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Talking conflict on an FHT board

By Kate Dewhirst

Family health teams are interesting creations. What are they? Multi-disciplinary teams providing primary care services to communities across Ontario.

A new theme for family health teams is moving from physician-led boards to community or mixed governance and skills-based boards. One of the driving reasons for this change is to deal with potential conflicts of interest and to add a wider range of perspectives to these publicly-funded entities.

So how do you talk about “conflicts of interest” at your FHT board table? You undertake a six-step conversation with your board.

I just covered this in my June session of Legal Issues for Family Health Teams webinar series.

First, you need to tell your board members about their duties and explain what it means to be a fiduciary. SNORE. Yep, you are going to have to keep everyone’s attention here. Talking about conflicts of interest can put people to sleep. But, many new board members do not know what could be asked of them in their role. So it is important that you explain the range of decision-making they could be involved in. And then quickly move into step two – storytelling.

Second, you provide actual examples of conflicts of interest. The key here is to talk about the obvious ones and also add examples of the subtle ones. Everyone intuitively understands that it is a conflict of interest in a publicly-funded model to take money from patients in exchange for better or faster health care services. But, it is also important to talk about subtle conflicts such as how outside commitments can negatively impact on a board member’s ability to fulfill her duties.

Third, I like to ask board members to do a personal reflection exercise on all the “hats” they wear in their lives. By identifying their personal and professional connections and roles, they have a better sense of where conflicts can arise for them as board members of the FHT.

Fourth, it is often necessary to demystify a commonly held perspective of board members that they must “represent” certain professional or community interests on the board. Explain in concrete terms the duties of confidentiality and putting the interests of the FHT first.

Fifth, get the board involved by asking them, “what are your ethical hmmmmmms?” By asking them to identify the scenarios and situations that they have wondered about, you stimulate conversation about conflicts of interest using slightly more accessible language. You’ll be surprised what has been worrying your board members.

Sixth, explain the steps to manage conflicts of interest and the possible consequences of not managing those conflicts properly. Not all conflicts are bad news. Some can be easily managed. Yet, some are non-starters. Talk about the process at your board meetings about how to proactively identify conflicts and how to respond to conflicts as they arise.

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