UBC Department of Obstetrics & Gynaecology Governance

1. UBC Department of Obstetrics & GynaecologyGovernance Geoff Cundiff, Andi Martin Professor & Head Administrative Director

2. They Really Plan to Talk About Something as Boring asGovernance? Geoff Cundiff, Andi Martin Bore us to Death Yawn, ho hum Director

3. Does Governance Matter?Why Does Governance Matter? • Form Follows Function In Reality,……. • Function Follows Form Oh and by the way,….. • Funding Follows Form too

4. So What is the Department’s functions? • Education • Research • Clinical Care

5. 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

6. Departmental Educational Programs

7. UBC Department of Obstetrics & Gynaecology

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

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

10. Where Does Our Research Happen?

11. UBC Department of Obstetrics & Gynaecology: Regional Academic Sites St. Paul’s Hospital UBC Hospital Vancouver General Hospital B.C. Women’s Hospital

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

13. UBC Department of Obstetrics & Gynaecology: Provincial Academic Sites

14. 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

15. FoM Leadership Structure

16. Tri-Partide Mission Departmental Mission Investigation Education Quality Care

17. Provincial Health Authorities

18. The Health Authorities • Interior Health • Southern Medical Program • Thompson CaribooShuswap, 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

19. What About St. Paul’s Hospital? Providence Health Care • Has independent Board • Independent Credentialing • All Funding flows through VCH

20. What About Women’s Hospital? Providential Health Services Agency • Has independent Board • Independent Credentialing • All Funding flows from MoH

22. VCHA Maternity Sites Obstetrician Surgeon FP Surgeon Family Physician Midwife

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

24. Governance StructureRegional Department of Obstetrics & Gynaecology Regional Department Head Regional Executive Committee Site Head Site Head Site Head Site Head Rural Rep Site Head VGH BCWH LGH RH PRH SPH SMH SGH PHSA VCHA PHC

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

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

27. 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

28. How does university governance differ from Health Authorities? University FoM Health Authority Corporate Rule “Department Head” Parallel structures Medical staff structure Programmatic structure Relationship to Physicians Academic faculty Clinical faculty • Collegial Rule • “Department Chair” • Parallel structures • Academic structure • Administrative structure • Relationship to Physicians • Academic faculty = employees • Clinical faculty = vendors = vendors

29. UBC Academic governancePrior structure

30. UBC Academic governanceNew Structure

31. UBC Academic governanceNew Structure Advisory

32. UBC Academic governanceNew Structure Where decisions are approved Advisory Where decisions are made

33. UBC Administrative governance

34. Role Definitions UBC Academic Roles 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 • 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

35. Multiple and Competing Priorities

36. 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

37. How DO Faculty get Paid? MoH MoE HA $ GPO $ UBC VCH BCWH MSP $ PGME $ Clinical Faculty Academic Faculty

38. Goal: All Flying in the Same Direction

39. The Ideal Governance Structure MoH Board AHCN CEO UBC Dean BCMA Lead VGH PHC BCWH RCH SMH Dpt Med Dpt Med Dpt Med DeptSurg DeptSurg DeptSurg Dept O&G Dept O&G Dept O&G DeptPed DeptPed DeptPed

40. The Ideal Governance Structure MoH Board AHCN CEO UBC Dean BCMA Lead VGH PHC BCWH RCH SMH Dpt Med Dpt Med Dpt Med DeptSurg DeptSurg DeptSurg Dept O&G Dept O&G Dept O&G DeptPed DeptPed DeptPed

41. Departmental Governance structure EDUCATION GEN DIV GYN ONC DIV REI DIV GYN SPEC DIV MFM DIV IHA PHSA VCHA NHA PHC VIHA FHA

45. 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.

46. Questions? ?