Updated January 10/2016

This page represents some structural aspects of a patient centred applied MSK framework.

It is presented also under a  header for the MBJH Strategic plans for Manitoba MSK Care (The Power Grid)

An orthopaedic framework in a provincial Strategic Clinical Network (SCN) in Manitoba

1. Subspecialty groups. These are hip and knee arthroplasty and reconstruction, spine, trauma, sports medicine, foot & ankle, paediatrics, hand & wrist, shoulder & elbow, and general. Some different grouping could be considered such as geriatric orthopaedics. All surgeons to be members of any of these groupings they work in.
2. Clinical and academic (community & university) co-chiefs for subspecialties for the province. These dualities encompass surgical bone and joint care.
3. Co-chiefs responsible to subspecialty colleagues, the provincial network of associated colleagues and existing structures to frame the provincial bone and joint surgery panorama. Full participation is the standard, modified only by special circumstances (no “second-class” members)
4. Each clinical/academic subspecialty coordinates slates, intake and access clinics, CQI, after hours coverage, performance assessments and reviews, research and teaching, remuneration parity, intraspecialty consultation, manpower and resource needs, interdisciplinary connections (other orthopaedic specialties and beyond orthopaedics), in the setting of, and complementary to, existing systems in province.
5. Within these subspecialty groups, slates and clinics are allocated on a standardized and equalized system, allowing variability as needed, but avoiding a hierarchical, rigid structure of differential resourcing, to assure reasonable access for patients to a cohort of qualified surgeons.
6. These guidelines for regional hospitals would be managed by regional clinical and academic MSK chiefs, in response to local needs and an overall schematic provincial framework.

The current orthopaedic system grew out of a system of hospital based surgical programmes, until hospitals were grouped under regional health authorities in 1997. After that, each region either by action or passivity, acquired an MSK system different from its neighbours, allowing for gaps, variable access, and inattention to provincial definition and accomplishment of the MSK mission.
This leads regions and members to function in a less coordinated and cooperative manner than possible with a defined inclusive framework.

The current bone and joint surgery system is driven by the manifest benefits of an in-demand surgery specialty, selected projects (e.g. Hip and Knee Institute), and deficit financing.

The MSK Strategic Clinical Network is not presented to undo healthcare organization in Manitoba. We prefer to include the business community, patient advocacy, First Nation and remote population concerns, and others into a board of directors for the provincial MSK framework. The existing system is movng further towards centralization with the combining of university medical, dental, physiotherapy and other related faculties into a combined provincial health sciences faculty. A provincial medical leadership council and health workforce agency consolidates all manpower.

MBJH areas of application have included

1. Expanding board, and associates oversight and partnership in provincial patient centred care.
2. Compile  wait times for all MSK  subspecialties.
3. Strategies for access to orthopedic care, region by region.
4. Provincial coordination of regional strategies.
5. Strategies for access to care: First Nations, remote, and disadvantaged Manitobans.
6. Increased role for internet telemedicine in access to MSK care.
7. Long term provincial health care financial and service sustainability.