a bigger whole. Patients do not have single problems and they don't just live in one province of our country. I feel strongly that we must collaborate as a unified profession of orthopaedics and not as fragmented interest groups - subspecialties and/or provinces competing with each other for limited resources. The second pitfall from extensive collaborations is potential burn-out from frustration that progress is too slow. Expectations must be managed. Building relationships and seeing the fruits from collaborations do take time. Patience is a virtue.

So what I will leave you with today therefore is for you to consider creating a more effective collaboration with someone this year. You can think small, locally, or you can try to think larger - provincially. You can also do it nationally, with us at the COA. They can all have impact. I will do my best to facilitate collaborations within and between our strong subspecialty societies and provincial associations to the mutual benefit of them all. If successful, I think that every orthopaedic surgeon in Canada will be more effective, our Association and its partnerships will thrive, and we can help make our health system more sustainable. Most importantly, however, I think that all orthopaedic patients in Canada will benefit.

In closing, I would like to thank all of my personal mentors, collaborators, friends, family and supporters. Particular thanks to Glen Edwards who made me an orthopaedic surgeon, Norm Schachar who turned me on to research, Bob Hollinshead, Gary Hughes, Bill Johnston, Don Dick, Marc Moreau, and literally all of the orthopaedic surgeons in Calgary and in Alberta - who have supported me and helped protect my time to do these things. And finally, I'd like to thank Helene for her love and support.

Encore une fois, un gros merci pour votre présence aujourd'hui et pour votre soutien à l'Association Canadienne d'Orthopédie. J'attends avec impatience de collaborer avec tous et chacun d'entre vous dans l'année qui arrive.

Thank you. Merci beaucoup.