How are deliverables defined?
The first three contracts with the Government required that SEAMO fund the clinical and academic activities of full-time clinical teachers at Queen's University School of Medicine and some other physicians as defined in the contract. In addition, sixteen deliverables with the four domains of education, research, clinical service, and leadership and administration were defined. These deliverables dealt with health system outpatients such as "quality of care".
The failure of SEAMO and the Ministry of Health to operationalize these deliverables and establish performance criteria was a contributor in the government's insistence that shadow billing be introduced. With only centre-wide alternative funding arrangement in the Province, the Ministry of Health lacked the necessary resources to develop a meaningful and robust set of performance criteria.
How does SEAMO report?
In the original contract, SEAMO and the Ministry of Health negotiated a clinical reporting system. This system is based largely on chart extraction, and provides the Ministry with encounter-based information. The system captures in-patient activity, same day surgical activity, emergency activity, and clinic activity. SEAMO developed a new Accountability Framework which provided a robust system of reporting on deliverables in all three main areas: clinical service, education, and research. The Ministry, lacking resources to understand this accountability framework, required the introduction of shadow billing and it provided to SEAMO significant funding to achieve agreement.