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In a
recent poll, Premier Danny Williams received strong endorsement for
his handling of negotiations with the federal government on the
Atlantic Accord, and his government is enjoying an increasing level
of public confidence. With the “new-found-hope” will come rising
public expectations that will pressure government to stray from its
charted course of fiscal prudence. Nowhere will the pressure for
increased spending be greater than in the health sector. Indeed, the
same poll that praised the premier’s leadership confirmed a deep
public concern about the erosion of health care services and the
prospects for the future. Will it be possible to reconcile the
government’s fiscal agenda with the demands of the health system,
particularly medical care services? This is a crucial question as we
are about to enter negotiations with the Government of Newfoundland
and Labrador.
The
priorities of this province’s medical profession are not
significantly different from those of four years ago when we last
set out to negotiate an agreement with government. Most important,
we need to maintain a stable physician workforce with the correct
number, mix and distribution of physicians to foster timely access
to care. Because of the severe shortage of doctors, a situation
which is likely to deteriorate before it improves, we must remain
sufficiently competitive to attract and retain the professionals we
need. Although compensation will be a major determinant, so too will
the working environment. We must ensure that conditions in the
workplace enable physicians to provide safe and adequate care — that
means reducing stress and fatigue. Finally, doctors must have
meaningful and effective input into the policy and decision-making
processes that impact on medical care delivery.
At
both national and provincial levels, the public, the government and
the health professions agree on a number of imperatives for the
future. We must find ways to make health care more affordable
without compromising quality. The system must also be able to
develop and sustain an adequate supply of health human resources. We
need to ensure that all Canadians enjoy equitable access to more
timely care. To achieve such formidable goals all the stakeholders
will need to do some serious soul searching because meaningful
solutions will require major changes in how we think and act. How
will this play out in our imminent negotiations with the government?
To answer this question we need to reflect on the processes and
outcomes of the last negotiations.
The
current
Memorandum of Agreement** between the NLMA and the Government of
Newfoundland and Labrador was ultimately reached as a result of
binding arbitration. Both parties came to the table with
pre-determined positions and each tried unsuccessfully to move the
other side to their position. This approach was grueling,
time-consuming and frustrating, leading ultimately to an
unprecedented service withdrawal by the province’s doctors. Although
the award by the arbitrators has facilitated some short-term
solutions, the real systemic challenges are yet to be addressed. We
need to find a better way.
An
alternative to the positional bargaining approach described above is
“interest-based negotiations”. Neither party comes to the table with
fixed pre-determined positions. Instead, both sides work together to
define problems and set a mutually agreeable list of priorities. The
parties then identify their common and separate interests in an
effort to reach solutions together, which best accommodate both
sides. The advantage to this approach is that it aims beyond merely
reaching a negotiated settlement, but also lays the foundation for a
stronger and more productive working relationship after an agreement
is reached.
NLMA
President Dr. Andrew Major and I met with Finance Minister Loyola
Sullivan and Health Minister John Ottenheimer just a few days before
the provincial budget to discuss upcoming negotiations. We all
agreed that to meet the health system challenges of the decade ahead
successfully, a cooperative approach rather than an adversarial one
was needed. Although both sides have very limited experience with
“interest-based negotiations”, it was felt that there is sufficient
goodwill and opportunity for mutual gains to achieve a positive
outcome. We have sought and received the endorsement of the
Executive Committee to proceed with “interest-based negotiations” in
order to expedite discussions and to achieve a timely agreement.
While
there is always risk associated when breaking new ground, we believe
that this is a worthwhile endeavor. Needless to say, we will be
proceeding with caution and will be consulting with members on a
regular basis. We intend to pause and reflect at various stages of
the process and will always have the option of withdrawing if we
feel it is warranted. The government, of course, has the same
options. As we enter this new frontier of negotiations, I am
convinced that both parties are approaching the effort with
sincerity and a deep desire to best serve the people of Newfoundland
and Labrador. We look forward to signing a new agreement before
September 30, 2005. |
