2018 CMPA Annual Report · Salus Global partnership, Saegis SafeORTM program CMPA Perspective ... results, and that our future success depends on our ability to adapt to the changing

2018 C M P A A N N U A L R E P O R T

T H E C A N A D I A N M E D I C A L P R O T E C T I V E A S S O C I A T I O N

2 2018 CMPA Annual Report

Our mission: To protect the professional integrity of physicians and promote safe medical care in Canada.

Our vision: The CMPA is valued as an essential component of the Canadian healthcare system.

Our value proposition: At the CMPA, we believe in a healthcare system that provides quality care for patients, promotes physician and provider wellness, is efficient and effective in its delivery, and is sustainable for the future. To achieve this, we provide value to the Canadian healthcare system by:

For more information, please visit www.cmpa-acpm.ca

Table of contents:

4President and CEO message

9

Performance report

26

Financial and risk management report

41

Leadership

Delivering physician-to-physician medical-legal education, advice and assistance

Providing timely and appropriate compensation to patients harmed by negligent medical care (fault in Québec)

Collaborating with stakeholders and leveraging our pan-Canadian experience and perspective to effect positive change in healthcare

Advancing innovative solutions to meet evolving member and stakeholder needs

Supporting physicians in delivering safe care to Canadians through evidence-based products and services

2018 CMPA Annual Report 3

For more information, please visit www.cmpa-acpm.ca

over

17,900 CPD attendees

How the CMPA provided value in 2018

over

9,700 newly opened

medical-legal cases

over

22,600 newly opened advice

matters

over

310 continuing

professional development (CPD)

sessions and

Salus Global partnership,

Saegis SafeORTM program

CMPA Perspective

FEATURE ARTICLES:

▪ College complaints are on the rise: Better communication can help

▪ Medical assistance in dying: Where do we stand two years later?

▪ Creating a culture of accountability promotes safe medical care

▪ Managing stress when transitioning to new electronic record systems

Compensation

to patients

$260 million

over

250 policy

submissions and stakeholder engagements:

eHealth, patient safety, medical and

healthcare standards and frameworks, and other

issues


We are pleased to report that 2018 was another highly successful year for the Canadian Medical Protective Association (CMPA), as we continued to provide the high quality medical liability protection and risk management services that our almost 100,000 physician members rely upon. Our 2018 CMPA Biennial General Membership Survey confirmed that Canadian physicians overwhelmingly value our assistance and the services we provide.

In an increasingly dynamic environment, the CMPA seeks to effectively balance continuity and change. We recognize that our past record of success is no guarantee of future results, and that our future success depends on our ability to adapt to the changing requirements of our members and the healthcare system in which they practise.

During 2018, we made important progress in improving our ability to meet physicians’ changing medical liability protection needs. Our Member Support Program, aimed at assisting physicians whose medical-legal experience is greater than their peers, is unique in Canada. When combined with the tailored education programs of our subsidiary Saegis and those of other organizations, the Member Support Program provides a pathway for those physicians to return to a professionally satisfying career. By 2020, our highly regarded resident symposia will ensure that all residents in Canada receive exposure to medical liability considerations early in their career.

Working closely with Saegis, we are delivering an increasing number of evidence-based in-depth programs that benefit physicians, the teams they practise with and the institutions in which they deliver care. Saegis’ flagship surgical safety program, SafeORTM, brings together the innovative technology of the Operating Room Black Box® with data-driven, solutions-oriented risk management assistance to greatly improve the safety of care in surgical operating rooms.

Our decision to partner with the Healthcare Insurance Reciprocal of Canada and the Society of Obstetricians & Gynaecologists of Canada to advance the efforts of Salus Global and its MOREOB program is just one illustration of our willingness to collaborate with others to improve the safety of care. It recognizes that, regardless of their type of practice, physicians do not practise alone and that a “just culture” is essential in well-functioning teams and institutions.

President and CEO message

2018 CMPA Annual Report 5While we at the CMPA are proud of our accomplishments in 2018, we know that, if we are to continue to be valued by Canadian physicians, we must evolve what we do and how we do it. Our efforts to encourage provincial and territorial medical regulatory authorities to apply compassionate regulation, and our advocacy for broader system-level commitments to improve physician wellness are just two examples of how we positively shape the environment in which CMPA members practise.

The CMPA recognizes that, when appropriately implemented, technology can substantively improve the effectiveness and efficiency of care. However, when implementation is poorly conceived or executed and when physicians are not constructively engaged in the process, it is physicians and their patients who bear the brunt of the resulting shortfalls. We are committed to assisting physicians as they adopt new tools and processes. We will also enhance our services through the application of technology, including greatly improved access to the information and assistance members need.

Our recently released 2019-2022 Strategic Plan will guide the Association as we move forward in a challenging environment, as will our ongoing adherence to the core values that reflect the ethos of the medical profession. Both our elected council of physicians and our physician-led management team understand the challenges of practising medicine in Canada. By providing empathetic assistance to physicians experiencing medical-legal difficulty and by improving the safety of medical care, we will continue to earn the trust of physicians and their patients. In 2019 and beyond, our members can rely on the CMPA to be there when needed.

Debra E. Boyce, BSc, MD, CCFP, FCFP President

Hartley S. Stern, MD, FRCSC, FACS, ICD.D Executive Director and Chief Executive Officer


99,708MEMBERS Specialists

50%

Residents Family medicine

37%

OUR SERVICES

In 2018, membership grew by 2.1%, an increase of just over 2,000 members. Since 2014, membership has grown by 8.9% or just over 8,100 members.

Continuing professional development

BRITISH COLUMBIA

AND ALBERTA

SMAT* ONTARIO QUÉBEC

Events 86 60 100 72

Attendees 5,531 1,807 5,761 4,852

Physician-to-physician contact is an important part of our service model. Our physicians interacted directly with members over 61,000 times in 2018 through a variety of channels to provide advice and offer caring and meaningful support.

*Saskatchewan, Manitoba, Atlantic provinces, and Territories

OUR MEMBERS

2018 by the numbers

380active employees at the end of the calendar year

Our physicians are experienced in the following areas of practice:

29% Family medicine

28% Surgical specialty

OUR PEOPLE

By type of work:

40% Medical specialty

3% Obstetrics and gynecology

81 physicians and other healthcare professionals

By region:

ONTARIO

40,042MEMBERS

ç 9% since 2014

SMAT*

13,249MEMBERS

ç 6% since 2014

QUÉBEC

20,280MEMBERS

ç 7% since 2014

BRITISH COLUMBIA AND ALBERTA

26,137MEMBERS

ç 12% since 2014

60 years and older

22%

41 to 59 years

41%

40 years and younger

37%

By age:

13 %


QUÉBEC

OUR SERVICES (Continued)

■ NEW MEDICAL-LEGAL CASES 2018 2017 2016 2015 2014 Legal actions 900 837 891 862 863 College (medical regulatory authority) matters 5,628 5,235 5,088 4,723 4,252 Hospital matters 1,955 1,675 1,743 1,611 1,486 Paying agency matters 236 246 218 198 256 Other Ɨ 1,041 993 963 923 895 TOTAL NEW MEDICAL-LEGAL CASES 9,760 8,986 8,903 8,317 7,752

■ RESOLVED LEGAL ACTIONS 2018 2017 2016 2015 2014Judgment for plaintiff 8 14 9 4 26 Judgment for physician 53 48 45 55 85 Settled 276 274 290 350 377 Dismissed/discontinued/abandoned 441 433 495 483 578

TOTAL RESOLVED LEGAL ACTIONS 778 769 839 892 1,066

■ NEW ADVICE CONTACTS 2018 2017 2016 2015 2014

Advice to members 22,622 21,828 20,632 19,267 17,770

ONTARIO

SMAT*

Legal actions settled

BRITISH COLUMBIAAND ALBERTA

Legal actions dismissed/ discontinued/abandoned

Judgment for plaintiff

Judgment for physician

0 100 200 300 400

ONTARIO

QUÉBEC

SMAT*


0 2,000 4,000 6,000 8,000 10,000 12,000

*Saskatchewan, Manitoba, Atlantic provinces, and Territories

QUÉBEC

Other


College (medical regulatory authority) matters

Hospital matters Legal actions

0 1,000 2,000 3,000 4,000

ONTARIO

SMAT*

Ɨ Effective 2018, “Other” includes human rights, inquests, privacy investigations, threats and other matters.


What members told us in the 2018 CMPA Biennial General Membership Survey

The compassionate, professional, informative support that I have received on the occasions that I have called the CMPA is very much appreciated. All those at the other end of the phone have provided timely, solid advice.

I felt cared for as a person and professional, all the way through. I cannot imagine facing a complaint without the CMPA advising and supporting me.

The CMPA helped restore my personal confidence and allowed me to move forward in a more positive direction, ultimately translating into improved focus and patient care.

I think the CMPA does an excellent job in supporting its members with medical-legal issues and in providing ongoing relevant educational tools.


1Assist

physiciansContribute to safe medical

care

2Support the

medical liability system

3

2018 P E R F O R M A N C E R E P O R T


Delivering relevant and valued medical liability protectionPhysicians contact the CMPA every day, seeking advice and assistance for the challenges they face in their medical practice. In 2018, our physician advisors provided informed, reliable and professional guidance on over 22,600 advice matters, ranging from duty of care to communication and reporting duties to diagnostic concerns and electronic medical records.

The experience…met my needs and my question was

answered immediately and accurately. I was able to

manage my issue later that day and felt confident in how I

approached it. — CMPA member

Members also turned to us in increasing numbers to assist them with medical-legal issues. In 2018, we opened over 9,700 new medical-legal matters including civil legal actions, College (medical regulatory authority) complaints, hospital matters, and other medical-legal issues. While the number of legal actions has remained stable over the last decade, we continued to see an increasing number of members seeking our assistance with College and hospital matters. These increases have been experienced in every region and reflect the range of pressures facing physicians across the country.

Every day I talk to members and help them with issues that arise in their medical practice. This involves opportunities to provide meaningful support, coaching and advice. Members regularly tell me that our conversations and CMPA articles greatly contribute to reducing their stress and allows them to focus on what is most important to them—providing excellent healthcare for their patients.

Canadian physicians care for their patients, confident the CMPA will assist them in reducing their medical liability risk and protect their professional integrity.

The CMPA provides medical liability protection for matters arising from the professional practice of medicine. Our continuum of support includes education to reduce harm and, in response to a medical-legal issue, advice, support and, if required, legal assistance. In the event a patient has been harmed by negligent medical care (fault in Québec), the CMPA provides appropriate compensation on the physician’s behalf.

Assist physicians

1

Dr. Geoffrey Hung is an associate senior physician advisor in our Physician Consulting Services department. He joined the CMPA in 2013 following eight years in practice as a pediatric emergency physician in Vancouver.


We are committed to listening to members, understanding the evolving healthcare environment, and adapting our assistance to meet changing conditions. Our 2018 CMPA Biennial General Membership Survey provided additional insight on the challenging nature of the environment in which physicians practise. While we are encouraged by the high levels of member satisfaction with the range and quality of our services, we recognize that, to continue to deliver value to our members, we must adapt those services and how we deliver them to align with the evolving needs of Canadian physicians.


Hospital matters opened

96% satisfaction

95% satisfaction

94% satisfaction

89% satisfaction

Advice, support and

guidance

Civil legal actions opened

College(regulatory authority)

matters opened

Supporting members with College complaintsRequests from members for assistance with College (regulatory authority) complaints have risen by 80% over the past 10 years, totaling over 5,600 newly opened matters in 2018. Members report that the experience of a College complaint can be very stressful and that the CMPA’s assistance with understanding the process and navigating the system is highly valued. In addition to assisting members who are already the subject of a complaint, we deliver data-driven education to reduce the likelihood of members becoming involved in such situations.

As communication, either with patients or between healthcare providers, is at the root of many College complaints, we provide practical advice on improving communication in our presentations and workshops.

College complaints on the rise:Better communication can help

Communication is at the root of many College complaint cases. To improve interactions with patients, potentially curb

complaints and reduce stress, physicians should consider their communication skills.

In the last 10 years, requests for CMPA

assistance with College complaints have increased

from 3,130 requests (2009) to 5,628 (2018).

Tips on being a better communicator

When receiving information from patients1. Focus on your patient2. Listen actively3. Understand your

patients’ perspective

When delivering information to patients1. Express empathy2. Provide clear and

simple information3. Share decision

making

For more tips on being a better communicator, read “College complaints on the rise: Better communication can

help” at www.cmpa-acpm.ca

2009 ... 2018

80%


Through its ongoing engagements with medical regulatory and hospital authorities, the CMPA is committed to ensuring that, when faced with a College complaint or hospital matter, physicians have access to compassionate and fair resolution of those matters. To that end, we have actively advocated for the development of a just culture in which all parties are treated respectfully and fairly, and where the emphasis is on remediation.

I hear from members every day that they feel stressed. Changing regulatory processes, issues with colleagues, and expanding public expectations all contribute to the increasingly challenging nature of medical practice. As a CMPA physician advisor, I’m here to support my physician colleagues and provide informed and compassionate advice, knowledge and assistance to help them through these matters.

SUCCESSFUL PATIENT INTERACTIONS had 61 participants in 7 workshops across Canada.

This course is a great tool for improving team effectiveness. Having a course that facilitates collaboration between physicians and nurses (and other disciplines) is something that is unique and can really help transform a team. —Effective Team Interactions participant

EFFECTIVE TEAM INTERACTIONS had 92 participants in 9 workshops across Canada.

In 2018...

This course enabled me to translate technical medical terms and language into a conversation with the patient that I feel enables the patient to better understand their diagnosis and plan. I feel like the patient better understands what we are trying to accomplish as a team, and this reduces risk of misinterpretation and complaints and lawsuits. —Successful Patient Interactions participant

Dr. Shena Riff joined the CMPA as a physician advisor in 2013 after 15 years in practice as an emergency medicine physician in Ottawa, where she continues to have a clinical practice.

Our subsidiary Saegis offers programs for physicians and other healthcare practitioners designed specifically to enable more effective communication and safer interactions with colleagues, teams, and patients.

In 2018, 16 Effective Team Interactions and Successful Patient Interactions workshops were delivered by Saegis educators to over 150 attendees across Canada, and the Clinical Communication Program was launched. This unique 3-day intensive program is the only program of its kind in Canada and is designed specifically for physicians who want to reduce the risk of complaints and improve safety in their practices.


Providing tailored assistance for members in needThe CMPA’s Member Support Program (MSP) proactively identifies and offers assistance to members whose medical-legal experience is greater than that of their peers. This innovative program addresses factors that contribute to medical-legal difficulties, enhances the quality of patient care, and helps members to have professionally meaningful and fulfilling careers in medicine.

At the end of 2018 and one year after the launch of the MSP, we had provided tailored support to over 230 members in need. Through one-to-one advice and individualized education plans, tailored support was offered to address members’ specific needs. Recognizing that change is often difficult, the program included ongoing outreach and support to members as they reflected on and took measures to improve their practice.

The response to the program has been highly positive, with many members embracing the opportunity to deal with the factors contributing to their medical-legal difficulty.

THE CMPA MEMBER SUPPORT PROGRAM:

a year of positive change

We know that every one of our members aims to provide the best care possible every day. We also know that many physicians face significant pressures which can sometimes frustrate the provision of optimal patient care. When these pressures lead to challenges with communication, collaboration, and professionalism, they can trigger complaints and contribute to the risk of a legal action.

It gives me a sense of support and safety that the CMPA is looking after physicians. The MSP has a

number of different support options and it’s great to know that there are different programs out there to

address the various issues that may arise from day-to-day life as a physician.

—Member Support Program participant

Dr. Dale Taylor is the senior physician advisor leading the Member Support Program. He joined the CMPA in 2012 after 27 years in practice as a general surgeon in smaller urban centres in Ontario.


Promoting healthier physicians Evidence-based research demonstrates that physician wellness positively influences the quality of patient care. Heavy workloads, increased administrative demands, decreased autonomy, growing public scrutiny, and inadequate institutional support can all contribute to a deterioration in a physician’s well-being. Since there is rarely a single factor leading to physician burnout, the CMPA strongly advocates that supporting wellness must be a shared responsibility that draws on the efforts of multiple organizations at the provider, health delivery and policy levels of the health system.

When members call, they tell us they value the opportunity to speak to a physician colleague who understands the pressures they are facing. Our physician advisors guide members to the resources available in their local jurisdiction and we are increasingly working with the resource providers to support physicians in need.

Our post-contact survey results highlight the value of the advice CMPA members receive:

98% of members were satisfied with the service they received

71% reported a drop in their stress levels following contact

2018 CMPA Annual Report 15At the healthcare delivery level, we believe that an emphasis on just culture embraced by physicians, healthcare teams and leaders creates a supportive system, leads to a safer healthcare environment, and reduces physician burnout and stress. In 2018, we delivered workshops to over 400 physician leaders to assist them in gaining the knowledge and skills required to establish a workplace culture that promotes and prioritizes safe medical care. In 2018, Saegis began offering the Just Culture Certification course that supports healthcare institutions in adopting a culture of learning that can improve patient safety and reinforce behaviours that support and protect the organization’s values, improve systems, reduce negative outcomes and improve team morale.

Supportive policy and regulation is also vital for maintaining the wellness of physicians and other healthcare providers and the CMPA actively seeks to influence policy and regulation to improve physician health and wellness. Our 2018 Information Session, entitled “Healthier physicians: An investment in safe medical care” brought together thought leaders to extend the critical conversation around physician wellness and to advocate for substantive progress in addressing this pressing issue.

This CMPA backgrounder was released at the 2018 CMPA Annual Meeting and Information Session.

By the end of 2018, the document was viewed over 3,500 times and ranked amongst the top 100 most viewed pages on the CMPA website.

JustCulture


In support of a high-quality and effective healthcare system, the CMPA contributes to safe medical care to reduce harm resulting from the provision of care.The CMPA contributes, in collaboration with stakeholders, to safe medical care by leveraging our knowledge and expertise to identify risks, analyze their causes, and develop and deliver safe care strategies. The Association actively promotes policies, programs and practices, and shares data, analyses and strategies to contribute to the provision of safe healthcare.

Physicians in practice

161 events

25 events

73 events

Physicians in high risk specialties

Physician leaders

Delivering practice improvement education

9,786 attendees

Physicians in training

59 events

3,052 attendees

1,493 attendees

3,620 attendees

Contribute to safe

medical care Delivering safety improvement education to healthcare teams across

Canada affords me the opportunity to meet with physicians and their teams regularly. Not only do I share proven safe care knowledge and practical tips to help reduce risks in their practice, I also have the opportunity to engage with members and hear about their needs and concerns. These insights help to inform our future education offerings, ensuring they remain valued and relevant.

The CMPA provides members with data-driven risk management information, advice, and education on leading safe care practices. In 2018, our experienced physician educators delivered over 300 sessions to almost 18,000 physicians and other healthcare professionals on a variety of safe medical care topics addressing communication, collaboration, safer diagnostic processes, and disclosure and resilience following an adverse event. Our regional conferences, customized workshops, and presentations reach members from coast-to-coast-to-coast, assisting them in delivering safe care and in addressing issues that affect their ability to practise.

2

Dr. Robert Johnston is a physician advisor in our Practice Improvement department. He joined the CMPA in 2017 following 20 years of practice in the Canadian Armed Forces, most recently as medical director of the Canadian Armed Forces Medical Simulation Centre at CFB Valcartier.


With a view to improving the safety of patient care, we share our evidence-based safe care knowledge through CMPA Perspective and CMPA eBulletin articles, publications, our website and The Good Practices Guide. Each article is developed using data-driven insights garnered from analyzing medical-legal cases, our calls with members and lessons drawn from our strong network of safe care collaborators. This information is available on our website and increasingly through mobile devices, providing members with ready access to valuable safety insights.

97% satisfaction with our resources

96% say the CMPA is their go-to resource when looking for information about medical-legal or patient safety matters

say they incorporated their learning into their everyday practice85%

more than 7 out of 10 respondents would recommend our resources

Providing resources that matter



Collaborating and innovating to improve safe care

Salus Global partnership to enhance obstetrical safety

With the goal of advancing the safety of obstetrical and perinatal care in Canada, the CMPA joined the Healthcare Insurance Reciprocal of Canada (HIROC) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) as an equal partner in Salus Global, the provider of the MOREOB program. By significantly improving teamwork and communication across all disciplines involved in care, the MOREOB

program has a long track record of improving clinical outcomes and reducing harm in obstetrical and perinatal care.

Joint publications

Building on the knowledge of each organization, the CMPA and HIROC have expanded our collaborative efforts to enhance the safety of care, including by publishing a report entitled Delivery in Focus: Strengthening Obstetrical Care in Canada. With the goal of improving obstetrical outcomes for patients, the report identifies contributing factors to patient safety incidents and offers mitigation strategies for healthcare providers and organizations. This report is the result of a comprehensive review of 10 years of CMPA and HIROC obstetrical cases and provides value-added analysis on our shared top risk areas.

Surgical Safety Technologies partnership

Through our subsidiary Saegis, the CMPA is fielding a range of healthcare safety programs and practice management services, reaching physicians, healthcare professionals, hospitals and institutions. As one example, the SafeORTM program aims to enhance safety and improve teamwork in surgical units. By partnering with Surgical Safety Technologies (SST), the SafeORTM program combines the groundbreaking technology and analysis of the Operating Room Black Box® with the education and quality improvement expertise that Saegis has built as a member of the CMPA family.

As is the case with any successful organization, the CMPA continually seeks to innovate and look for new opportunities and partnerships to add value for our members and contribute to the delivery of safe medical care. By bringing our strengths to partnerships and collaborative efforts, we are making a tangible difference in improving patient care across the country.


Fun and interactive means of presenting information that could have easily been dry.

The symposium had relevant take home points and made it easy for me to identify how to integrate

and apply patient safety into my practice. —University of Ottawa resident

92%would

recommend the symposium to

their peers

92%of residents believe they can

reduce their medical-legal risk as a result of participation

in the symposium

99%of residents intend to make improvements

in their practice related to: clarifying responsibilities, documentation,

consent discussions, teamwork, and disclosure of harm

CMPA Resident SymposiumIn collaboration with Resident Doctors of Canada and with the support of Canada’s 17 medical schools, we are delivering the innovative CMPA Resident Symposium to resident physicians across the country, providing early career physicians with risk reduction knowledge that will benefit them and their patients throughout their careers. In 2018 we delivered the symposia to approximately 1,300 resident physicians at six schools and will expand this to all 17 Canadian medical schools by 2020.

Resident physicians from the University of Toronto


Empowering safe care through evidence-based research

The power and potential of data is emerging more and more in our current environment. It is a foundational building block of CMPA work. The research my team performs is converted into safe medical care knowledge translation products that are shared with our members and stakeholders. Our insights and analyses turn data into action.

Using medico-legal data to support safe medical care: A contributing factor coding framework

Published in the Journal of Healthcare Risk Management, this paper discusses a new patient safety-informed framework developed by the CMPA, which acknowledges the effects of team, organizational, and system factors, in addition to physician care.

Improved hospital safety performance and reduced medico-legal risk: an ecological study using two Canadian databases

This paper, published in CMAJ Open, analyzes databases from the CMPA and the Canadian Institute for Health Information’s (CIHI) Discharge Abstract Database, to determine if there was a relationship between in-hospital patient safety events and medical-legal cases involving physicians in Canada.

The following are two of our research manuscripts published in 2018:

We recognize that healthcare system transformation relies on data analytics and research. In my role, I help translate data into meaningful insights that can be shared not only through our own publications and education events, but also at conferences and in journal articles where they can reach broader and more diverse audiences.

Using innovative quantitative and qualitative analysis techniques to leverage the potential of our extensive medical-legal data holdings, we gain insights and identify gaps in medical care. Building on our long history of sharing our insights with members through risk management information, education and publications, we have increased our efforts to publish our findings in peer-reviewed journals, further supporting physicians and researchers in quality improvement, patient safety, and medical education.

Dr. Lisa Calder joined the CMPA as the Director of Medical Care Analytics in 2015 after 15 years in practice as an emergency medicine physician in Ottawa.

Heather Neilson is a research author in the Medical Care Analytics department. She joined the CMPA in 2018 after 14 years with Alberta Health Services as an epidemiology research associate.


Building member capacity to improve safetyAs building physicians’ skills and abilities to improve their practice leads to improved safety, our educational programs are designed to have a lasting effect on how members deliver care. Through analysis of our data and by listening to our members, we identify subject areas where our education can add the greatest value. One such area is ensuring and maintaining effective test follow-up processes.

In 2018, we began delivering the “Is No News Good News? Build a more reliable follow-up system for test results” workshop, geared to help members with identifying potential process failures in a practice and planning a safer system for managing investigation results. Through this workshop, members are invited to participate in our coaching program to receive additional support in implementing changes in their practice, thereby supporting an enduring effect of the educational program.

88% of 400+ workshop attendees were “inspired to take action to assess and improve their test result follow-up system”.

Members participating in the coaching program reported a 92% positive impact on their practice and 100% felt that their anxiety was reduced.

I had an epiphany at the workshop and now appreciate my level of responsibility to close

the loop and ensure effective test follow-up. —Workshop participant

Our workshops and presentations provide our members with the tools and knowledge necessary to effect scalable improvements in the safety of care. Members who volunteered to participate in a commitment-to-change program received individualized telephone support to foster implementation of what they learned in the workshop. They tell us that they identified instances where test results were ‘caught’ that otherwise might have been missed—all as a result of changes to their processes following the workshop. They also tell us that they adopted lessons learned from our training, and they are successfully sustaining the change in their practice.

Dr. Janet Nuth is a physician advisor in our Practice Improvement department. Prior to joining the CMPA in 2008, she worked in the department of emergency medicine at the Ottawa Hospital for over 20 years.


Support the medical liability system

The CMPA supports an effective and sustainable medical liability system that meets the needs of physicians and their patients.

By supporting the availability of physician care, an effective and sustainable medical liability system is an essential element of a well-functioning healthcare system. The CMPA works with members, medical and healthcare organizations, and governments to advance collaborative approaches to contain medical liability protection costs. With the goal of retaining a fully funded position, the Association maintains a transparent and predictable membership fee structure.

Influencing key legislation, regulation, and policiesAs Canada’s largest physician organization, and with the support of our nearly 100,000 physician members, we offer data, expertise, and expert viewpoints to effect positive change on healthcare and medical-legal issues. In 2018, we engaged with governments, medical associations, regulatory authorities, healthcare leaders and others to influence legislation, regulation and policies that impact the member practice and medical-legal environments. We also supported our members with understanding and navigating these system changes.

▪ Regulated health professions acts (including Bill 130 in Québec)

▪ Physician wellness

▪ Membership fees and system costs

▪ E-health (electronic medical records)

▪ Patient safety (medical assistance in dying, opioid prescribing, quality of care, and culture of safety)

Top 5 areas of engagement

3


Containing medical liability protection costsThe CMPA recognizes that increasing medical liability protection costs can place pressure on our members and, through reimbursement programs, on provincial and territorial governments. Within a service delivery model that continues to deliver the high quality services members need, we share the goals of containing the growth in costs and maintaining a predictable fee structure, and, in 2018, our membership fees were over $50 million less than the preceding year. We remain committed to the prudent use of the resources that members have entrusted to us.

$Improving medical liability system effectiveness and efficiency While the Canadian medical liability system is widely recognized as being one of the best in the world, we advocate for sensible reforms that can further sustain its effectiveness, efficiency, and equity. The CMPA employs a defence philosophy that, while ethically defending the defensible, aims to quickly resolve those issues where medical negligence has resulted in patient harm.

We are also committed to contributing to initiatives that can improve the medical liability system and we have been active in wide-ranging consultations with provincial governments and other bodies to reduce unnecessary system costs or processes that unduly extend the time required to resolve medical-legal matters, be they through the civil justice system or the administrative system used by Colleges and hospitals.

As one example, in 2018 we contributed fact-based and expert perspectives to the quadrennial review of the Ontario discount rate, building on our knowledge of sound practices in other Canadian and international jurisdictions.

4


I feel fortunate to be able to leverage my past education and experience, and link my current studies in healthcare quality to my work at Saegis. Gaining the knowledge to systematically examine, evaluate and measure current tools and approaches to system improvements allows me to contribute to advancing patient safety and practice management.

Kirsten Devenny joined the CMPA in 2009 as a medical analyst and recently moved to a new challenge as a Program Lead for Saegis. Kirsten is a registered nurse and prior to joining the CMPA she worked in general surgery at the Queensway-Carleton and Ottawa hospitals. Kirsten is currently pursuing a Master of Science in Healthcare Quality (MScHQ) at Queen’s University, which specializes in linking theory and practice in quality, risk and safety in healthcare.

Supporting and empowering a talented workforceThe transformation of healthcare and the growing impact of technology affects our members and how they practise. This dynamic environment necessitates a greater degree of organizational flexibility and responsiveness and requires a talented, empowered workforce that can respond quickly to changing member expectations. Employee wellness is crucial as our staff deliver high quality results and we continue to offer market competitive compensation and benefits, providing employees with greater choice so they can tailor those benefits to their needs. To align the capabilities of our staff with future organizational needs, in 2018 we invested in learning opportunities that emphasized analytical skills, change leadership, critical thinking and project management and we supported staff as they undertook programs to further enhance their knowledge and skills.

Improving results through a culture of innovationWhile encouraged by the very positive results from our 2018 membership survey, we continue to challenge ourselves to achieve results that improve the member and employee experiences and address operational effectiveness and efficiencies. By encouraging staff level problem solving and challenge of the status quo and by recognizing creative ideas and initiatives, we are committed to a culture of innovation.

In 2018, our staff proposed and implemented ideas for streamlining processes, addressing pain points, more effectively using data analytics and implementing technologies. Our members continue to benefit from the culture of innovation that characterizes the CMPA and our employees.


A new converged data storage and virtualization server solution was implemented in 2018 which provided increased performance, flexibility, and capacity, allowing our analysts better access to data that they turned into insights for adapting our products and services to members.

Leveraging technologyThrough carefully considered investments in technology, we continue to cost-effectively enhance our capabilities to deliver services in a secure and efficient manner that provides members with improved access to the information, advice and assistance they need. Increased availability of mobile and web-based services, such as the streamlined membership application process, improve the member experience, strengthen organizational resilience and support cost-effectiveness. By combining a wider array of digital services with the ongoing ability of members to have one-on-one discussions with our physician advisors, we are recognizing and responding to the busy schedules maintained by practicing physicians.

Krishna Kunkala is an infrastructure architect in the Information Technology department. He joined the CMPA in 2018 after 17 years working on leading edge technologies in India, the United Kingdom, and Canada.

Championing diversityEffective organizations succeed when they make the best use of a wide range of perspectives and skill sets and the CMPA is committed to enhancing the diversity of our workforce and elected council. We value both the experiences that a diverse team brings to our ability to serve an equally diverse membership and we actively encourage diversity through our recruiting and employment practices and through the nominating and election process of our Council.

Effective and engaged governanceMembers benefit from an engaged council of physicians elected by their colleagues from across the country. Council and its committees bring the perspective of the practising physician to CMPA decision-making and, recognizing the career-long relationship between the physician and the Association, are committed to the long-term health and sustainability of the CMPA. Ongoing renewal of council through elections ensures an optimal balance of continuity and new perspectives. In 2018, we enhanced the information available and the processes through which members seek nomination for election to Council, resulting in an all-time high number of well-qualified and diverse candidates for consideration by the Nominating Committee.


2018 F I N A N C I A L A N D R I S K

M A N A G E M E N T R E P O R T


Financial informationREPORT OF THE AUDIT COMMITTEE

The Canadian Medical Protective Association (CMPA) undertakes to manage the funds it holds in a prudent manner. The funds are held to meet incurred obligations arising from the provision of legal representation to members and appropriate compensation for patients proven to have been injured through negligent medical care (fault in Québec).

The CMPA Audit Committee is responsible for reviewing the consolidated financial statements and the annual report, and for meeting with management and external auditors to discuss internal controls over the financial reporting process, auditing matters and financial reporting issues. Council, on the recommendation of the Audit Committee, approves the consolidated financial statements.

The Audit Committee is comprised of five members of council, plus two external financial experts, all of whom are independent of management. The Committee meets quarterly to ensure its fiduciary duties are discharged in an appropriate manner consistent with good governance and sound operational procedures. The reports of the Audit Committee to council are a standing item on the quarterly agenda for council meetings.

In the coming years, the Audit Committee will continue to ensure potential financial risks to the Association have been identified and adequately assessed, and appropriate measures implemented to manage those risks.

On behalf of the Committee, I am pleased to report the delivery of the 2018 consolidated financial statements as prepared by management and audited by the firm of KPMG LLP.

The external auditors have provided an unmodified opinion on the statements, attesting that they present fairly, in all material respects, the results of the 2018 operations, and the financial position of the CMPA as of December 31, 2018.

Darcy E. Johnson, BSc, MD, CCFP, FCFP Chair


2018 Financial results overview

The CMPA provides timely and appropriate compensation for patients proven to have been injured as a result of negligent medical care (fault in Québec).

Compensation to patients

$10 MILLION

The CMPA actuarially estimates the total resources required to provide protection to its members including providing compensation to patients.

Provision for outstanding

claims

$88 MILLION

Assets to compensate patients and

support members

$114 MILLION

In 2018, the CMPA paid $260 million to patients harmed as a result of negligent medical care (fault in Québec), an increase of $10 million from 2017.

The CMPA invests to secure sufficient funds to compensate injured patients and to decrease membership fees.

The provision for outstanding claims includes the potential liability for future compensation to patients, legal and administrative expenses, for claims resulting from members’ practice.

At December 31, 2018, the actuarial estimate for the provision for all accumulated outstanding claims was $3,769 million, an increase of $88 million from December 31, 2017.

By investing membership fees, the CMPA seeks to generate sufficient returns to compensate injured patients and fund members’ protection, by matching or exceeding the long-term assumed return expectation of 5.5%.

In 2018, the portfolio produced positive returns. The net investment portfolio value of $4,594 million increased by $114 million over 2017.


2018 Financial PerformanceCMPA membership provides occurrence-based protection, which means members’ protection extends from the date care was provided, irrespective of when the claim is made. When compared to the claims-made protection offered by most insurers, this protection reflects the nature of medical protection and best meets the unique needs of physicians. Given the nature of our occurrence-based protection, the Association carries a potential liability for medical liability matters arising from its current and prior members’ medical professional work. This includes the work undertaken in 2018 and that from all preceding years.

The Association’s long-term financial objective is to hold at least one dollar of assets available for claims for each dollar of discounted liabilities. This approach provides physicians and their patients with confidence that, in the event of harm resulting from negligent medical care (fault in Québec), resources will be available to provide the appropriate protection and compensation. As of December 31, 2018, we hold $4,763 million in assets against the $4,118 million in liabilities, $3,769 million of which represent the accumulated provision for outstanding claims.

The consolidated financial statements include the accounts of the Association and our wholly owned subsidiaries:

Dow’s Lake Court Inc., was originally incorporated to manage the land and buildings occupied by the Association. Its mandate has since expanded under the operating name Saegis to include the provision of safe care and practice management services to the healthcare sector in Canada. Saegis’ mission is to make a difference in healthcare provider and patient experience through professional development, quality improvement and practice management solutions.

CMPA Investment Corporation, which holds a number of investment assets.

The Association’s long-term financial objective is to hold at

least one dollar of assets available for claims for each dollar of

discounted liabilities.

https://www.cmpa-acpm.ca/static-assets/pdf/about/annual-report/2018/2018_CMPA_Consolidated_Financial_Statements-e.pdf


HIGHLIGHTS OF THE CMPA’S FINANCIAL STATEMENTS WITH COMPARATIVE FIGURES FOR THE PREVIOUS FOUR YEARS

For more information, see the consolidated financial statements for the year-ended December 31, 2018, along with the Independent Auditors’ Report and related notes.

Investment portfolio Portfolio investments represent the value of assets held by the Association to fund the unpaid claims resulting from members’ professional practice. The performance objectives of the portfolio are to:

▪ provide sufficient returns to fund members’ protection and, as appropriate, compensate injured patients, by matching or exceeding the long-term actuarial return expectation of 5.5%; and,

▪ achieve positive value-added returns (over a passive benchmark return) after deducting management fees.

($ millions) 2018 2017 2016 2015 2014

STATEMENT OF FINANCIAL POSITION

Assest

Investment portfolio $ 4,681 $4,480 $3,872 $3,507 $3,134

Other assets 82 87 103 183 101

Liabilities

Provision for outstanding claims 3,769 3,682 3,579 3,585 3,468

Other liabilities 349 244 190 199 127

Net assets/(deficiency in net assets) $ 645 $ 641 $ 206 $ (94) $ (360)

STATEMENT OF OPERATIONS

Revenues

Membership revenue $ 637 $ 690 $ 566 $ 656 $ 404

Net investment income 3 415 204 158 334

Expenses

Compensation to patients, legal and experts 453 433 347 365 405

Insurance 25 57 68 - -

Increase/(decrease)in the provision for outstanding claims 88 103 (6) 117 281

Other expenses 74 69 68 68 63

Excess of revenue over expenses/(expenses over revenue) $ 0 $ 443 $ 293 $ 264 $ (11)

https://www.cmpa-acpm.ca/static-assets/pdf/about/annual-report/2018/2018_CMPA_Consolidated_Financial_Statements-e.pdf


($ millions) 2018 2017 2016 2015 2014

STATEMENT OF FINANCIAL POSITION

Assest

Investment portfolio $ 4,681 $4,480 $3,872 $3,507 $3,134

Other assets 82 87 103 183 101

Liabilities

Provision for outstanding claims 3,769 3,682 3,579 3,585 3,468

Other liabilities 349 244 190 199 127

Net assets/(deficiency in net assets) $ 645 $ 641 $ 206 $ (94) $ (360)

STATEMENT OF OPERATIONS

Revenues

Membership revenue $ 637 $ 690 $ 566 $ 656 $ 404

Net investment income 3 415 204 158 334

Expenses

Compensation to patients, legal and experts 453 433 347 365 405

Insurance 25 57 68 - -

Increase/(decrease)in the provision for outstanding claims 88 103 (6) 117 281

Other expenses 74 69 68 68 63

Excess of revenue over expenses/(expenses over revenue) $ 0 $ 443 $ 293 $ 264 $ (11)

The Association has adopted investment policies, goals, and procedures to manage the investment risk to which it is exposed. Our investment practices are designed to avoid undue risk of loss and impairment of assets and to provide a reasonable expectation of fair return given the nature of the investments. We continue to believe that appropriate diversification is the most effective means of managing investment risk.

The portfolio produced positive returns during the year and the net investment portfolio value of $4,594 million represents an overall increase of $114 million over the year-end 2017 position (see “Net investment income” for more information).

Public assets are valued using the closing market price for each security at year end. Private assets (including private debt, equity and real assets) are valued at their original cost, less any accumulated impairments or estimated reductions in value. Unrealized gains on private assets are not recorded in the financial statements. It is estimated that net unrealized gains in the value of the private investments totaled $282 million at December 31, 2018; this is not reflected in the net carrying value of the portfolio.

The various classes of assets in the net investment portfolio are shown here.

19%

34%

20%

7%

4%

8%

Private assets measured

at amortized cost

Public Assets measured

at fair value

Public equities

Hedge funds

Private equities

Private debt

Private real assets

Fixed income

19%

73%

8%

Cash and short-term

investments

8%


Provision for outstanding claimsThe provision for outstanding claims is an actuarial estimate of the total resources required by the Association to provide medical liability protection to its members related to occurrences up to and including December 31, 2018. At December 31 2018, the actuarial estimate for the provision for all accumulated outstanding claims was $3,769 million, an increase of $88 million from December 31, 2017.

The difference in the provision for outstanding claims represents the year-over-year change in the estimated value of all unpaid claims resulting from the care already provided by our members. The table below illustrates the change in the liability from the beginning of the year to the end of the year, broken down between the updated experience of prior occurrence years, the addition of the current occurrence year, and the impact of insurance contracts used to transfer risk. The provision includes the estimated liability for future compensation to patients, and legal and administrative expenses for both reported claims and expected claims that have not yet been reported. It is prepared annually by the Association’s Chief Actuary, subjected to peer review by external actuaries, and audited by the external auditor. The provision is valued on a discounted basis of 5.5% to reflect the long-term investment return expectations.

FIVE-YEAR COMPARISON OF CHANGE IN PROVISION FOR OUTSTANDING CLAIMS

($ millions) 2018 2017 2016 2015 2014

Provision for outstanding claims, beginning of year $ 3,682 $ 3,579 $ 3,585 $ 3,468 $ 3,187

Payments on claims relating to occurrences in prior years (446) (416) (331) (362) (403)

Revaluation of the provision for outstanding claims relating to occurrences in prior years 73 11 (174) 14 234

Change in provision for outstanding claims in respect of occurrences in current year 536 573 541 465 450

Potential risk transfer from insurance contracts (75) (65) (42) - -

Provision for outstanding claims, end of year 3,770 3,682 3,579 3,585 3,468

Increase/(Decrease) $ 88 $ 103 $ (6) $ 117 $ 281


($ millions) 2018 2017 2016 2015 2014

Provision for outstanding claims, beginning of year $ 3,682 $ 3,579 $ 3,585 $ 3,468 $ 3,187

Payments on claims relating to occurrences in prior years (446) (416) (331) (362) (403)

Revaluation of the provision for outstanding claims relating to occurrences in prior years 73 11 (174) 14 234

Change in provision for outstanding claims in respect of occurrences in current year 536 573 541 465 450

Potential risk transfer from insurance contracts (75) (65) (42) - -

Provision for outstanding claims, end of year 3,770 3,682 3,579 3,585 3,468

Increase/(Decrease) $ 88 $ 103 $ (6) $ 117 $ 281

Net assets Net assets are the difference between assets and estimated liabilities and provide a point-in-time measure as to whether the Association has the resources necessary to meet its estimated liabilities. The overall net asset position can be expected to change from one year to the next, largely as a result of externally driven factors such as investment returns and/or claims experience. As of December 31, 2018, the Association had net assets of $645 million; the net asset position improved by $4 million over 2017.

80%

90

%

1

00%

110

%

12

0%

1

30%

121%

126%

106%

92%90% 90%

98%

105%

116% 116%

A TEN-YEAR VIEW OF THE CMPA FUNDED RATIOS (TOTAL ASSETS/TOTAL LIABILITIES)

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018


Membership revenuesRecognizing that the full cost of the medical liability protection arising from a given year may not be known for 35 or more years, the CMPA seeks to collect, as fees, sufficient funds from our members to cover the anticipated liabilities arising from care they will have delivered in that year. Given the nature of our occurrence-based protection, the fees collected in 2018 will be used to pay out protection costs resulting from care provided in 2018 over the next 3 to 4 decades. With the goal of members paying the costs of protection for the year in which the care was delivered, the CMPA estimates the expected occurrence-year costs1 as a basis for membership fees. In the event the actual experience is different from the predicted values, future fees may be adjusted (either increased or reduced) to address the difference.

The following graph provides a ten-year review of occurrence-year costs and membership revenues

800

700

600

500

400

300

200

100

0

(100)

Occurrence year costs (OYC)

Fee debit (credit) and other adjustments

Actual membership revenue

1. Expected occurrence-year costs are actuarially estimated costs for compensation to patients, and legal and administrative expenses arising from adverse medical events in the year of occurrence.

TEN-YEAR REVIEW OF OCCURRENCE-YEAR COSTS AND MEMBERSHIP REVENUES

($ millions)

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Occurrence year costs (OYC) (2019 estimate)

Fee credit (2019 schedule)

2018 CMPA Annual Report 35Net investment incomePortfolio investment income is the combination of interest, dividends, securities lending income, unrealized and realized gains and losses earned on securities, and impairments or recoveries of impairments in the year. Net investment income is comprised of portfolio investment income less investment expenses. The investment expenses represent monies spent, whether with external fund managers or internally within the CMPA, to generate investment income. In 2018, the portfolio generated revenue, before expenses, of $59 million. After taking into account investment expenses of $56 million, the net investment income was $3.5 million.

$50m $65m

-$78m

$22m

$59m

+- =Interest

incomeDividend income

Net realized/unrealized gains/losses and

impairment expense

Other

PORTFOLIO INVESTMENT INCOME


20%

15%

10%

5%

0%

The following table shows the annual returns calculated using the Modified Dietz Methodology2

compared against the actuarial investment return assumption. It demonstrates the year-over-year variance associated with investment returns and reinforces the need to maintain a long-term perspective in considering both asset management and the Association’s financial position. The 2018 investment return was 0.7%, below the assumed 5.5% return.

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Investment return

Actuarial assumption

2. The Modified Dietz Method is a calculation used to determine an approximation of the performance of an investment portfolio based on individual cash flows by the amount of time from when those cash flows occur until the end of the period.

PORTFOLIO INVESTMENT RETURN

2018 CMPA Annual Report 37Compensation to patients, legal, expert, and insurance costsCompensation to patients on behalf of members, along with the cost of legal services, expert consultants and insurance constitute the CMPA’s primary expenses, accounting for 86% of annual expenditures in 2018 (excluding the change in provision for outstanding claims). The specific timing of individual compensation payments can be difficult to predict and the totals may fluctuate from year to year.

In 2018, the $260 million in payments to patients was $9.6 million more than in 2017 and was the highest annual total to date. When compared to the prior year, this increase is largely attributable to a higher frequency of payments on cases with a value between $1 million and $5 million.

The following table highlights the year-over-year variability in payment totals, both at the regional level and when considered nationally.

COMPENSATION TO PATIENTS BY REGION

250

200

150

100

50

02009 2010 2011 2012 2013 2014 2015 2016 2017 2018

British Columbia and Alberta TotalQuébec

Ontario Saskatchewan, Manitoba, Atlantic provinces, and Territories

($ millions)

With the objective of reducing the volatility inherent in the compensation to patients component of the provision for outstanding claims, the CMPA has an insurance program to help protect the Association from unexpected costs for occurrences prior to December 31, 2018. At the end of 2018, the CMPA held six insurance policies that provide $673 million of protection against rising costs, subject to policy limits and thresholds.


Legal fees and disbursements are broken down into two categories: legal costs related to civil actions and threats (i.e. those that might lead to compensation to patients), and non-civil matters, which include advice, College complaints, hospital matters, and other forms of medical-legal assistance. The 5.5% increase in legal expenditures from 2017 is primarily due to the increasing volume of cases: civil, College, and advice case volumes have increased 4%, 9% and 11% respectively over 2017, with College and advice cases having steadily increased over the past 10 years.

The count of civil cases has been relatively consistent over the past decade, whereas it has increased for non-civil cases; meanwhile the average legal costs per case have remained generally constant as illustrated in the following graphs.

20

16

12

8

4

02009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Count (Only cases with costs have been included in the count)

Average $ per case

($ thousands)

10,000

8,000

6,000

4,000

2,000

0

Average per case

AVERAGE LEGAL COSTS PER CIVIL CASE

Number of cases

20

16

12

8

4

02009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Count (Only cases with costs have been included in the count)

Average $ per case

($ thousands)

16,000

12,000

8.000

4.000

0

Average per case

AVERAGE LEGAL COSTS PER NON-CIVIL CASE

Number of cases

2018 CMPA Annual Report 39Excess of revenue over expensesIn 2018, the CMPA’s revenues exceeded expenses by $0.4 million.

Financial summaryThe CMPA’s net asset position stands at $645 million, an improvement of $4 million from 2017. This positive funded position should provide members and their patients with confidence that the CMPA is appropriately resourced to meet the medical liability protection needs of our almost 100,000 members and the compensation requirements of patients injured as a consequence of negligent medical care (fault in Québec).


Significance and relevance

The CMPA must remain relevant and important to its members and stakeholders by responding to their needs, while preserving the mission and values that underpin the CMPA’s business model.

The CMPA took significant steps in 2018 to enhance member services and reinforce the CMPA’s value proposition. For example, the CMPA advanced the Member Support Program, launched the Resident Symposia, and continued investment in the infrastructure necessary to support these and other strategic initiatives. The CMPA also initiated a refresh of its strategic plan, a roadmap that builds on past success and supports the Association’s continued significance and relevance to members and stakeholders.

Financial sustainability

Increase in demand for CMPA services, combined with rising compensation and legal costs, place pressure on the CMPA’s financial position.

The CMPA promoted medical-legal risk reduction using a combination of education and research strategies, implementation of new products and services by its subsidiary Saegis, and collaborations aimed at meaningful improvement to the safety of care. The Association worked with stakeholders to explore opportunities to contain medical liability protection costs, including a submission to the subcommittee of the Ontario Civil Rules Committee, and provided input on other reasonable system improvements.

Changing healthcare perspective

The healthcare environment is changing rapidly, and the CMPA must continue to innovate and work collaboratively with stakeholders to support members in the delivery of safe care.

The CMPA engaged with governments, Colleges (regulatory authorities) and others to support members’ perspectives on key decisions affecting the delivery of safe and sustainable care, and the compassionate resolution of regulatory matters. By providing innovative educational programming and one to one support and guidance, the CMPA promoted members’ awareness and understanding of topics such as physician wellness, cultures of accountability, safety in high-risk practice, and cyber-security.

Managing our risksThe CMPA employs a risk management framework to identify, assess, and respond to risks that could have a positive or negative effect on the Association’s ability to achieve its strategic objectives. The incorporation of risk themes promotes awareness of the possible effect that a change in one risk may have on others, thus supporting an enterprise-wide approach to all risk management activities. This integrated and comprehensive process enables our risk control efforts to focus on what is important, ensures informed decision-making, and permits effective mitigation of unanticipated events.

Risk theme Risk consideration Mitigation activity update 2018 L E A D E R S H I P


2018 L E A D E R S H I P


Council 2018-2019

BACK ROW—Drs. Gerard P. Craigen, Fredrykka Rinaldi, Gordon A. Crawford, Birinder Singh, Michael Curry, Darcy E. Johnson, Alexander C. Barron, Katy A. Shufelt, Elliot M.H. Halparin

MIDDLE ROW—Drs. Victor F. Huckell, Patrick Trudeau, Claude Mercier, Yolande Leduc, Paul A. Farnan, Yvonne Molgat, Jean-Joseph Condé, Michel Lafrenière, Robert Cooper

FRONT ROW—Drs. Patrick C. Bergin, Sally Jorgensen, M. Christopher Wallace, Michael T. Cohen, Debra E. Boyce, Jean-Hugues Brossard, Michael E. Sullivan, Jennifer A. Gillis-Doyle, Steven M. Edworthy

MISSING FROM PHOTO—Drs. Susan M.J. Chafe, David Naysmith

The CMPA is governed by an elected council of physicians representing 10 geographical areas across Canada, and practising in different specialties in the fields of medicine, surgery, and general practice. CMPA Council plays an important role in the overall success of the Association. It governs the Association and provides direction, guidance, and support to CMPA management in running the Association’s day-to-day business. The 2018-2019 governance structure consists of council and 11 committees. Each year, approximately one-third of the positions on council are scheduled for nomination and election. The council meets quarterly to foster the long-term success of the Association.


AREA 1—BRITISH COLUMBIA, YUKONMichael Curry, LLB/JD, MD, CCFP(EM), FCLM, FCFP Vancouver, BCPaul A. Farnan, MB, BCh, FCFP, FASAM, ABAM West Vancouver, BCVictor F. Huckell, MD, FRCPC, FACC, FSCAI, FAHA, FESC, FCCS Vancouver, BCDavid Naysmith, BSc, DMD, MD, FRCSC Victoria, BC

AREA 2—ALBERTASusan M.J. Chafe, MD, LLB, FRCPC, ABR, BMed Sci, BSc, ATCL Edmonton, ABSteven M. Edworthy, MD, FRCPC Calgary, ABFredrykka Rinaldi, MD, CCFP, AFCI, MBA, LLB, MPA Medicine Hat, AB

AREA 3—SASKATCHEWAN, NORTHWEST TERRITORIES, NUNAVUTVacant - Position scheduled for the 2019 election

AREA 4—MANITOBADarcy E. Johnson, BSc, MD, CCFP, FCFP Winnipeg, MB

AREA 5—ONTARIOAlexander C. Barron, BSc, MD, MSc, MBA, FRCPC, DABP, FAAP, CGPL Toronto, ONDebra E. Boyce, BSc, MD, CCFP, FCFP (President) Peterborough, ONRobert Cooper, LLB, JD, MD, CCFP, FCFP Toronto, ONGerard P. Craigen, BSc, JD, LLB, MD, FRCP(C), DABPN, FACPsych, FAPA Toronto, ONGordon A. Crawford, MD, BSc(Hons), FRCSC Barrie, ONElliot M.H. Halparin, MD, CCFP, FCFP Georgetown, ONKaty A. Shufelt, BSc, MD, FRCPC Peterborough, ONBirinder Singh, MD, LLB, CCFP, Ontario Bar Association Toronto, ONMichael E. Sullivan, MD, FRCPC Aurora, ONM. Christopher Wallace, BSc, MSc, MD, FRCSC Kingston, ON

AREA 6—QUÉBECJean-Hugues Brossard, MD, CSPQ, FRCP (2nd Vice-President) Montréal, QCJean-Joseph Condé, MD Val-d’Or, QCMichel Lafrenière, MD Québec, QCYolande Leduc, MD Longueuil, QCClaude Mercier, MD, FRCSC Montréal, QCYvonne Molgat, MDCM, FRCSC Québec, QCPatrick Trudeau, MD, CSPQ, FRCSC Chicoutimi, QC

AREA 7—NEW BRUNSWICKJennifer A. Gillis-Doyle, MD, CCFP(PC) Fredericton, NB

AREA 8—NOVA SCOTIASally Jorgensen, MB, BS, CSPQ, FRCSC Bridgewater, NS

AREA 9—PRINCE EDWARD ISLANDPatrick C. Bergin, MD, FRCPC, FACP Charlottetown, PEI

AREA 10—NEWFOUNDLAND AND LABRADORMichael T. Cohen, MD (1st Vice-President) Grand Falls-Windsor, NL

Your CMPA Council members


The composition of the council and the structure of its various committees are outlined in this table and on the following page. Additional governance details are available on the CMPA website including the CMPA’s Act of Incorporation and Bylaw which outlines the requirements of council in Article 4; and terms of reference for council and committees, which articulates the way in which council organizes and conducts itself to fulfill its responsibilities, and describes the responsibilities of councillors.

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Council MembersBarron, Alexander

Bergin, Patrick

Boyce, Debra (President)

Brossard, Jean-Hugues (2nd Vice-President)

Chafe, Susan

Cohen, Michael (1st Vice-President)

Condé, Jean-Joseph (past President)

Cooper, Robert

Craigen, Gerard

Crawford, Gordon

Curry, Michael

Edworthy, Steven

Farnan, Paul

Gillis-Doyle, Jennifer

Halparin, Elliot

Huckell, Victor

Johnson, Darcy

Jorgensen, Sally

Lafrenière, Michel

Leduc, Yolande

Mercier, Claude

Molgat, Yvonne

Naysmith, David

Rinaldi, Fredrykka

Shufelt, Katy

Singh, Birinder

Sullivan, Michael

Trudeau, Patrick

Wallace, Christopher

External Members

Bodkin, Wendy

Cotsman, Stephen

Crosby, Edward (past President)

Groves, Lawrence (past President)

Hume, Doreen

Moore, John

Murray, John

Thiessen, Gordon

Ex-officio Chair Member

Composition of council and structure of its committees


EXECUTIVE COMMITTEE

The Executive Committee considers and determines issues of strategy, policy, risk governance and other matters requiring action between council meetings. Council may delegate to the Executive Committee all or part of its powers, except the power to appoint councillors, committees, and the executive director. The Committee generally meets nine to eleven times per year.

AUDIT COMMITTEE

The Audit Committee assists council in fulfilling its oversight role with respect to financial management and controls across the CMPA. The committee’s financial oversight role extends to all financial matters (policies, procedures, and risks) including those that might also be under the purview of other governance bodies. The Committee generally meets four times per year.

CASE REVIEW COMMITTEE

The Case Review Committee considers the conduct or defence of matters or proceedings, by action or complaint, against active, former, and deceased members. This includes the authority to determine the nature and extent of assistance to a member. The Committee also provides strategic guidance to, and governance oversight of, the CMPA’s medical-legal case management control system, including the provision of legal services. The Committee generally meets at least twice a month.

EXTENT OF ASSISTANCE COMMITTEE

The Extent of Assistance Committee reviews issues surrounding requests for assistance by CMPA members and develops the philosophy and principles to guide the CMPA’s discretion for consideration by council. The committee provides guidance on strategic initiatives impacting members, member service and CMPA programs related to the mutuality obligations of members. It identifies and considers organizational risks related to the protection of members. The Committee generally meets two to three times per year.

GOVERNANCE COMMITTEE

The Governance Committee strengthens and enhances the Association’s governance performance by overseeing and advancing sound and effective corporate governance principles and practices designed to aid the long-term success and governance integrity of the Association and its council. The committee provides oversight and direction of specific governance projects and activities approved by council. The Committee generally meets three to five times per year.

HUMAN RESOURCES AND COMPENSATION COMMITTEE

The Human Resources and Compensation Committee provides strategic guidance to, and governance oversight of, the CMPA’s human resource functions. The Committee generally meets three to four times per year.

Committee mandates


INVESTMENT COMMITTEE

The Investment Committee establishes the CMPA’s investment policy, and reviews the results in comparison to the approved investment strategy. The committee establishes the strategic asset allocation strategy intended to deliver the required investment returns within the risk budget approved by council and advises council as to the long-term expected return on the CMPA’s investment portfolio. The Committee generally meets four times per year.

MEMBER AND STAKEHOLDER RELATIONS COMMITTEE

The Member and Stakeholder Relations Committee provides strategic guidance to, and oversight of, the CMPA’s communications and stakeholder engagement activities, including the understanding and managing of relevant and emerging issues in the external environment. The Committee generally meets three to four times per year.

NOMINATING COMMITTEE

The Nominating Committee identifies and proposes council candidates to members who will ensure that the governance of the Association is of the highest caliber and reflective of the Association’s membership. The Committee generally meets three to four times per year.

PENSION COMMITTEE

The Pension Committee provides oversight on matters affecting the policy and administration of the CMPA’s pension plan. The committee safeguards the plan assets, monitors the fund investments, ensures compliance with applicable legislation and regulation, and acts in accordance with the best interests of the plan beneficiaries. The Committee generally meets quarterly.

SAFE MEDICAL CARE COMMITTEE

The Safe Medical Care Committee supports and provides strategic guidance to the CMPA’s efforts in safe medical care, including research and analytics, safe medical care stakeholder collaboration, and practice improvement and risk management. The Committee generally meets three times per year.

COMMITTEE MANDATES continued


INVESTMENT COMMITTEE

The Investment Committee establishes the CMPA’s investment policy, and reviews the results in comparison to the approved investment strategy. The committee establishes the strategic asset allocation strategy intended to deliver the required investment returns within the risk budget approved by council and advises council as to the long-term expected return on the CMPA’s investment portfolio. The Committee generally meets four times per year.

MEMBER AND STAKEHOLDER RELATIONS COMMITTEE

The Member and Stakeholder Relations Committee provides strategic guidance to, and oversight of, the CMPA’s communications and stakeholder engagement activities, including the understanding and managing of relevant and emerging issues in the external environment. The Committee generally meets three to four times per year.

NOMINATING COMMITTEE

The Nominating Committee identifies and proposes council candidates to members who will ensure that the governance of the Association is of the highest caliber and reflective of the Association’s membership. The Committee generally meets three to four times per year.

PENSION COMMITTEE

The Pension Committee provides oversight on matters affecting the policy and administration of the CMPA’s pension plan. The committee safeguards the plan assets, monitors the fund investments, ensures compliance with applicable legislation and regulation, and acts in accordance with the best interests of the plan beneficiaries. The Committee generally meets quarterly.

SAFE MEDICAL CARE COMMITTEE

The Safe Medical Care Committee supports and provides strategic guidance to the CMPA’s efforts in safe medical care, including research and analytics, safe medical care stakeholder collaboration, and practice improvement and risk management. The Committee generally meets three times per year.

Hartley S. Stern, MD, FRCSC, FACS, ICD.D Executive Director and Chief Executive Officer

E. Douglas Bell, MD, FRCSC Associate Executive Director and Managing Director, Safe Medical Care

Stephen M. Bryan, OMM, CPA, CMA Chief Financial Officer and Managing Director, Enterprise Management

W. Todd Watkins, BSc(Hons), MD, CCFP, CCPE Managing Director, Physician Services

Senior management 2018—as of December 31, 2018

The senior management team is responsible for the strategic and organizational success of the Association.

Pascale Belleau, MSc, MA Director, Communications

Lisa Calder, MD, MSc, FRCPC Director, Medical Care Analytics

Pamela Eisener-Parsche, MD, CCFP(COE), FCFP, CCPE Director, Physician Consulting Services

Cory Garbolinsky, CPA, CA Director, Finance

Christine Holstead, BMath, MBA, CMC Director, Information Technology and Corporate Services

Linda M. Jones, BPA, MPA Director, Executive Services and Governance

Annette Keough, MMS, B.Comm(Hons) Director, Safety Programs Management

Lila Lee, BA, CCP Director, Human Resources

Guylaine Lefebvre, MD, FRCSC, FACOG Director, Practice Improvement

Lorraine LeGrand Westfall, MD, FRCSC, CSPQ Director, Regional Affairs and Chief Privacy Officer

Lori Lennox, MHA, BSc (OT) Director, Business Strategy and Analytics

André L’Espérance, FCIA, FCAS, FSA, MAAA Chief Actuary

Josée Mondoux, CFA, FMA, FCSI, CAIA Director, Investments

James Watson Director, Membership and Contact Centre Services


PRACTICE IMPROVEMENT

SENIOR PHYSICIAN ADVISOR

Steven J. Bellemare, MD, FRCPC, CPE

ASSOCIATE SENIOR PHYSICIAN ADVISOR

Tino D. Piscione, MD, PhD, FRCPC

Physician Advisors —as of December 31, 2018

Our team of physician advisors offers professional and personalized frontline service to physicians.

PHYSICIAN ADVISORS

Eileen Bridges, MD, MSc, CCFP. Dip Sport Med

Liisa Honey, MD, FRCSC

Robert Johnston, MD

Shirley Lee, MD, CCFP(EM), MHSc(Ed), FCFP

Caryne Lessard, FRCSC, MD Med, MM

Richard Mimeault, MD, FRCSC

Janet Nuth, MD, CCFP(EM)

Ellen Tsai, MD, MHSc, FRCPC

Professional AdvisorsGENERAL COUNSEL

Gowling WLG

AUDITORS

KPMG, LLP

PHYSICIAN CONSULTING SERVICES

SPECIAL ADVISORS

Louise Dion, MD, FRCSC

Jeffery H. Robertson, MD, FRCPC, FACC

SENIOR PHYSICIAN ADVISORS

Deborah Davis, MDCM, CSPQ FRCPC

Dennis Desai, MD, FRCSC, FACS Julie Jenner, MD, CCFP

J. Peter O’Neill, MD, FRCSC, FSOGC, MDIV

R. Dale Taylor, MD, BSc, FRCSC

ASSOCIATE SENIOR PHYSICIAN ADVISOR

Christopher Canny, MD, FRCSC Sharon Caughey, MD, FRCSC

Geoffrey Hung, MD, FRCPC, FAAP Marc Roy, MD, CCFP, FCFP

PHYSICIAN ADVISORS

Carolyn Atkinson, MD, CCFP

Liette Beauregard, MD, FRCPC, LLL

Heather Blois, MD, CCFP

Christine Bourbonnière, MDCM, MSc, CCFP

Micheline Boyer, MD, CCFP, FCFP

Meri Bukowskyj, MD, MPA, FRCPC

Lindsay Carr, MD, CCFP(EM)

Ann Cranney, MB BCh, MSc, FRCPC

Caroline Ehrat, MD, CCFP(EM), FCFP

Giuseppe Ficara, MDCM, FRCPC, FAAP

Allan Forse, MD, FRCSC, FACS

Andrew Gilchrist, MD, FRCPC

Christopher Goodall, MD, CCFP

Elaine Hall, MD, CCFP

Merril Harmsen, MD

James Kissick, MD, CCFP(SEM), Dip Sport Med

Sandra Lang, MD

Katherine Larivière, MSc, MD, CCFP

Martin Leahy, MD, CCFP(EM)

Louise Lefort, MD, CCFP(EM), FCFP

Suzanne MacMillan, MD, FRCPC Yolanda Madarnas, MD, FRCPC

Dale McMahon, MD, FRCPC

Alain Millette, MD

Stephanie Minorgan, MDCM, CCFP

Cheryl Pollock, MD, MPH, CCFP(EM), FCFP

Maria Rif, MD, CCFP(EM)

Shena Riff, MD, CCFP(EM)

Sharman Robertson, MD, FRCPC

Andrée Rodrigue, MD, CCFP, FCFP

Angela Sirnick, MD, FRCPC

Jocelyne Tessier, MD, FRCSC

Charlene Thomas, MD, CCFP, FCFP

PHYSICIAN CASE FILE MANAGER

Brien G. Benoit, MD, MSc, FRCSC, FACS


AUDITORS

KPMG, LLP

Saegis leadership 2018—as of December 31, 2018

BOARD OF DIRECTORS

Hartley Stern, MD, FRCSC, FACS, ICD.D Board Chair

Alexander C. Barron, BSc, MD, MSc, MBA, FRCPC, DABP, FAAP Director

Kevin Ford Director

Bruce A. Joyce, FCPA, ICD.D Director

David Naysmith, BSc, DMD, MD, FRCSC Director

Andrea Seymour, B.Ed, CHE, FCCHL Director

MANAGEMENT

Vacant Chief Executive Officer

Tara Garcia, CPA, CA, CFA Chief Operating Officer

Liz Jackson, BScN, MA, LSSB Director, Practice Management

Dr. Tom Lloyd, LLM, MB ChB, MD, MRCS, MFFLM Director, Saegis Safety Institute

Documents

2018 CMPA Annual Report · Salus Global partnership, Saegis SafeORTM program CMPA Perspective ... results, and that our future success depends on our ability to adapt to the changing