Will We Make the Made-in-Ontario Solution Work, Or Start Over Again?
By Ted Ball and Elinor Caplan
Most normal people’s eyes glaze over when healthcare policy wonks launch into their babble-speak about LHIN’s resource allocation formulas, wait-time comparisons, quality measures, etc.
People just want the high quality healthcare system that they have already paid for with their taxes and premiums. There really isn’t a public appetite for debating the merits of health reform mechanisms like centralized vs devolved planning bodies - or whether we should maintain or eliminate local governance.
However, while there isn’t much of a public interest in the “how to” debates, or any of the structural details of health reform, people really want the health service providers and their government to get on with it: they want their healthcare system fixed!
“Fixes-that-Fail”
Historically, Ontario has shuffled Ministers and/ or Deputies every 18 months. Instead of implementing the health reform du jour, most reform initiatives are abandoned and replaced by the next “big fix” that fails. Strategy execution isn’t something we do in Ontario. We just keep doing more strategy development, seeking the magic solution.
The new “big fix” appears to be centralized administrative control – the countervailing force against devolution and community governance that has emerged in Western Canada.
In Alberta, Premier Stelmach has just delivered a body-blow to his leadership rival, Jim Dinning (the former Chair of the Calgary Health Authority) by replacing the nine regional boards with a single, all-powerful, centralized decision-making authority governed by a “super board” of six people and an all-knowing “super bureaucracy” that will be based in Calgary.
The new monolithic Alberta Health Services Board will now determine what is best for local communities in that province.
Independent & Interdependent
Meanwhile, in Ontario, we are just now taking our first baby steps toward implementing a unique and innovative health system architecture that balances the benefits of independent governance and management of health service providers (hospitals, community services, health clinics, etc), with the need to integrate and co-ordinate healthcare services so that they are safe, of high quality and patient-centered -- rather than bureaucratic, or designed for the benefit of some powerful vested interest groups.
Our “Made-in-Ontario” health system design maintains independent health service providers who, under a local governance structure, will be able to collaborate as interdependent services within their LHIN -- so that patients will have a “seamless experience” across their local health service delivery system.
“Once again, we are stalled at the strategy execution phase of health reform.”
While Ontario has a chance to implement many of these long-awaited and badly needed reforms that are in the public interest, it would appear that we are, at the moment, stuck.
We estimate that perhaps only 30% of healthcare provider organizations today are actually “on board” and ready to roll out the implementation of their community’s Integrated Health Service Plans (IHSP). What worries us is that instead of mobilizing and galvanizing local managerial talent to reform the system, some LHIN’s continue to think and behave like the command and control health ministry officials of a by-gone era.
As a consequence, there really isn’t any deep or sustained commitment to health system reform in several LHIN’s. Many of our leaders are still trapped in win/lose power dynamics -- instead of collaborative problem-solving. In our judgment, once again the Ontario healthcare system’s leaders are stalled at the strategy execution phase of health reform.
Implementing Reforms
Rather than re-open the Pandora’s box of system design, what we need is the commitment of governance and managerial leaders across the province to implement the “Made-in-Ontario” model of local resource allocation and collaborative planning facilitated locally by the LHIN’s. In the near future, the LHIN’s will negotiate Service Accountability Agreements -- which will set out agreed-upon goals and targets for system development and performance improvements with each provider.
If we are to succeed in reforming our delivery system, Board members from health service provider organizations need to shift their thinking from the traditional silo-orientation to a public interest, patient-centered perspective. Healthcare Board members need to shift from their organizational focus, and begin to represent the interests of the “owners” --the citizens of Ontario, and the people in their community -- and nobody else. They need to focus on quality, safety and value-for-their-taxes at the healthcare service delivery level.
LHIN Boards and staff need to resist becoming overlords and supervisors, and instead become facilitators of the collective intelligence of those who are best able to develop local system strategies: the delivery system’s operational leaders -- at the managerial and governance levels.
Queen’s Park also has to practice what they preach and stop attempting to “control” the system by micro-managing LHIN’s, who, in turn, will attempt to control our independent health service providers. Instead of struggling to be “in control” of the system, the Ministry of Health Long-Term Care needs to implement their own stewardship model.
If we are to succeed with health reform in Ontario, we need our talented Chief Executive Officer’s, Executive Directors, senior managers and Boards to mobilize to actually implement the “Made-in-Ontario” model. If we don’t, we fear that the Alberta solution will be upon us before we know it.
Hon. Elinor Caplan is a former Minister of Health in Peterson’s Liberal Government. She is a Strategy Coach with Len Domino and Associates and principal at Canada Strategies Inc. She provokes thinking with probing questions that enable people to think strategically. Prior to coaching, Elinor served in provincial and federal cabinets of David Peterson and Jean Chretien and has recently facilitated a new partnership between Women’s College Hospital and Sunnybrook Health Science Centre. Elinor’s passions include excellence in governance and patient safety.
Ted Ball was Health Minister Grossman’s Chief-of-Staff in Bill Davis’ Tory Government. He has spent the past 15 years learning about organization and whole system redesign in the health, education and high technology sectors. Ted’s focus has been on the integration of systems thinking-based tools for strategy development, strategic alignment, project management, strategy execution, story-telling, dynamic evaluation and action learning methodologies.
Ted is leading expert in accountability systems design, cultural transformation, transformational leadership development, balanced scorecarding and coaching. Ted is a partner in Quantum Transformation Technologies based in Toronto.