Saturday, November 1st, 2014

Stakeholders

What is a stakeholder?
Merriam-Webster’s online dictionary defines a stakeholder as one who is involved in or affected by a course of action.

Patients
Yes, you are a stakeholder! You are part of the stakeholder group that both pays for our health care system and is the end-user of it. You are the subject of much debate concerning health care legislation and policies and are often cited as a factor by other stakeholder groups furthering their own interests. You possess valuable knowledge based on your experiences, yet are provided with few opportunities for contributing to the policy-making and decision-making of the system for which you pay, for assessing its performance or offering ideas for change. 

The interests of health care organizations, medical professionals and other health care providers are represented through various government bodies, professional organizations and labour unions. While there are many groups representing patients with specific diseases, illnesses or conditions, or a specific issue like patient safety, the opportunities for them to personally speak with a federal Health Minister or introduce a bill into the House of Commons is limited.

As the stakeholder with the most to lose or gain, how much power and influence you wish to have in our health care system and your personal health care journey is up to you.      

Government
The Federal Minister of Health is responsible for Health Canada and its agencies:
Public Health Agency of Canada
Canadian Institute of Health Research
Hazardous Materials Information Review Commission
Patented Medicine Prices Review Board
Assisted Human Reproduction Canada

Each province and territory has a Minister of Health responsible for its own provincial/territorial Health agencies. Each agency creates legislation, policies and programs for administering its health insurance plan and delivering its health services. This is usually done through a number of provincial/territorial, regional and local organizations.

Medical Professionals and Other Health Care Providers
These stakeholders are often referred to as the “frontline” workers in health care as they provide health care services directly to patients. They include physicians, nurses and other health care providers.

All physicians, nurses and many other health care providers are regulated by provincial/territorial legislation. Nurses and physicians represent the two largest regulated groups.

Professional Licensing Bodies and Associations
The provinces and territories are responsible for the regulation of health professions through legislation and can grant self-regulatory powers to licensing bodies and associations. 

Most medical professionals and other health care providers are represented by self-regulated professional licensing bodies and associations concerned with establishing and maintaining professional standards, standards of practice and codes of conduct for their respective professions. 

Protective Associations and Societies
Many professions own and operate these non-profit organizations as legal defense funds to provide liability protection to their members. They also provide information and education on legal risks and issues specific to the practice of their profession. Eligible members receive legal advice and representation and financial assistance. These organizations usually maintain general counsel as well as provincial/territorial legal firms.

The costs of services for members are drawn from a reserve fund supported by annual membership fees. Some protective associations and societies charge annual membership fees to individuals while others charge them to their member organizations. Membership fees vary in regions throughout the country.   

Most provincial and territorial governments subsidize the costs of membership fees for protective associations and societies and premiums for commercial professional liability insurance.

Labour Unions
These stakeholders negotiate the terms and conditions of employment between member employees and their employers. The collective bargaining process aims to reach a collective agreement between member employees and their employers. The union also negotiates with employers regarding the requirements of employees for joining or funding the union. Employees contribute to unions through the payment of union dues.

If unions and employers cannot reach a collective agreement a conciliation process follows whereby a government-appointed mediator tries to assist the parties in coming to an agreement. If this process fails then either party can initiate a work stoppage in the form of a strike (led by employees) or a lockout (led by employers). A union’s right to strike is sometimes limited by members whose work is deemed to be an essential service. In these cases, a process of binding arbitration is entered into whereby a third party arbitrator hears the case for each side and then makes a decision in the dispute which becomes binding for both parties.   

Unions are regulated by both federal and provincial legislation. Many unions belong to larger unions and national union organizations.

Medical Schools
There are 17 publicly funded faculties of medicine in Canada providing education, research and health care services through their connected health care organizations. Each faculty accepts a limited number of students each year. 

Students of health care 
These stakeholders include all students pursuing studies in the area of health care. They represent our future physicians, nurses and other health care providers. Most of them belong to professional associations and students’ associations.

Sources:

Canada Health Act Annual Report 2007-2008
http://www.hc-sc.gc.ca/hcs-sss/pubs/cha-lcs-ar-ra/index-eng.php

Canadian Medical Protective Association website
http://www.cmpa-acpm.ca

Canadian Nurses Protective Society website
http://www.cnps.ca

In Review 2007-2009, a publication by the Canadian Federation of Nurses Unions
http://www.nursesunions.ca/media.php?mid=1010

All About Unions in Canada
http://www.joinufcw.ca/canada/facts_about_unions.php#fact1

The Relationship Between Health Professional Unions and Health Professional Licensing Bodies in Canada, National Union of Public and General Employees, Discussion Paper, Ottawa, 2003
http://www.nupge.ca/files/publications/CHPS/Relationship_Between_Health_Professional_Unions.pdf

The Association of Faculties of Medicine of Canada website
http://www.afmc.ca/education-e.php
http://www.afmc.ca/pdf/pdf_sa_vision_canadian_medical_schools_en.pdf







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