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
Bang-on once again, Shawn! How can we as a profession or through our professional association, get this message out to the public? Is there a way to promote a different path while pointing out the fallacies of what the government is doing?
Thanks Paul!
I think change happens when everyone does whatever comes naturally. Some write. Others talk, protest, or create really cool infographics.
It HAS to change!
Thanks again,
Shawn
I’m a good deal more cynical than you are, and can’t see how the nebulous “sub-LHIN” is anything other than the Price Report’s “Patient Care Group”, just with a different title. (To paraphrase The Bard, a bureaucracy by any other name would accomplish just as little.)
Make no mistake, our esteemed Deputy Minister Dr. Bob Bell remains enamored with the Price Report in broad strokes. He articulated as much at the Family Medicine Forum in November, even without resorting to the bafflegab pols and public servants usually speak in. I’m not sure there’s a substantive difference between Patients First and the Price Report anyways, except for the issue of physician pay (as if the Ministry would ever cede control of that one).
As I see it, the whole point of the exercise is to use geography as a proxy for physician succession planning. There’s some sense in that notion, but the chosen approach is misguided. As you point out, it puts WAY too much faith in the skills of bureaucrats to implement and monitor this. We have plenty of evidence against these skills being in abundance, if they exist at all. It would have been much simpler to make new grads work in an underserviced area for three years, full stop. Not nice, not ideal, but we’ve all had to pay our dues, and you never know when someone’s going to fall in love with an adoptive hometown.
The other aims of this ill-conceived plan, though not explicitly stated, entail longtime goals of the Ministry: 1) walking back the FHG-FHO deals that created as many problems as they were supposed to fix (Bell shared some examples that were most unflattering to our less-than-conscientious colleagues out there), and 2) doing away with conveyor-belt walk-in clinics, particularly in the big cities.
You point out the most idiotic aspect of the LHINs, namely that they’re run by people that aren’t health care professionals. Can you imagine a school principal that wasn’t a teacher? Or a police commissioner that wasn’t a cop? And yet we’re to believe that someone with an MPA or MBA has any perspective on health-care decisions beyond personal experience?
At the end of all this, it’s going to cost millions upon millions of dollars in red tape and B.S. before a single patient is seen. Worse still, it’s going to be almost impossible to get rid of these roided-up bureaucracies once they’re entrenched.
What an excellent comment, Frank! Thanks so much for taking time to write this. You captured a tonne of important points that I didn’t make in my post.
My favourite comment, that I think captures the most important issue, is: “Worse still, it’s going to be almost impossible to get rid of these roided-up bureaucracies once they’re entrenched.” Well said!
I appreciate you sharing more about what Dr. Bell said. Scary stuff. I understand your comments about restricted licences, but it goes against my passion for liberty. We should attract people to work in areas of need, not force them to.
Thanks again for sharing such a thoughtful note!
Best regards,
Shawn
Shawn,
Where in the LHIN Act does it prohibit physicians from being appointed to the board of directors?
As for non physicians being appointed to boards of directors and making decisions about healthcare at the local level, how are LHINs any different than the boards of directors of every agency funded by the government for health care activities?
We currently have several physicians in health care leadership roles, including the Minister of Health, and making very important decisions about the care physicians deliver and still, we physicians feel that we are not being heard and our concerns are not being adequately entertained.
Personally, I wish these physician leaders went back to practice.
Thanks Monique!
I’m hunting for an answer to this right now. Perhaps, you got on as a board director despite the legislation, or the legislation changed, or my source was incorrect. I will double check and get this straight.
I sure appreciate you raising the issue!
Best
Shawn
PS I LOVE your parting wish! 😉
Thanks, Shawn, good reflection(s) with good links to the evidence and the literature. Ontario carries on with a different experiment than the rest of the provinces, proving once more that a Canadian Health (care) System does not exist.
Recently, we took a look at the outcomes of “regionalization” of the Canadian Health System over the last two decades: has it made a difference? One component of the article describes the players who have been missing so far, i.e. the communities and the physicians. [CJPL 2(4):65-70, 2016].
John
http://www.physicianleaders.ca/assets/cjplwinter2016.pdf
Brilliant!
Thanks so much for taking time to read and share the article, John. It helps to know that other provinces do not believe in such a command and control approach to ‘leadership’.
Great to hear from you!
Cheers
Shawn