I have been negotiating on behalf of my colleagues since 1999. At that time I was the lead physician for the Hamilton Primary Care Reform pilot site. I was part of the Ontario Medical Association team that negotiated the 2004 agreement and I Chaired the OMA Negotiations Committee in 2008. In 2012 I Co-Chaired the OMA team, along with vascular surgeon Dr Wayne Tanner.
I was also a member or Co-Chair of the Physician Services Committee for almost a decade. This committee is the main point of contact between the Ministry of Health and the OMA between periods of formal negotiations.
I’ve lectured across the country on many occasions for both the OMA and the Canadian Medical Association about the negotiations process.
I document this so you will know that I’m speaking from first hand experience.
In the mid 1990’s relations between the Government and the OMA were in disarray. Cooler heads prevailed and the two parties realized that they were both better off, and more importantly the people of Ontario were better off, if they were able to sit in a room together and put patient interest first and agree about health care issues.
A very conscious decision was made to engage in interest-based negotiations, also called mutual gains negotiations.
In this model the parties start by declaring their interests, or what they hope to accomplish during negotiations. Declarations of financial positions are not made at this point.
The parties explore their areas of common interest and try to understand what are the other party’s interests. Often there are many areas of common interest. After all both doctors and government want to do what is right for patients. For areas without overlap, the parties try to understand why the other side needs something and they explore ways to satisfy those needs while protecting their own interests.
This process often leads to win-win negotiations. People talk about making the pie bigger.
Brainstorming sessions are a must. These discussions are done ‘without prejudice’. Neither side considers the other committed because of what was said during brainstorming.
The interests of both sides are satisfied in one long running list, a wish list, and no item is agreed to until all items are agreed.
When it works it works very well. In 2004 it was often hard to remember who was bargaining on which side. The good faith in finding solutions to patient problems was amazing.
At this point the hard work of costing the various interests occurs and it is often found that the total cost is too high. It is only at this stage that the financial mandates of the parties are considered. Both sides think about their priorities and give up less important items.
Make no mistake, at the very final stage, both sides do some hard bargaining and make some tough decisions. Everyone makes sacrifices.
This model was used in 2000,2004 and 2008. It resulted in many enhancements to patient care that were not related to higher fees. It was this model of negotiations that led to primary care reform, electronic medical records, the Academic Alternate Funding Plan and many other system improvements detailed in my last post.
This is not the type of negotiations that occurred in 2014/2015 between the OMA and the Government. After the June 12 2014 election resulted in a majority Liberal Government, the Ministry declared their fiscal position. No interests were ever explored after the election, only the government’s fiscal position.
Now that’s a great way to buy a house or a car. It may even work well in traditional labour negotiations where a single item (price) is up for discussion. It does not allow for system reform. The size of the pie stays the same or shrinks and the only way to succeed is to get a great big piece of that very small pie.
There is a clear winner and a clear loser. And that does not bode well for the next set of negotiations.
The interests of the patients are ignored, although the interests of taxpayers appear to be protected. One problem is that those taxpayers are also patients. We all need health care.
The other big problem is that the relationship between the two parties is harmed. How can the Government seriously expect to engage physicians in system reform after they have imposed cuts using bully tactics?
Sooner or later, in 2 weeks, in 2 months or in 2 years the Government is going to have to negotiate an agreement with physicians. The only way to do that is to engage in interest-based, mutual gains bargaining.
We need to check our positions at the door. Our patients deserve it.
Scott Douglas Wooder, MD