Sunday, April 3, 2011

I'm catching the Saskatchewan wave!

What's new with you?  How about me?  Oh, not much...  Just a NEW JOB!

As of this month, and for the next year, I'm going to spend half my time doing my usual clinical work in urology, and dedicate the other half to working with Saskatchewan's Health Quality Council (HQC).  HQC has contracted with me to develop a physician quality improvement fellowship program, support HQC's Clinical Practice Redesign (CPR™) work and, I suppose, be general clinician-about-town.

It's an incredible opportunity for me.  I'm excited about it, yet anxious at the same time.

I'm excited because it's a chance to have dedicated time to work on a large-scale quality improvement (QI) effort.  I've enjoyed working "informally" with HQC for over 4 years.  Our office's Advanced Access/CPR™work has benefitted hugely from HQC's support.  But, even with the generous donation of time (mine and theirs) from my partners, it's still work that's done off the side of my desk.  Clinical responsibilities always trump quality improvement work.  (If that last sentence made you cringe, then join the club!)

I'm excited because HQC does an amazing job of promoting QI work in Saskatchewan, and I know that they're never satisfied with the pace with which QI is moving.  They are steeped in QI and measurement and I look forward to learning from all the enthusiastic staff.

I'm excited because creating a physician QI fellowship has the potential to expand QI expertise and leadership widely in Saskatchewan.

I'm excited because this is the first major professional upheaval I've had in 20 years of practice.

And, I'm anxious because this is the first major professional upheaval I've had in 20 years of practice.

For 2 decades, I've been the boss and the expert.  In my office, the hospital and the OR, I usually have the final say.  Technically, I am accountable to my patients, colleagues, regulatory groups, health region, and the government insurance board, but no one has ever explicitly told me what they want me to do, nor what the specific deliverables of my job are.  In my HQC consulting work, there will be explicit expectations and timelines.  My work will be scrutinized on a peer-to-peer basis.  I am utterly unaccustomed to this degree of transparency.

I'll be learning on the job.  I have no experience in developing training programs.  I feel uneasy about it already.  In my regular work, I like the fact that I have previously come across most clinical conditions and don't have to struggle with a management plan.  After 20 years, urology is comfortable.

And that's what motivated me to take this leap.  I felt comfortable.

I've heard it said that it takes 10-15 years for surgeons to develop their practice to the point where they feel comfortable.  Even though there is always ongoing professional development - learning new techniques and treatments, and abandoning outdated ones - the ride does get smoother after that many years.  Why not just enjoy the ride until retirement?

I'm taking this job partly because I see so much that we can do better for our patients (ourselves!).  There is so much untapped energy and potential in clinicians.  We all want to do a great job, but don't have the time or tools we need to make improvement changes.  I have felt the great satisfaction that comes with making clinical improvements, and I'd like to share that with colleagues.

I'm taking this job partly because of the example set by my senior partners.  The two of them - one retired, one on the cusp of retirement - have been deeply involved in medical politics and quality improvement all through their careers.  They recognized that their responsibility and influence extended beyond the one-to-one patient encounter of clinical practice.

I'm taking this job partly because of the incredible support of my other partners.  When I proposed switching to half-time clinical practice, we all knew that it would be a significant burden for them.  Their response? Unanimous and without hesitation (well, that they let show to me, anyway!): Do it!  Thank you all.

But, mostly, I'm taking this job because there's something palpable happening in Saskatchewan healthcare.  The government is supporting the Sask Surgical Initiative.  Specialty practices are starting to explore pooled referrals and other aspects of CPR™.  Health policy makers regularly refer to the Patient First review as a basis for decision making.  Momentum is building.

I want to paddle out and catch this wave.

Wish me luck!


  1. Congratulations once again.
    I definitely commend HQC for their courage in this initiative and I want to commend you for stepping outside your comfort zone in the noble pursuit of Quality Improvement on a macro scale in addition to trying to explore ways to help fellow clinicians in their own quests to, firstly, improve the patient experience in healthcare and, secondly, trying to improve the macro healthcare environment to make it easier for all of us to provide high quality care that exceeds patient expectations.
    Kudos to all concerned in this venture.

  2. Thanks, Shabir. I agree that HQC is taking as big a leap as I am. I hope our work together will encourage other organizations to see that funding QI work is a key investment.

  3. Congratulations! I have no doubt you deserve it.

    Bohica from California (formerly Saskatoon)