Author: Shawn Whatley

Ontario Debt: I Want It NOW!

i-want-it-now-300x300Children choose dessert before supper.  They stay up late, sleep in ’til noon, and leave homework for tomorrow.  They never choose to spend less of Mom’s money.  If my kids could, they would eat and play and spend until it was all gone.

Ontario debt rests in the hands of voters.  Will they act like children?

Arrogance makes us think riots only happen in other countries, less civilized places.

Ignorance makes us think we can keep spending other people’s money, increasing debt and handouts.

We’ve almost run out of other people’s money to spend.  Ontario has $300 billion of debt.  ($300 freaking billion!) We cannot fix our finances by taxing the rich; they already fund most of the taxes.  Industry won’t risk investing in Ontario if they think tax hikes loom next year.

We must spend less.

Ontarians must insist that politicians spend less.  We must cut any service we can live without until we can pay for it debt free.  We must stop all discretionary spending and choose the cheapest options for necessities.

If we do not, capital markets will turn on us.  Interest rates on our debt will sky rocket.  We will become insolvent, unable to cover our liabilities.

Solutions include: austerity measures, issuing debt bonds, heed the 350 recommendations of the Drummond report, increased class sizes, no funded kindergarten, and consider every opportunity for privatization.  Bureaucracy is a luxury we cannot afford until things improve.

Childish instant gratification threatens to ruin Ontario…and the rest of Canada with it.

I hope Ontarians vote like adults.

(photocredit: memegenerator.net)

 

Patient Outcomes Before Structure & Process

dv074003bMy 9-year-old plays Beethoven.  Most people recognize it.  My brother-in-law, a concert pianist, plays the same notes on the same piano with a different outcome.

Same piano.

Same score.

Different outcome.

Identical structure and process do not produce an identical outcome.  Health care obsesses over structure and process but, for the most part, ignores patient outcomes.

Donabedian first studied health system performance in the mid-20th century.   He suggested we look at structure, process and outcomes.

Structure

Providers love to talk about structure.

“Just give us more beds/nurses/doctors/operating-room time…”

“We don’t have enough X, Y or Z!”

With Beethoven, you might say performer talent counts as structure, the raw materials.  Fair enough.  Even so, healthcare isn’t sophisticated enough, or brave enough, to differentiate between provider talents.

Process

Regulators love to talk about process.

“Standard of care; best practices; quality based procedures”

Ontario’s Quality Based Procedures focus on process.  Essentially, QBPs define complicated tick-boxing to qualify for funding.  They completely ignore patient experience and do not put patients first, ahead of process or budgets.

Despite medical miracles like heart transplantation, antibiotics and test-tube babies, the greatest leaps of innovation mostly ended in the mid-20th century. Healthcare distrusts innovation.  No one wants to mess with success.  We’d rather do more of the same or look to experts to tell us how to do it.

Outcomes

Patients care most about outcomes.

Inadequate structure plus innovative process can produce great outcomes.  Dr. Venkataswamy developed an assembly line process to deliver cataract surgery, at a fraction of the cost, for millions of poor people with as good, or better, outcomes in the Aravind eye hospital in Mumbai.   Dr. Venkataswamy could never develop an Avarind in North America.  We obsess over process.  We refuse to change without sufficient structure.

Venkataswamy focused on outcomes, first.  He gave millions of poor people their sight without having money or surgeons to do so.

Patient Outcomes

We should start with the sound of Beethoven, with patient outcomes.

Focusing on structure and process, before outcomes, is backwards.  We need to focus on what we hope to achieve, how we are going to measure success, and then fund structure and build process to deliver it.  Not the other way around.

(photocredit: houstonpianocompany.com)