1. Bringing About Cultural Change Among Providers
Dr. B. Postl
CEO Winnipeg Regional Health Authority
February 9, 2007

2. Wait Times – Nature of Recommendations
Wait time report focused on two major areas:
Research
Management techniques and innovation, including information technology

3. How Does Culture Impact Wait Times?
Culture:  is a shared, learned, symbolic system of values, beliefs and attitudes that shapes and influences perception and behavior -- an abstract "mental blueprint" or "mental code."
Characteristics include:
1)  Learned.   Process of learning one's culture is called  enculturation.
2)  Shared by the members of a society.  No "culture of  one."
3)  Patterned.  People in a society live and think in ways  that form definite patterns.   4)  Mutually constructed through a constant process of social interaction.
5)  Symbolic.   Culture, language and thought are based on symbols and symbolic meanings.
6)  Arbitrary.   Not based on "natural laws" external to humans, but created by humans according to the "whims" of the society.  Example: standards of beauty.
7)  Internalized.   Habitual.   Taken-for-granted.    Perceived as "natural."

4. Importance of culture
Without a movement that changes attitudes, assumptions and patterns of behaviour of the leaders, managers, and providers of care (that is, a change in culture) concrete measures are unlikely to succeed.

5. Why is culture important?
As health care professionals, our ‘culture’ impacts on how we deliver services, how we interact with other professionals in the system and most importantly, the relationship that we foster between ourselves and our patients.
Shaped – in part – by our professional roles and responsibilities…..
….. with no universal ‘culture’ among health care professionals.

6. Focus on Physicians
The community of health care professionals is comprised of diverse groups of individuals, each with important roles in the overall delivery of health care
Physicians represent only one component of health care providers – but are in a unique position within the system

7. Why Focus on Physicians?
Degree of their influence within the health care system.
Their independence compared to other service providers.
Relationship with patients.

8. Physicians’ Role in System
Perceived as ‘gatekeepers’.
Autonomous.
Powerful position – able to support or resist change.

9. Physicians as Agents of Change
Physicians are key in ensuring that system transformations that will support improved patient access to care are are successful.
Occurring NOW! Many contributing to change processes that are impacting access generally and wait times specifically.
Provinces that have had success in this area have done so with champions.

10. Physician Associations, Regulatory Bodies and Schools
Changes proposed will impact the entire health care system.
“ Forces of change are seldom as strong as the forces against change.”
Extent to which those changes are embraced and accepted depend – in large part – on physician reaction.
These organizations have considerable role in determining direction of change and facilitating acceptance of change.

11. Changes proposed in Wait Time Report
Recommended changes will produce ‘system transformation’ - and will result in improved efficiency throughout health care system.
However, cannot be successful without advice and input from medical community – associations, regulatory bodies, educators.

12. Physicians Influence Acceptance of Change
All participants in health care system have duty to promote system change that contributes to quality care

13. Cultural Enablers – Facilitated by several forces
Medical education must incorporate concepts of timely access, efficient high quality care and equity of access as critical values into curriculum
Regulatory bodies must ensure minimum standards of competency of all providers
Associations must be proactive in seeking input.

14. Recommendations within this Context
Develop base for receiving advice from health professionals.
Colleges establish professional/ethical standards to monitor mgt. of wait times.
Faculties of Medicine develop curricula that support changing health care systems and that recognize changing expectations of physician competencies
Re-define clinical roles to enable health care professionals to work at full potential and to suggest economical and sustainable innovations in health care.