Central Planning – Triumph or Fiasco?

An acquaintance planned a spontaneous Caribbean getaway for his wife. He researched and booked a great resort. He got a super deal on flights. He informed his wife’s employer and secretly booked time off. He thought of everything, even a limo ride to the airport that evening.

His wife melted, how thoughtful!

Then she asked, “So who’s watching the kids?”

With only hours before their flight, they made frantic calls. Friends and coworkers ended up baby-sitting for a few days until the grandparents arrived on a last minute flight.

Planning – How Much is Enough?

Almost everything needs some planning. Even students back-packing Europe on Mom and Dad’s credit card still have to plan. Planning is good. But more of a good thing is not always better.

Leaders tread the line between thoughtful planning and micromanagement every day. They adjust their tactics based on results (past), or based on the nature of the situation they face (future). We can do the same with healthcare.

Central Planning in Healthcare

1. Results – How have we done?

• Commonwealth fund study 2014 ranks Canada 10th out of 11 countries overall.
• Patients wait up to 3 times longer in Canada.
• Unemployed specialists look for work, while patient suffer long waits for the same specialty.
• Overcrowded Emergency Departments remain the biggest problem facing emergency care.

Also, the Ontario government has supported naturopathy as mainstream care, has the world’s largest debt of any sub-sovereign government and has been plagued by political scandals.

2. Future – What can we expect?

Politicians should ask themselves: do they have the tools necessary to lead healthcare?

• Can they lead managerial performance?
• Can government influence attitude and initiative; if so, by how much?
• What kind of workforce will a government service develop?

The “… public sector, by providing secure if unexciting jobs, can attract people who are relatively rigid and risk averse.” p 219 of Getting Health Reform Right A Guide to Improving Performance and Equity.

Seniority and patronage creep into every hospital. They occupy the space left by quantitative drivers of performance that dominate a typical business. We have a generation of managers who like seniority and patronage and have been attracted into management because of it. Not all managers. Many hold their noses and carry on. But on balance, patronage and seniority shape culture.

Government cannot control managerial level performance. It cannot control attitude, initiative or drive. How could it? It has no real levers to influence at that level.

The fact that the ministry of health wants to manage everything becomes the most important influence on managerial behaviour. It makes managers beholden to the ministry of health. It makes managers care about who controls the flow of money to their department instead of caring about patients who need service.

Government produces great crowds of administrators whose main objective is to stay out of trouble and not anger the ministry. Patient service need not improve above mediocrity; it’s a non-issue.

Policy vs. Implementation

Government needs to distinguish between policy and implementation. Over the past 35 years, government has usurped control over healthcare. Government no longer just pays for healthcare, it attempts to plan and run it.  It develops policies and tries to implement them but does not have the basic tools to do so.

Canadian healthcare performance lags. Even armed with the best solutions, government fails on implementation. We need to hold politicians to account and insist that they stick with politics and leave implementation to the professionals.

We need government to give medical professionals the freedom to innovate, lead and creatively solve practical problems for the patients they serve every day. We need a little less faith in central planning.

photo credit: viceroyhotelsandresorts.com