being recorded and also if you are joining by phone so once again if you're joining by phone star nine um you can raise your hand and to unmute yourself that would be star six um all right next slide please um together we honor the land that we are on that many indigenous nations from across Turtle Island, including Inuit and Métis, have lived, worked, and maintained a connection to from time immemorial. We acknowledge and thank all generations of Indigenous peoples for their commitment, contributions, and protection of the land and its resources. Ontario is covered by 46 treaties and agreements to peaceably share and care for the land and its resources, including the One Dish and One Spoon Wompton Belt.
Covenant. Other Indigenous nations, Europeans and newcomers were invited to the Covenant in the spirit of respect, peace and friendship. We are mindful that Indigenous peoples were not asked to share their territories with settler populations and that covenants were broken. Recognizing our privilege as beneficiaries of this land, we strive to make this right with the land and with each other. All right.
On to the agenda. So our first agenda item is human resource structure for medical affairs. And the reason we chose this agenda item is because of the variability amongst all our medical staff offices.
As you know, some of us have one person, some of us have 10 people on our teams. And we thought based on all the environmental scans that are going around, this would be a good discussion for all of us to have. The second agenda item is about medical leadership structure, which basically the first one is a good segment to the second one. And the discussion started from, first of all, the medical staff offices, whether reporting to the VP medical affairs, chief of staff. And I know there are all other org structures out there.
We're also interested in discussing the org structure for the chiefs. division leads, medical directors, and you know they're called all kinds of different things so we thought it's a good idea for us to discuss what our practices are. So each of the agenda items are going to be 40 minutes. All right so our first agenda item is being led by no other than Margaret Margaret is probably one of the most experienced of our team members.
She has been doing leading medical efforts since 2007, and probably she has touched many of your hospitals at one point in her experience. So I'm going to leave Margaret to introduce herself more in detail. And our second agenda item is being presented by Brian Venduren. He is...
the Director of Medical Affairs and Medical Recruitment at Chatham-Kent and with by Sebastian Landry and he is the Director of Medical Services at Montfort Hospital and on to Margaret. Thanks Nellie, appreciate that lovely introduction. I don't know if that's a good thing that I've been in this sector for such a long time or not but I'm delighted to be here and help to facilitate this conversation that I think all of us often get asked.
And, you know, I think it's always a good thing to share. So both Alton and I had a discussion and just we thought we'd start off by asking everyone, you know, what what is your current human resources structure like within your departments or your teams? And and.
you know, we're looking at your team membership, what roles you have, what kind of plans you have in place for succession planning, because I think we all know that this is really a niche area and often it's not something that you get ready or, you know, easy exposure to unless you're in the actual area or department and it comes with time. So I'll throw it out there in terms of anybody willing to share their human resources structure. I'll start off with my own experiences.
I've been in a number of organizations and had to construct departments of medical affairs, having individuals that are specifically focused on helping the credentialing. model, and as well as the other activities. I think when Allison and I spoke about this, we all, we identified some core areas that I'll throw out there in terms of whether or not we all agree, but I think credentialing is a core business that we all share in terms of our focus and our purposes.
I think the other component of medical affairs that we all have some hand in is recruitment of physicians and supporting that process. Some departments or groups might deal with performance metrics. I'll throw it out there.
Is there anything else that you believe? as a core function medical affairs across hospitals share in terms of its primary roles and responsibilities. So Margaret, maybe I can, oh sorry, Sebastian.
No, no, go ahead, go first. I just wanted to add we are very heavy on manpower planning. We get a very tight leash on number of physicians in our hospital so that's one of the busy activities in our hospital.
Yeah I think that's a key role that medical affairs plays in terms of helping our chiefs and the departments forecast out. It also helps to strategize our activity in the upcoming years and helping to make sure that it's a coordinated approach. Anything else?
Well, just to continue on that point, I'm curious to see maybe on your side talking about recruitment and how many of you are the absolute gatekeepers when it comes to recruitment and impact analysis and so on. So I guess it could be something interesting to find out. One of the questions I wanted to ask, the original question I was going to ask was about the coordination of all the academic part where residents and students.
I know some medical affairs in the province do manage this. And I guess depends on if you're an academic site or not. But I know we have.
colleagues in Ottawa who are not academic centers where medical affairs takes on the coordination of such activities, so all the residents and students. So is it for academic centers, is it usually medical affairs that do this or not and vice versa? How does it work in hospitals where they're not, they don't have the title of academic hospitals?
And Tracy, you had your hand up. Just to answer Sebastian's question from an academic organization, we do not oversee the students and residents. We do have our hands slightly in that pot when it comes to fellows.
As far as recruitment goes, because we're a large center, it's largely decentralized. So the departments themselves take care of the recruitment, but we manage... the impact analysis forms and ensure that all the T's are crossed and the I's are dotted in terms of, you know, making sure that they have their CNPA and all the appropriate licensing pieces around credentialing.
The other piece that I wanted to flag is because of the relationship we have with our credentials committee, so the subcommittee of MAC, we also would have a bit of a bit of a bird's eye view on some of the medical staff that might be having performance or behavior issues and helping the leaders to manage that or support the chief of staff in setting up the appropriate next steps and structures around how to manage those staff that might be having those kinds of issues. Thanks for that, Tracy. Amanda?
Yeah, to what Sebastian stated, we do take care of all of our medical students, fellows, residents, as well as anybody who's observing with our physicians. So that's definitely a large workload. The other thing I want to touch on, and my coworker, Deb, who's on here, would speak more to it. The financial aspect, HOC, stipend, all of that is a big job in our office as well. Yeah, HOC brings back some recent memory for all of us with the application.
Yeah, that's a huge portion, actually. Anyone else? That's embedded in your department, or do you work with your finance partners to support that activity?
Amanda, do you have a couple more questions? Deb Green would have to speak more to that. She deals with the financial stuff, but she, as far as I know, deals with most of it on her own.
At OVH, we do it ourselves. I mean, we have a finance support person, but Trevor really manages all the finances, and we manage the hawk in terms of... even completing the 37 applications that we did working with the divisions to try to maximize our opportunity for success, which I'm sure some of you did as well.
Yes, thanks, Amanda. It's Deb. Sorry, I was having trouble finding my hand on Zoom here. I do take care of all of the hawk and a lot of the physician. stipends.
I did all the COVID funding, it came through our office. Ola Bruce in the office does take care of the leadership, physician leadership stipends as well. So a good chunk of the financial portion does come through our office, not through finance in the hospital. What about AHRQ Health? Does any of your offices take care of?
mask fit testing, tracking or vaccination, COVID vaccination. Oh, sorry, Alison, you have your hand. Sorry, I think we can't hear you well.
But yeah, okay. Yeah, does any of your hospitals take care of all health? Because I've seen some variation, for example, here for COVID vaccination, we kind of keep track of it on CMARS.
However, I know some hospitals do the total shebang at medical staff office. Lori. Hi, yeah, thanks.
So our medical affairs office, which is a department of two, We do keep track of the mask fitting and actually our mask fitters ourselves, just so it's a little bit more convenient for the professional staff. They don't tend to need to make an appointment. One of us is usually available to offer that.
And we're working with CMARS to include that in the annual reappointment database. I don't think it's in their other hospitals. I know we've been chatting with them about it.
This is our first year. This was our first year using CMARS for reappointment. We did not have the mask fit set in there and found that physicians were just throwing in random dates that they thought they might have had their fit test.
So we want to make sure that it's included in there when they're last. test was so they really are only seeing it if they need to do it again in the two-year period but the only other thing i was going to add around the financial piece in addition to hawk and the leader stipends our office has also been responsible for the um it's been a few different names but the temporary summer locum program financials so that emergency medicine top up applied to each physician on an hourly basis. We're responsible for tracking that as well as all of the travel accommodation associated with that.
So, Lori, how many physicians do you have? Active, about 140. So I'm based out of Stratford General Hospital. We're an alliance of four hospitals.
Stratford is our largest site. And then we have... Clinton Public Seaforth Community and St. Mary's Memorial.
We're all in southwest Ontario. And between the two of you, do you also do credentialing or credentialing goes to somewhere else? No, it's us. In addition, I'm responsible for recruitment to, I mean, our specialty services reside in Stratford and we're the secondary care center for Huron and Perth counties. But my role for physician recruitment does extend to the community.
So I'm responsible for family medicine recruitment. When I started in this role about 10 years ago, At that time, all the family doctors across our sites were involved in inpatient care, so saw their own inpatients. And since that time, we have transitioned all sites to a hospitalist model.
So it's a little bit more work on my end to stay connected with primary care, and the majority of them are no longer in hospital. Oh dear. Thank you. Deb, you have your hand up. I was just going to echo what Lori stated.
Our office does track, I do track the mask testing for physicians and their COVID vaccines at that time. I think that was all I wanted to add. We do that as well here. And I thought it was a great idea that we could consider maybe becoming fitters ourselves because it's in another building, not in the hospital where they do it. So it is an inconvenience for the physicians to have it done.
Trevor? Yeah, I also, I love that mask fit idea. I think that would save a lot of headaches, at least on our end, and thought that was great. The occupational health pieces is always of interest to me.
We actually developed a sort of a memorandum of understanding or a service agreement with our occupational health department for some of the services they provide just to have some cushioning to land on when things don't always go the way that we think they're going to go. But for the most part, we're entering into CMARS. We're getting the information from Ock Health with the service they're providing, but administratively for all of the things that we need to input, changing, updating of records, mask fit testing, all those pieces, we do them. It's keying that we end up having to do just because capacity is not there on the other side.
We've tried to get them to do it. I don't know what other sites are doing, but for the most part, that's workload that we've taken on and we do. There were comments about the temporary locum program as well, the CTSLP or whatever they're calling it these days. We do all that as well.
We track, we manage, we submit the reports to make sure that we're getting our funding. Wow. So, Lori, just to clarify, so when you say you guys do mass, like you do the actual testing, the fit testing, is that what you do?
We do, yeah. We are trying to do mass fitters. Okay. um thanks for that brian i am not a mask fit tester good for you um wow yeah i'm similar to trevor from the occ health perspective right we liaise with occ health uh and they and they handle all that i wanted to follow up laurie on your comment that you you oversee family physician recruitment as well did i hear that correctly for the for the community broadly yeah you did i would i would be fascinated to have a broader conversation about that with you someday We handle all specialist recruitment here, but we intentionally don't touch family physician recruitment for the community.
And pridefully, I think they would benefit from our involvement, but we're not involved. And that's interesting. That's innovative.
So I've been involved with your, you're in Chatham, correct, Brian? I was involved with your community in my time with Health Force Ontario. And then. previous to that with Western. So I think there was a little bit more collaboration between hospital and community.
And although the workload of it is significant, I do think, you know, it represents well when you're at a job fair, for example, you're recruiting family physicians for the hospital, for inpatient work, for surgical assist, and then for the community. for primary care or quality care or whatever. You know, in some cases, we've got like two community groups at one event.
And, you know, I think the optics of that can be a bit concerning at times. So I do think there's certainly value. Oh, yeah, I don't disagree.
It's more the politics of it that I'm fascinated with. Right? I mean... It's always hard to step into someone else's kingdom.
and take that over. So yeah, interesting. It's always been a part of my role.
So I'm happy to chat with you offline further about it. All right, Connie from Ross Memorial. Do you, I'm not sure if your microphone works, but do you want to tell us more about what you do? Hi, everyone. So here at the Ross, it's a little sporadic depending on what it is.
So I have parts of some processes and not others. I'm kind of the coordinator of all of the AUC health information. I send it to AUC health. They do the fittings on site if needed, and they track the information. And then we're at a point where They have a different system outside of CMARS where they track that information.
Also for HAWC payments, I send the schedules to finance and they actually coordinate it and pay it out quarterly. But I pay all of our locums. As far as recruitment goes, I manage the recruitment part.
But we typically will send a... director to any job fairs that we do so that they can answer operational type questions for the physicians should they have them. And we also have a community recruiter who works on site here, but they work for the community, but they also have a partnership with us and they handle these students.
It used to be done through this office. But then the workload just got too big that to manage all of it together. So I do little bits of pieces here and there with all of those things that we just talked about. Thank you for that.
James, do you want to elaborate on your comment? Hi, folks. James Chan here.
I'm one of the people that help with medical affairs at Sioux Area Hospital. And I think I was putting in the chat there that we do some HR functions similar to what's already been mentioned. And I really appreciate the list of all of the things that people spoke about in terms of the functions that go on.
We do all of that here as well. I guess one of the things I would say is that, first off, we're a small hospital. community-based hospital, about 300 beds and a small department.
And there's definitely room for improvement around how we function with regard to medical affairs. So I'm learning a lot, really appreciative of being part of OMACOP. There is one slight difference. I don't think I heard yet that the city is involved.
So here in our city, we have a trifecta between our hospital, our largest health center, and... also our city council where we have physician recruitment as a partnership. So that kind of is run out of the tri-partite agreement and that's where we have some support for recruiting physicians and that may be a bit of a difference.
I'm not sure but I have heard that this kind of thing exists elsewhere in Ontario. Thank you for that. Trevor? There's been a few comments about sort of the learners, the residents, the fellows.
That's always been an area of interest for me at our sites. It was under medical admin historically, at least that's my understanding, but it was divested over to our professional practice, our learning area. So I'm just curious how other sites are structured. I'm hearing a little bit of both.
Some are doing... it in how or within medical admin some have other departments doing it like us where it's administered through professional practice do you want to start with yours or a Margaret do you want to go ahead so I'll just share what I know of the St Joseph's current setup it is I guess if you want to look at the traditional model still here at St Joseph's where medical affairs is responsible for the oversight of medical learners. So there is, you know, all the trainees come through medical affairs. We support the onboarding and orientation of those medical learners. We're not the paymaster for the residents.
That function or responsibility lies with London Health Sciences. And with the transition that's happening out here in London, they will continue being the paymaster for the residents. But to your question, Trevor, medical affairs is also responsible for academic learners that are medical trainees, as well as, I guess, the dentists and any middle wives that are.
coming through as residents. We also have observers that are still under medical affairs that want to come and observe some of our physicians. So I guess if you want to say that St. Joseph's London has that traditional medical affairs model, but I do know that there are a lot of other organizations that, like you said, have moved their medical learners and integrated them within academic departments or education departments.
So that would be St. Joseph's Healthcare in Hamilton. So we've actually transitioned all of our learners, which includes our residents and medical students under the VP of Education, so our Department of Education and Learning. But I still have oversight of the learners to some degree.
Amanda? So for my position, I do all of the credentialing at Southlake. I also take care of all of the medical learners, residents, fellows, and observers. Most of our students need to be registered. We have an agreement with U of T, so they do a lot of the financial aspect.
And we also have agreements with McMaster as well. We also take on ACPs, the advanced care paramedics, a couple of times a year through Georgian College. Sorry, Amanda, I'm trying to find out which hospital are you from? From Southlake Regional Health Center. Okay, okay.
So you're departing, okay, interesting. And sorry, can I ask, since you're taking care of them, how do you deal with two different MOUs with like McMaster and U of T? So you just share the resources equally?
First come first serve. I'm just thinking about call rooms and all. So our VP, I believe our VP of medical affairs deals with the education piece and all the agreements and everything. I deal with just the registration, getting the students oriented and all of that. Got it.
Thank you. Anyone else would like to share your structure with us? Yeah, this is interesting.
I'm trying to like, as I'm talking, I'm trying to figure out if I can make a poll because it would be interesting just for us to get a picture of how many people each of us have, how many people do credentialing, if we do medical education or not, but I can't figure it out. And Laurie, you have your hand up. Well, we, like many others, are the office where the student or resident would attend to when they arrive on site. We organize all of their documentation to support their rotation, organize their accommodation.
And I think because we're also involved in the recruitment of professional staff, it's a pretty critical role, we feel, because our biggest success in physician recruitment certainly comes from the students and residents who rotate with us. And, you know, over time, we are able to develop. strong connections with these learners throughout their training. This past weekend, one of our roles also in medical affairs is we receive recruitment and retention both equally and we organize an annual physician Christmas party and we extend that invite. I reach out to each of the chiefs of the departments to confirm which residents or locum physicians who we're focusing our recruitment efforts on and we extend an invite to those individuals to join us as the guests of the HPHA and we cover the cost of their ticket.
So we had about a dozen individuals and their significant others attend the party on the weekend and it was excellent. I'm now receiving the feedback. from the residents saying, you know, it's one thing to rotate at your hospital, but it's another to really get to know your medical staff outside the day-to-day work. It works.
Hi, I just wanted to add, that would be a great idea, Nellie, if we could gather that information. Our office, there's three of us. We have Amanda, who does credentialing, and all of the medical students and observers.
Myself, I do the physician recruitment, the financial piece, support the MSA. mask fit all other miscellaneous things and we have an executive coordinator who does physician contracts some financial pieces and supports our chief of staff we find we're light in our office and you know could use a little bit a little bit of extra like for different things and strategies for physicians and stuff so it would be nice to see the setup of other organizations to see we don't have a manager and we don't have a director yeah those are so as PSA support. That's another huge one. You're right. We don't have that support.
Like, for example, this year, I reached out to Brian in Chatham for an LMIA, you know, like different things are coming our way. And it would be nice to have that extra support. So to see how other organizations and offices are done, would be really a great asset for us. And Deb, you're from Southlake, right? Yes, from Southlake.
And Margaret, I think you had your hand up. Yeah, I mean, that was going to be my next question was, how many of us have some dedicated support or resources available to support the professional staff organization or association or your medical staff association? Or do any of us support or provide any kind of support to the PSA?
um brian yeah so we we have what 200 credentialed physicians i guess in total and we have four department of four people which i think is about uh appropriate size i guess um we provide some support for the for the professional staff association um i think i i my experience is because we've we've redeveloped the department a little bit since i came here three years ago and i find you always fill the resources right so how many people you have there's work to be done to a certain extent um some of that depends on who is in our roles which is the next topic and how much support they need to do their roles effectively so we have here does sort of clearly defined support activity for various committees and subcommittees and those certain things. And I think that's a really valuable role for me and for the medical leaders and for the physicians broadly. So Brian, you have four people for, sorry, you mentioned 200 physicians? Yeah.
And across all categories? Yeah, yeah. So we have 120. uh active or associate and then a good handful of locums and courtesy positions and senior staff i think a lot of us are so jealous of you yeah and again the trade-off is the expectations are higher in terms of the day-to-day activities right so the core legislative work of the role continues but then there's a lot of other duties as assigned but I think hospitals would find that a well-resourced medical affairs department pays off pretty quickly, in my opinion. I'm with you. And is the EA to your chief of staff part of the four or the EA to chief of staff is separate or to whatever you have on top?
Yeah, that's my EA and she's part of the four. I'm the director of the department. the department and then we have one EA and two, uh, we call them medical affairs specialists, which is, they, they have similar but slightly diverging responsibilities in terms of recruitment support, credentialing support, uh, retention activities, that sort of thing.
Interesting. Before we go, go ahead, Mark. Can you just, um, identify your hospital?
Sorry. Oh, Chatham Kent Health Alliance. Thank you.
Sorry, can I jump in there? Brian, are your coordinators, or sorry, I couldn't remember the title you used, are they... department or division specific? Are they like a portfolio based or are they responsibility based? Great question.
So originally they had, when I came here, they had two completely different roles. One focused more on recruitment and credentialing. The other one focused more on medical learners and educational programs and that sort of thing. And we restructured so that they had the same title.
We've divided out the the department between the two of them. So they more or less do the same job, but we split the hospital in half and they each take a half. I would imagine that would be beneficial from a relationship standpoint, because I find at least here at Markham, a lot of what we do ends up being, you know, the relationships that we've cultivated, especially, you know, you made the comments about the support that some of our leaders need and some of our leaders don't need.
So I think that that plays a big role there. 100%. And then you have redundancy, right? If one of them is away, leave, whatever, you're not quite so crippled from a HHR perspective. Just before we go to Tracy, our amazing Simona, who's been organizing all these meetings and doing all the technical work in the background, she made the poll in the background as we were talking.
So after we finish, she can do a poll. So we just did number of medical affairs people. But if you have any questions that you think we should call, maybe just put it in the chat and we'll quickly create it.
Tracy, go ahead. So like I'm having like conniptions of envy. So we credential 1400 medical staff and we have basically two and a half FTE. That doesn't include me as the director because I don't.
find I'm particularly integral to the process other than I do some of the medical HR planning with the 12 departments that we have. But we're a teaching hospital and a lot of it's decentralized in terms of recruitment. As I mentioned earlier, we don't do a lot of the recruitment. Although sometimes the boundaries seem to, as we're starting up new programs hospital-wide, they start to blur a little bit and we get into that.
Oh, I've just been corrected. 1,600, over 1,600 temporary medical staff, if you include all the temporary ones, like locums and so on. So it's fascinating to me.
I originally put my hand up with the original question of does for your professional, I think they were calling it the PSA or we call it medical staff organization. They actually fund half of an admin. So that admin sits in our department.
The admin is dedicated to them for a half time of her workday, kind of fluctuates a little bit, but she is definitely hands on within our team, takes care of all the fellows, for example, and general questions and is supposed to support me and the rest of our other two FTE that are working in the department. And the Medical Staff Association has become very active under new leadership in the last year. So she's... very busy with them and supports a number of hospital-wide committees. There's three of them actually.
So it's fascinating to see. I think this is where the understanding the size of your organization versus the resources. Brian's comment about, you know, a well-supported one. And it really, in some ways, it's interesting to know the different responsibilities that we have, but it, you know, we're all different sizes, have different response, just different functions within our communities.
And it goes to show you that there is a lot of variation for good reason, probably. But that having that there's a lot of variation also on the just simple number of bodies that you have to manage your work. We don't have to do recruiting, but we still have to actually credential and make sure that we're legally bringing on these 600 people for the 12 departments that we support. Fascinating conversation. This is really interesting.
um sebastian uh yeah it's a great discussion um similar in size to others for we have a 450 physician probably 250 active um team of three and we recently added and that was my question actually to the group um we recently added a fourth person after five years of asking uh But the fourth and main person is in direct support of the department chiefs. And maybe it's something we'll talk about in the later part of the discussion. But curious to see.
If any of you, or is it typical that medical affairs provide admin support for department chiefs, or is that something that is done entirely separately from medical affairs in most hospitals? I'm just curious to maybe get the discussion in that direction in terms of support for CHAP. Any of you supporting, we talked about PSA, but actual medical departments?
This is such a good question. Hi. Ours is a little convoluted. We do provide the administrative support for our chief assistants.
So we do provide those for our department chiefs. But they're not one, like they're not a full FTE. So a lot of our, at the maximum that we, in terms of administrative support that we provide our chiefs would be 0.6 of an FTE. The other 0.4 or 0.5, depending on what that turns out to be, is usually either.
they're either supporting another department chief or if they choose to support their current chief clinically, um, then we would be reimbursed from that chief for their services for that, for the, the remainder of the FTE complement. And then we have some chief admins that are actually employed by HHS, but supporting citywide department chiefs, um, because in Hamilton, we have HHS, St. Joe's, and then McMaster also comes into play where we have some, um, administrative support. supports that are employed by McMaster, supporting our department chiefs, and then we either reimburse them through invoicing.
It's a bit of a mess. Yeah, and I think in some academic hospitals, sometimes they just cover the admin from the university side, and then they don't cover the hospital side. For Halton Healthcare, some...
So we have some assistance for some chiefs, some chiefs don't have assistance. Sometimes we have one assistant for too many departments. So not standardized. And a lot of times we find ourselves supporting the chief as well. Okay.
Maybe I'll go from the bottom. Lisa, do you want to comment? Department chiefs get support from their. Yeah, our department chiefs.
you know this question has come up before about you know um generally they can they're supported by the director's admin assistant if they for only for their administrative component of their role right for their chief role um and i'm sure i could open a kettle of fish on office space as well too um some of them have office space that honest you to God, they never use. And we're so stretched for space in the organization right now. It's a comment that comes up all the time. Others choose to use their own office space for their practice. So it can be, it's a bit of a hybrid of everything.
Yeah. And so there are some suggestions. for the poll.
The poll on Zoom is very basic. So we can basically say one, two, three, four, but you're right. Sebastian's four is not the same as mine, which I don't even have four. But yeah, you're right. But I think for now, we can just get a quick poll just to get an idea.
But I'm trying to figure out if I can make a spreadsheet and for all of you to just put numbers in without the names. I think that would give us a better idea. So we say this is the number of physicians, this is the number of medical staff office, yes or no to director and manager, and PSA. So I'll just try to break that down while we are doing this. Let me see, we had one more comment from Ellie.
Yeah. As you're reading your chat field, I'm just wondering, maybe I'd be willing to work with you. Maybe we can do like a survey monkey. and send it out to folks.
And then that way we can ask all of those questions. I recently did some benchmarking just with a few of you. And I think just to give you some context, I was recruited to St. Joseph's London.
And one of my objectives is to create a new department. So as part of that work, I had contacted a number of you here just to do some comparison, but I'm happy to help. construct something like that Nelly, we can send it out to folks for everyone to populate and then we can post that through the Omicomp site, the results, and if everyone's agreeable we'll identify the organization and that way if you need to connect with that organization you can do so independently.
Margaret, if you are limited with SurveyMonkey, which often we are, we can take this offline and we can put it in REDCap. REDCap gives us a lot more latitude and send out a REDCap survey. Awesome.
Okay, I'll do that. Thanks. Okay, so maybe Simona, do you want to run it? I mean, we all know the limitation of this poll, but Simona, maybe you can share it.
That would be a segment to our next. Topic. Oh, and maybe for this survey, don't include the director and manager.
That might make sense. Right. Okay, and can folks see the results as it's going? Or is it just me that can't see it? You can?
No? Okay. Simona, I think, can you just share?
Or can we do this live? I don't know. All right. It seems most of us have, six of us have three.
One person has one, two has two. one person has four and one person has five who's the five all right yeah like you know this is very limited so we'll uh we'll work on creating that survey and sending it out to everyone all right thank you so much margaret and i know that you have other commitments so nice seeing you all i don't Talk to you. Have a happy holiday.
I can't believe I'm saying that. All right. Onwards to our next presenters. So we have Sebastian and Brian talking about the org structure and medical leadership structure. Everybody.
Brian, do you want to start or do I just give a quick intro of the plan? If you're OK to do that, that sounds good. Okay. Can I try to, if you don't mind, share? I had a slide and I forgot.
I didn't send you. Can I share? Okay. I think, I believe so. Give me one second.
I believe it's this one here. Are you seeing the slide? Yeah.
Okay, good. My name is Sebastian Andrew. I've been at Montfort.
hospital for almost 10 years now. Sorry, I lost my toolbar. Okay, good. For 10 years now, again, like I mentioned earlier, around 400 physicians, around 200 actives were in Ottawa, very close to Tracy and the Ottawa hospital.
And I wanted to take Trevor and Tracy and Brian also. We had a great discussion. few weeks ago to kind of talk about the points that we wanted to raise here and i think one of the the things we want to do is obviously like we just did uh previously with this amazing amazing dialogue is to stir the pot a little bit with with maybe these topics that you're seeing here and and again when we're talking with tracy and and and and she was explaining all the different things we have that they have, I was very, very envious of what TOH has and realizing that we're in the early days of most of the points, the five points that you see here. But the goal was, again, to try to understand from a physician leadership structure, how does the hospital look like in terms of... Mostly department chiefs, division chiefs, medical directors, I guess, probably depends on the size that you have.
You're probably all dealing with tightening of the belt in terms of financial situations. And so one of the things we're curious about was, again, not to divulge too much prior information because we're all really familiar with the OHS survey. But maybe I have an idea of...
of this type in giving to physician and I think most importantly with all the pressure has been going on lately with all the professional staff for nursing staff and so on have you considered increasing those type and so that type of information in terms of physician structure so does everybody have physician as a formalized contract and so on talking about roles I think is obviously something not very trained I don't want to say tri-D, but very apropos in terms of wellness, EDI, ethics, and all other potential specific roles that your physician leaders could have. Talking about the reporting structure, obviously all the MAC, but what do all those chiefs, whether it's division chiefs, department chiefs, medical directors, what's the expectations in terms of workload attending? And for us? Where we're lacking a lot is the succession planning in terms of how do you identify leaders and how do you train them? How do you bring up the pipe?
And again, talking about the budget. So the point was to put those five topics there and to go back and forth and then next 40 minutes or so and give everybody a chance to address either. five of them or whichever is dearest to your heart at the moment but um and that would be that then take a you brought up the issue of a survey that would be amazing it's something that we can probably all write paragraphs about each of those topics so maybe to give everybody a chance to maybe add their little two cents on this would be interesting so either survey or some other post meeting a mean of doing so so that'd be the plan um And again, so Brian, if you want to jump in, I know if you want to share a few maybe of your structure and what you have, or if you want to add anything else to maybe help steer the discussion. For sure.
Amazing. Thanks for that introduction, Sebastian. And just by way of introduction or to reintroduce myself again, my name is Brian Van, Medical Affairs, Medical Recruitment at CKHA or the Chumkin Health Alliance.
And I bring greetings from the southwest of Ontario. I think I'm the only one of my colleagues. here because I actually managed to scrounge up internet access in my office. If I can leave you with anything, it's take cybersecurity seriously, everyone.
It is outrageously crippling to get somewhere attack and start coming back up. So that'll be the better part of two months that we've been down. Experience similar timelines and it is with you.
So prepare for it now. Season play. But here we are.
And I find this, I think there will be huge differences and distinctions based on size, complexity. acuity of the different hospitals. One of the things I struggle with the most is compliance and that speaks to me primarily about process and about structure, right?
How do we address issues? How do we have structures in place to deal with those kinds of difficulties? And again, as a medium-sized hospital, but within this context, much smaller than a lot of other hospitals around.
I think many of my colleagues would share this experience that finding medical leaders can be a challenge. Finding people within a team willing to step forward and lead that team is not always simple. And so you don't always get people who come with a full toolkit. of the skills required for a leadership role. And then what do you do?
How do you support them? How do you, how do you, uh, help them? How do you deal with them or support those who have to deal with them when they're maybe not fulfilling their role in the best possible way? Uh, you know, that, that goes to structure, that goes to roles, that goes to reporting, uh, and it goes to succession planning as well. How do you find the next generation?
Um, For all of us on this call, I think our level of authority to manage this varies, and sometimes authority is what you make of it. It's the power that you take on. wield more so than what you're given um but but that can have that can have negative repercussions as well um so i wonder if if it's helpful to go in a bit of a sequential fashion and if anyone has comments about their experiences about their structure um i personally am a an advocate for transparency i don't know that a lot is gained by you not sharing, but I know there's also sensitivity there.
So we want to take that into account. If people are comfortable sharing amounts or numbers or things like that, that's certainly understandable. For our perspective, just to provide context as we kick off this discussion. So given the size of our hospital, we have one chief of staff.
We don't have a split role or anything like that, medical executive and chief of staff. One chief of staff. who is expected to fulfill that role, something like two, two and a half days per week.
He still maintains an active clinical practice as well. And it's sort of a, I guess I'll call it a half-time rule. Our department chiefs, generally speaking, the expectation is that they're spending about one day per week in those roles and the compensation lines up with that for the most part.
So that's how we've... structured our hospital. And then some of our more complex departments have a number of heads of service underneath them, surgical department, medicine department, that sort of thing. And they all receive, I would say, a relatively minor, sometimes vanishingly small stipend for that work.
But very curious to hear what other people's experiences are. Hi, Brian. We are, I've been told, and I want to get my numbers right, because Trevor will get mad at me, 596 professional staff at Oak Valley Health.
And we have a chief of staff, we have 11 department chiefs. We have a site chief for Uxbridge because it is a smaller hospital. So instead of like having, and that chief covers both the eMERGE and the inpatient unit there. So that's why we have 11 chiefs.
We do have division heads now. We started that and clinical leaders probably about, I think this is our third year of that. We are very transparent and I'd like to say equitable, as equitable as we can be.
We base our stipends on the OHA stipend review. So I... benchmark against all Ontario, all community. I look at the bed size, similar bed size, similar budget, and then I look at bed and budget together. And I do that every year.
And then I also do the calculation on what they're getting paid, both the mean and median. And then I also do a calculation based on the hours per hour. year commitment which then I drill down to days per week so in general our chiefs most of them are a day per week surgeries I think a day and a half per week some areas are like 1.1 or what have you and then we have bands so we have a we have bands um three steps so if you're a new chief you'll start on step one and then you'll transition to step two and then step three and we that was all based on this OHA stipend.
I wish more hospitals would participate in the OHA stipend review for this reason, because we do get people coming to us all the time and saying, oh, well, my colleague at such and such a place gets this or gets that. Well, almost none of the Toronto hospitals participate in the stipend review. And then, you know, you can't really benchmark against some hospitals that are, you know.
not similar to it, it becomes difficult. So that's what we've done. And it allows us to be to be defensible in terms of the value that we attribute to any particular role, if that makes any sense to you.
Sorry, Lisa, just a quick question. So if let's say if you're you have a new chief of medicine. and a new chief of surgery, would they, and they both work one day, would that be the same rate or is it a different rate for surgery than medicine? Well, it's the same rate. So the bands are the same for the chief.
So we have the clinical leaders and division heads. Then we have corporate leads. So like we have an IPAC corporate lead, and then we have chiefs.
When I started six years ago, everybody got paid the same daily rate, whether you were a chief or a corporate lead, and it didn't seem quite right. So we adjusted it. So the way it works is that the lowest band level is say a division head.
there'll be three bands and band one is the lowest band three is actually band one of the next level which is the corporate leads right and so then they have three bands as well and band three of the corporate leads is band one of the chiefs and then they have the three band structure so if you are um a chief of um family medicine and you're a chief you of psychiatry and they're one day per week and you're both hired and new at the same time you will get paid the exact same amount of money yes awesome thank you any other comments uh Sebastian do you want to elaborate on this Yes, thanks, Lisa. That's amazing. So just say you're talking about your corporate leads. Where do corporate leads have a lesser stop in the sheets, is what you're saying? Yeah, we have a corporate lead for Auck Health.
So he's the physician that manages Auck Health and sets like the policies and procedures for Auck Health and manages really the medical. expectations in that range. We have a corporate lead for midwifery.
We have a core because we are in Canada alongside midwifery unit. We have a corporate lead for IPAC. We have a corporate lead for quality.
Trevor, am I missing anything? I think that's it for corporate leads. And then does the C... The C... Does CMIO fall under your... Yes, CMIO gets paid through us and is in the classification of corporate lead in that range, right?
And right now we're going through CPOE, so it's a very relevant, like that role is quite important for us. I've kind of hijacked the screen. Sorry, Brian.
our corporate leads are here. So I think you mentioned ASP, CMIO, medical education, IPAC, FMTU, midwifery, stroke prevention, quality, and our OHT lead. Do they have particular term length, three years or anything? Great question. So for our chiefs, it's five plus five.
For our corporate leads, so what we've done this year, because there were a lot of, there's a lot of contracts and We do all the contracts for our stipends. We roll them over for the corporate leads and the division heads and clinical leaders every year. Now, I don't make them do a brand new contract, but I will extend their contract and they'll get a letter of extension.
It makes it easier for us. So all of those contracts come due on January 31st. And then the new letters go out effective February 1st.
So we'll, in January, beginning of January, we'll reach out to the chiefs and say, okay, have a look at your division heads and clinical leaders and what have you, are you still good with them? And then if not, is anybody transitioning out, what have you, and that's how we manage that. And do you have to bring those to the board for approval? Like we bring annual of chief positions, it's kind of a format.
Yes. it is it's exactly the same brian it's a formality just to say this is what's happening you're great and not great so one of yeah so one as an example for us it's been i'm guessing a lot of you are under the same again final pressure uh for longest time we had everybody on the same i love the idea of lisa with the different steps but everybody is getting the same whether you were here year one or year 10, although now they're not allowed to go more than two terms, so four years max. Yeah, so for the longest time, they were at the fixed stipend of even below their OMA rate of one day a week.
And again, thanks to the OHA data, we were able to convince Ironman that we were subpar in terms of paying our physician leadership. So we did get an increase across the board. And we did go just... recently to increase type and for obviously the bigger departments uh so a few of them are now 1.5 days um but we're still probably even even then a bit um below that so um and we are adding this year division chiefs like for hospitalists and icu so uh this is new for us again as we're going growing and a number of physicians and and patient also um I mean, every year, if you look at the OHA stipend review, and I don't know if anybody else looks at it in the detail that I do, but because I do do the math every year on that, it ebbs and flows.
Like last year, it was up. This year, I noticed it was down, right, a little bit in terms of what, when I compare it, it seems to go every other year, it goes up a bit, and then it goes down. And so then I look at it, and I just had this meeting with our chief of staff last week and said, okay, these are the ones I think we have to adjust. Or this one I actually think is paid more than, you know, the comparator. So when that person, like when that position rolls over, I would suggest adjusting it down to find the right up point, right, for them.
So, yeah. That must be a difficult move to make. Well, it is if they talk to each other.
Like if they're. timing out of a chief role and then they say to their colleague yeah and I get paid this and then we offer them something that's not that and then they say well wait a second my colleague said I was get that he was getting this then I have to demonstrate which I can and that's the beauty of the stipend review as I could say but this is what you know what the average and the mean and the median is across the province and our comparators so we've level set to this. Great.
One of the questions I want to ask was, and it's a bit in line with what we're talking about succession planning and maybe I shouldn't, but I'm going off the rail. What's the process at which chiefs are getting voted? Is there any involvement from hospital administration?
I know there's a lot of interest because we have a lot of new... VPs and CEO here that are curious to see if there's a willingness to change the appointment process. Again, going back many, many years, it's always been, again, struggling to find pretty much whoever hasn't been chief and hasn't been here the longest. But it's always been an internal vote in the department. And then that person gets presented to the MAC or There's never been any involvement from, again, other clinical VPs or directors or CEO, for that matter, into that process.
And if you have that in terms of how do you appoint the next chief, is anybody else than the physicians involved in picking them? I'll let others go first, but I've got a bunch. say about this but curious what other people's experiences are okay so brian i'll tell you uh uh and sebastian this is what we do prepare yourself um we do an external review whenever a chief is turning over so we do we have a very robust process uh we bring in um and they review the department and so we have a physician leader And we have an administrative leader come in. They work as a dyad.
They're in our organization for two days. And we set them up with a bunch of one-on-one interviews, but also interviews with the department. And then we give them about a month to go back and write the review. They give us the review.
We get a steering team, steering committee team together to decide who the reviewers are going to be. I have a terms of reference for that if anybody's interested. And then based on that, that.
report and that information helps inform the direction of the next five years. And it also allows for, particularly if you have external candidates, we provide them with the external review so that when they come to the interview, they know what they're getting themselves into and what the reviewers have identified as strengths and weaknesses of the department. And then that informs them.
But at the interview, we, and at every step of the way, we've had their colleague involved. Yes, administration involvement, but also nursing allied, et cetera, et cetera. So we really try to make it robust interprofessionally. Brian, I love that. That's great.
Yeah, we do a less formal review process every every five years. which again tries to inform the leader. Our selection process is to include a bit more direction about how to select department chiefs and factors that are in the selection itself, the chief of staff, the vice president of operations, the board chair, the clinical Three other chiefs, a physician member of the department, a patient advisor. It's about a dozen people, which is great. It's a bit humorous when you have one applicant for the position and the applicant isn't very good.
It's a lot of effort for a decision that's essentially already made, right? Because we're not going to not have a chief of the department. So it's kind of interesting, right? It's both an excellent process and kind of a bit of a clown fiesta sometimes.
All right, Lynn, do you want to ask your question here and then Connie? Lynn, I can't figure out which hospital you're from. Hi, I'm Lynn Robinson. I am the executive assistant for the chief of staff and medical affairs at Aurelia Soldiers Memorial Hospital. And we've faced challenges when we've had department chiefs resigning from their roles at the end of their contracts.
It's happened two years ago and then again this past year to try and find anyone to volunteer, accept the nomination and step up into these department leadership roles. And as well as we do have some various other leadership roles that still remain vacant that we've had to restructure as well. So I'm just wondering if anyone has any other strategies for small to medium sites who are not large academic centers. But we still provide, you know, academic learning as well and various department sizes to include that for anyone, you know, recruitment of these leadership positions.
Does anyone have any recommendations? I mean, we have larger sites in Oakville and I have smaller sites, too. And I see what you're saying.
So. I'm interested to hear it myself, too. We have a challenge in smaller sites for someone to step up.
Yeah. Burnout is very high, and it just kind of seems to be adding to that administrative burden that just if there's, you know, the feedback we've received so far is it's not really a monetary reason why they're not stepping up. It's more related to the burden and workload.
So if anyone has any ideas or strategies that we can, you know. look at would be appreciated so lynn are you a single site or a multi-site or a single site okay i don't have a specific comment in that regard but i think it's very reassuring to hear that everybody's going through the same struggle when it comes to to to well a lot of people are going through the same struggle with succession planning leadership recruitment intention. I don't know if maybe... And not to put you on the spot, but I see you had some great examples at TOH of what you had in place in terms of potential training, leadership training, and give examples of maybe who's paying for it and so on. We're kind of seeing with the new generation of leaders on our side that one of the main things they're saying is, well, we've never trained into that.
area so is there actually there's been a lot of requests recently uh would you would you pay for leadership training would you pay for this and that so that they're more prepared to embark on such roles so it's obviously something we're trying to do but maybe learning from from folks who have been doing that for a long time maybe would would inspire some of us to to get going uh sebastien i'll jump in a little bit so you about five years ago, we, we had a budget line that was for leadership training, but it was, there was no real process around. So it was kind of like whoever asked, right. And so what we did is we took a step back, did a bit of a lit review, and just to sort of understand how physician or medical staff learners learn, and, you know, appreciating that it might be a bit different than other.
professional areas and also the fact that we wanted to um just make sure that we were going to if we were going to embark on on investing in learning uh um i'll call it administrative learning um that we were doing the right offering the right kinds of courses so we are hospital and we're a large um teaching hospital so you just want to keep that in mind that, you know, we have access to about $175,000 a year. And so what we do is we have identified courses over time, they usually run about $6,000 per person to sign up for them. And we do an annual call over a period of about a month where we say, okay, here are some of the courses that you might be interested in for your staff. If you want to nominate somebody from your area.
please do buy such and such a date. So they do. And then we look, we actually keep a ridiculous Excel spreadsheet, where we track who has been nominated, and when they might be selected. And we we managed to send probably about 30 people a year to the various courses.
And they don't have to be just courses that we've identified, like there's things offered through the University of Ottawa, Rotman has some the advanced health leadership program. And they also have another slightly cheaper, shorter program. Shulich at York University has some medical leadership training. And then there's just things like mediation and conflict resolution, that kind of thing.
There's some stuff offered locally. So the ones that we know about that we've sent people to on a relatively regular basis, we tell the leaders about, so department and division heads. And then we...
we welcome the nominations. And then we basically look at who might be identified through our succession planning process, which is a whole other conversation. So for department and division potential leaders, to make sure that we're at least getting them on the training track, but also then up and coming and emerging leaders.
And there's a hospital wide program also that's available to nursing and allied leaders that we could also send them to. And Then we just try and balance it out as best as we can in terms of who's been nominated, who got selected one year, didn't get selected another year, that kind of thing. And we try to balance numbers of men and women being selected because we're trying to increase the women leadership roles. So it's a bit of a cumbersome thing. It's about slotting people into different course availability.
The neat part, though, is that we really work hard to spend that entire budget line as best as we possibly can. And we do welcome requests. Usually they need to give us some lead time or time it around when this call goes out that for other people to identify other courses. So there's stuff offered at Stanford. There was even somebody who wanted some money to go to Harvard.
We don't give them the whole thing and we don't pay for their travel. And. accommodation and all that sort of stuff.
But we will pay, I think the maximum we've ever paid is $10,000 for a particular course. But that would be definitely with future thinking in terms of that has been an already identified leader but usually it's around six thousand dollars in that area that might be and if you get it one year there's no guarantee you're going to get it the next year at all so anyway it's a novel program has taken a number of years to sort of get fine-tuned but it's the one thing where we hang on to that budget line as much as we possibly can and try not to let it fall to the cuts that might happen at a corporate level every year. So that's our story. Amazing.
Thanks. We have two hands up to Lori and Aditi. I'm not sure the order.
Sorry. I'll go ahead. Thanks, Sebastian. Actually, my comment is in follow up to Lynn Robinson's kind of call for help on engaging.
leadership at small sites. So as I mentioned, we're a four hospital alliance. Three of our sites are small 20 bed hospitals run by family doctors who do a little bit of everything in patient clinic and emerge.
And as we know, that's not the type of physician we're training any longer. So they're basically impossible to replace when they are retiring. We've had a bit of a rotating leadership model, just kind of organically.
I don't want it, but you've not done it sort of thing. So that's kind of existed amongst the groups. And we found ourselves in a position in the last couple of months where one site, the leader said, you know, I don't want to do this.
And no one else wants to do it. But we do know that our. is important you know within the alliance so myself and the chief of staff kind of talked through what options were available and really what we learned is some of the non-site specific meetings were the burden so attending the various board meetings that are required of the physician leaders some of the priorities and planning for the organization really the meetings that were not specifically relevant to the site. So in the end what we did agree to was kind of an abbreviated role. She's still willing to play a role and we defined specifically what she was willing to do and could fit into her schedule and the remuneration was adjusted to reflect the time commitment.
And then for the other pieces we redistributed in one case to another member of the department and another case to our chief of staff who at those board meetings will be the voice of that site as well. I mean, it's not ideal, but I think it's the reality that we face. You know, some of these small communities, they're, well, I think in healthcare, many of our physicians and many of us are at risk.
pretty burned out as a result of the pandemic. And, you know, in smaller communities, I think the added burden is the majority of their emergency schedule is covered by locums, predominantly EDLP. So the locums are coming, swooping into your department and their reimbursement is...
double what the local physicians are making. I mean that's been a bit of a burden since the beginning of the program, you know, 10 plus years ago. So yeah, they're working with lean resources and just trying to make work what they can do and kind of offloading other pieces so their voices are still heard but, you know, it's...
it's not as great a role as it would be in another community. Hi everyone, my name is Aditi Gora and I'm the interim manager for Trillium Health Partners in the Medical Affairs Office. So this is my first meeting, so I'm really happy to see you all and at the same time hear all these great, exciting ideas that you all implement in your organizations.
So at Trillium Health Partners, we have over 12 medical chiefs and one chief of staff as well. Within our roles, we have different roles. We have a physician lead who supports operational supports at the local level, like a physician lead for a mental health program.
Within mental health, it might be supported, for example, inpatient mental health and outpatient mental health physician lead model kind of thing. Then there is division heads and service medical directors. So service medical directors take on more of the operational workload and the division head model take on more of the...
performance management and all the other kind of things. So we do have those different leadership models which help physicians to dip their toes in depending on how rigorous they want to go into their leadership journey. So they don't have to go into chief right away. They can dip their toes to see if they like the other leadership. Our office supports their program chiefs very immensely.
We lock arms with them. Any performance reviews, anything they have to do, any cases, we are very much close to them. So we support them, even for the division heads, if they have to do it at the local level, in terms of even writing some speaking notes for them or speaking points to help them because it's their first meeting that they're working towards and they don't know how to address those performance issues.
So we provide a lot of hands-on support at that way. Also, annually, we hold two medical leader skills sessions. So any new medical leaders that join this community, we provide them the training, like our medical, our director and medical leader, they go through the whole training.
And it's very scenario based. For example, if there is this recruitment credentialing, how would you support that if it's performance related, and it's a case based, so it's a case. And then we have discussion about how do they go about doing this? And, and what would they do in those circumstances?
So just very hands-on training that is provided twice a year to the new medical leaders and annually once a year we do another annual skilled medical leader skill session which was paused during pandemic but we have since then built it on again brought it back so we do that as well for the team based on what what we are hearing what type of cases are coming forward and what what can be addressed so this time around it was around wellness that our wellness elite who is a corporate wellness lead. She led through the annual medical leader skill session. So we provide those kinds of opportunities to our medical leaders.
And we have almost around close to 100 medical leaders within our structure. I love your training idea. Love it.
It is quite rigorous. Like, yes. And all our leaders really like it. The fact that they understand that, okay, this is, these are support. supports available to them.
And if they don't know what to do, MedAffairs is there to support them, even to guide them through speaking points. Sometimes we give them very detailed speaking points just so that they feel supported when they're going into the meeting, they know exactly how it would go or whatever. And sometimes even MedAffairs sit in it, like our senior advisors sit in those meetings, they write detailed meeting summary letters, which is sent back to the professional staff.
So there is a documented notes in terms of there is no he said he said or he should use it it's actually this is what's the documented so it's a third-party documentation um so it's we do quite rigorous sometimes it is brilliant uh again um like nelly mentioned and just curious on to on that one like your medical leader session so on they're given by existing or veteran medical leaders i'm guessing to the younger ones i'm guessing those physicians are compensated for that for those sessions They're not. They're not. Yeah. It's part of their expectation of their role. Yes, it is part of their expectation.
So we like we do keep keep an account of which ones did did not attend the new medical leaders. If they couldn't make it to the session that we offered, then they're called again to come in for the next medical session that is offered in the later part of the year. And we just we do use a benchmark to do our stipends as well. However, we. could do a better job in aligning with the grades.
Like it's not, we just have benchmarks for what a physician lead should get, what a division head should get, what a chief should get. But then between that, based on experience, based on other factors, it's get decided. And program review, Nathalisa, thank you so much. Yes, for this year, we actually started with our new, the program chief, who's for one of our program chief who's retiring. that we are actually going to be doing a program review as well.
So for us, that's a new thing that we will be launching. in terms of the new program chief when they come in. But it's quite rigorous in terms of we do external review. We collect all the ideas from frontline, what they want to see in their leader.
And then it's an open process in terms of how it gets selected. And the term is five years plus five years. And after five years, we do a 360 review of the program chief, which is done from all sorts of sources done by external consultant.
And then. that feedback is given to the program chief that which they absorbed in terms of when they're going to the next five-year term yeah i think we've borrowed from you and you forward from us and yes i think so and uh and it's been great a great relationship with amir and um and also i i will say that i love the chief we really love the chief um the chief um teaching session that you have and and we uh We'll have to run it again in the spring because we'll have four new chiefs. And so it's been great that that particular offering that you guys have.
Right. Gave me lots of ideas. I'll be reaching out to both of you to get some more guidance on this.
I'm just mindful of time. It's 1.32. Thank you so much everyone for joining. Simona is going to send evaluation at the end of the session. We do really need some ideas on topics to cover.
This session was a bit different from previous ones, so it was more interactive for everyone to get involved. But we are open to feedback and we want other hospitals to lead the sessions. So let us know if you're interested. And thank you.
and have a lovely evening thanks everyone thank you