Health-care lessons for Ontario

Posted on May 28, 2008 in Health Debates – comment – Health-care lessons for Ontario
May 28, 2008. Carol Goar

Bringing up the rear of the parade has its advantages. You can see where the pitfalls are and learn from the mistakes of others.

Ontario is the laggard in Canada’s health-care regionalization parade. Two years ago, it became the last province to decentralize the delivery of its health services.

Quebec was the trailblazer. Saskatchewan followed. By the end of the 1990s, most provinces had adopted some form of regionalization.

Ontario has finally fallen into step. It now has 14 regional outposts known as Local Health Integration Networks (LHINs).

A few of them are off to a strong start. A couple are plagued by internal conflicts. Most are still trying to determine their role and responsibilities.

To help these fledgling organizations get it right, the Change Foundation, a think-tank funded by the Ontario Hospital Association, invited health-care leaders from across the country to a symposium last week to talk about the rights and wrongs of regionalization.

It was a closed-door event. Participants were guaranteed anonymity on the understanding that the substance of their remarks could be reported.

No one claimed to have a model Ontario could copy. But the architects of regionalization in other provinces knew what worked, what didn’t, what they wish they’d done and what the biggest challenges are.

Here are some of their insights:

* Don’t spend a huge amount of time and money coming up with a mission or values statement for the regional health authority. The drafting and redrafting process will go on interminably. The bill will escalate. And the result will probably be a collection of empty generalities.

* Get a written statement from the government, spelling out how much independence the regional health unit has and what it is expected to accomplish. Otherwise it will be undercut by the minister every time it does something controversial or offends powerful interests.

* Don’t put off the difficult task of bringing doctors into the new structure. The longer they remain private entrepreneurs, working business hours on a fee-for-service basis, the harder it will be to divert patients from emergency wards, to computerize health records and get all the players in the health-care system talking to each other. Every province has tried to coax its physicians into being team players. None has succeeded and there is no consensus on how to do it. Some participants advised Ontario to be patient and persuasive. Others suggested shifting responsibility for basic medical care to nurses, nurse-practitioners and other health professionals.

* Take advantage of the chance to be creative. Regional health units can experiment in ways that big bureaucracies can’t. They can deliver health care in smart, sensible ways. They can utilize the talent that is being suppressed or wasted. They can get rid of institutional rigidities that hamper good patient care.

* Measure what matters, not just what the politicians demand. Too often, regional health units end up collecting statistics on hospital beds, wait times, CT and PET scanners and number of surgeries. To show that they’re making a difference, they need to demonstrate that they’re keeping people out of hospitals, improving their health and enhancing their quality of life.

* Let people know what’s going on. Most citizens don’t have a clue what regional health units do, how they work or who runs them. The solution is not sporadic consultations and focus groups. Local health leaders need to get out into the community, explain in plain language how the health-care system is organized and be as open and accessible as possible.

Already, it would appear, Ontario has made a few errors.

Most people are barely aware that LHINs exist, let alone why they matter. Most LHINs aren’t clear about the extent of their authority or the yardsticks by which their performance will be measured. Most doctors want nothing to do with them.

There’s still time for a course correction. But it would take provincial leadership, local ingenuity and an electorate that refused to settle for mediocrity.

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