Category: Politics

Fads and fashion shape everything, even healthcare.

Politicians love the chance to strut down the runway draped in new policies. No matter how bizarre the outfit, pundit paparazzi chatter with delight.

Innovation is the latest fad.

Everybody talks about it. We all want some. Hospital CEOs need to say something smart about innovation. At the very least, hire a Chief Innovation Officer!

Ontario has the Ontario Health Innovation Council. Americans have the Foundation for Healthcare Innovation.

Organizations stumble over each other to write about innovation:

• What Drives Innovation in Healthcare? – Wharton 2015
• How to Foster Innovation in Healthcare – H&HN 2015
• The Emerging Market in Health Care Innovation – McKinsey 2010
• Why Innovation in Healthcare is so Hard – HBR 2006

Innovation Defined

According to Yale, innovation is  “The process of implementing new ideas to create value for an organization.”

The Business Dictionary defines innovation as doing something differently to generate significantly more value. Translating an idea into a good or service that adds value. Inventions are not always innovations.

Harvard Business Review lists 5 Requirements of a Truly Innovative Company HBR 2015

1. Employees that think innovation

2. Clear definition of innovation

3. Comprehensive innovation metrics

4. Accountable and capable innovation leaders

5. Innovation-friendly management processes

A Liberal member of provincial parliament told someone recently that our government wants disruption. They want to disrupt healthcare and see what falls out.

‘Shake things up.’ No plan intended.

Innovation by Bureaucracy

We all play to our strengths and do what we know best. So it’s no surprise that government tries innovation by bureaucracy.

But innovation by bureaucracy is like cooking with crayons.

Bureaucracy exists to give us a sober second thought. It makes us look before leaping. Bureaucracy works as an anti-creativity filter to protect us from attempting something silly.

Government uses innovation by bureaucracy and just increases standardization, rationing, and homogeneity. It cuts spending on healthcare, writes new laws, and increases regulation.

After the Ministry of Health Patient Care Groups report belly-flopped last fall (aka “Price-Baker Report”), the Ministry tweaked their form and made another splash with their Patients First Paper.

The Ontario Medical Association offered an excellent, thoughtful response.  I had a different reaction:

Are You Serious?

No Partnership – The government gave doctors 2 months to respond to a major redesign. TWO MONTHS!  Like tossing pizza dough at the ceiling, they heave major papers at healthcare and see what sticks.

No Contract – The government does this when they should be working out a deal with the doctors. Redesign of medical care probably needs cooperation from doctors, no?

Doctors argue that government has trampled their basic human rights under the Charter: shouldn’t this be settled, first?

Duplicates Bureaucracy – The proposal relies heavily on LHINs and proposes yet another new, ‘sub-LHIN’, bureaucracy.

Do LHINs Even Work? – Why should we give LHINs more authority before the government completes its legislated review? Apparently, they started the review in 2014.

The Auditor General recommended changes to the LHINs, too. Has there been any change?

Patient Choice Ignored – Patients have the right to choose their provider, as outlined in the Health Insurance Act. But Patients First would force patients into practices they did not choose.

Private Businesses Kneeling Before Bureaucrats – The LHINs will ‘engage’ doctors to change medical practice. Doctors operate self-funded offices. They pay their office staff, leases, equipment, etc. out of personal billings. How can doctors run a business with bureaucrats in charge?

Fuzzy Details – Government offered no specifics on the governance of the sub-LHIN model. While they talk about solving inequity of access, it’s a structural problem. Command and control cannot fix access.

Doctors Banned From Leadership – The Local Health Integration Systems Act prohibits doctors from sitting on LHIN boards.

Out of Their League

A recent survey shows that 47% of Ontarians believe government is doing a poor job with healthcare.

This government has buzz but no substance. They are playing in the wrong league. One thousand of the smartest, Rhodes-scholar bureaucrats will never be as smart a 25,000 front-line physicians. That’s math, not hubris.

Innovation starts with government letting professionals do what they do best: help patients. Let doctors innovate. They know what their patients need. Let’s leave fashion to Zoolander and let doctors practice medicine.

photo credit: the first Zoolander movie

PS – Please check out my new book No More Lethal Waits: 10 Steps to Transform Canada’s Emergency Departments on Amazon. Thanks!

Grownup children sometimes ask the impossible.

“Whatever you do, Doctor, you must never mention the C-word to Grandma.”

I listen with a concerned frown.

“You know… Cancer,” her grandson whispers.

“Grandma’s scared to death of it,” her daughter says.

“It would kill her if you said anything. Promise you’ll never tell her, Doctor.”

I nod and say, “Maybe we should ask Grandma if she wants to hear the truth?”

Grandma usually takes it quite well. The children were scared to death of cancer, not Grandma.

Patients want doctors to help them understand as much as possible. They want doctors to speak up when something is wrong.

But many people want doctors to hide the truth. A number of docs are campaigning against cuts to medical spending in Ontario. At the same time, other powerful doctors, who work in government, or lead hospitals and medical schools, bully MDs and students to keep quiet.

“Be careful,” they say.

“Keep writing articles or giving interviews and we might not renew your hospital privileges.” 

“We saw what you wrote on social media. It goes against our rules and regulations. We will dismiss you if you do not keep quiet.” 

“You wouldn’t want to ruin your chances of getting a good residency spot, would you?”

Leaders who get money from government cannot allow their staff to publicize government failures. Does this cover-up benefit patients?

Leaders who bully others into silence do it to protect their income. Patronage demands that we keep our benefactors smiling on us with favour.

Afraid to Speak Up

Free speech is all but dead in Canadian healthcare. Not just limited, weak, or dying: dead.

Everyone on the inside must speak in generalities. Sure, you can report private clinics closing. You can also leak stories to the press, who then write about them second-hand.

But the people who know cannot speak. They dare not.

Here’s a short list of allegations I’ve seen or heard about:

• Delayed vaccine supplies…were they delayed to coordinate a dignitary’s photo op?
• Hundreds of thousands of dollars spent on technology that never got turned on, or used for only a few days.
• Over a million dollars spent in a rush at year-end on unproven programming, “Otherwise we won’t get the same funding next year.”
• Reporting different sets of financials than the ‘real’ ones used to run an organization.
• Houses built for executives by the builder who won the contract for a public facility.
• Departments insisting that only the product offered by the company they have a relationship with can be sold in other departments of the hospital.

Allegations can be explained away. The list above avoids breaking laws. But explaining nonsense does not mean it’s not nonsense.

Privilege, patronage, and waste always litter monopolies like garbage on sidewalks. Monopolies have no reason to clean it up.

We could pass a whistleblower law and demand that people speak up when they see waste or unethical behaviour.

But why would someone speak about an organization that pays them? Government might close the operation and put the whistleblower out of work.

We could tell the new patient ombudsman. Could they manage the volume?

We could empower patients. Give them transparency and choice. That way, if someone delayed a vaccine, patients could get it somewhere else, as soon as it’s available. A dignitary would lose a photo op, but patients would get care sooner.

The need for silence grows as healthcare runs out of money. Governments ration services to control spending, but they cannot fix the inherent waste in a monopoly.

Doctors must not publicize details about waste, rationing, and cuts. Voters might panic.

Maybe we should ask voters whether they want to know what’s really going on?

I suspect they would take it quite well. Maybe only the government fears the truth, not the public.

photo credit: www.mirror.co.uk about Grandma Betty.

Doctors love to talk. If you give them a chance, and show that you actually care, doctors have a great deal to say.

One doctor seemed to capture what so many others are saying. She gave permission to share the following email:

I feel it setting in with myself and my gp colleagues……..

this long drawn out affair with our contract and cuts is taking its toil…….

I fear another announcement about cuts is about to come……

we all feel powerless, helpless and I think many are getting disengaged from the fight with the government because it just seems to fall on deaf ears and yet they go on their merry way to fund this and that with no accountability of the public purse.

I could not work today- way too tired to be an effective doc-

provided an e consult for a patient with post partum depression- up north with likely very little services of this kind to help her effectively- this was all my brain could do

More Than Charts and Lab Tests

I think about my last three patients who died from cancer. Each one had the same look, at the end of their last office visit. They each said goodbye with their eyes.

Medicine transcends billing and audits, regulation and charting, guidelines and research. It touches people. It exists in a space between two people: the doctor and his/her patient.

The transcendent quality of care requires a special kind of person to handle it with enough gentleness to nurture, enough detachment to act.

Doctors do not train to fight. They train to care. Years of government attacks teach doctors to think differently. In subtle ways, prolonged disparagement undermines the medical character needed to serve patients.

Does government understand this? They play loose with a fragile resource.

A medical student described studying medicine in an air of animosity and how it flavours her whole education.  Her article laid blame where it belonged, with government.

But in a followup comment, she complained about her teachers (gated). How dare they mention the destruction caused by the Ontario government in front of “vulnerable” students! 

In the same way, outside observers lecture doctors on how best to talk with government. They scold doctors for expressing their feelings.

Medical Malaise