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Rory Demetrioff of Leonard Domino & Associates (LDA) attended a recent event to hear Dr. Alan Hudson comment on the plans and priorities of the McGuinty government and the Ministry of Health concerning wait times and governance issues. Dr. Hudson is the Lead within the Ontario Ministry of Health and Long Term Care on Wait Times and Access to Services.

Key messages delivered by Dr. Hudson were noted. The following represent the highlights of the presentation. All quotes reflect Leonard Domino & Associates’ interpretation of the discussion which took place, and have not been verified by the presenter.

Dr. Hudson addressed three areas, which he is considered to be the expert in:

1. Wait Times Results

2. Emergency Room / Appropriate Level of Care (ER/ALC)

3. Governance

Wait Times

  • The discussion highlighted how Dr. Hudson’s commitment and leadership have helped to achieve significant reductions in wait times in key areas of priority.
  • Successes included reductions in wait times for cataract and hip surgeries as well as CT scans.
  • A key element to address wait times is access to information. “Governance without data is an oxymoron”.
  • He highlighted the model of designing appropriate expert panels that have been used to provide guidance to the government decision makers.
  • “Wait Times Information Systems (WTIS) has a broader agenda … to improve access”.

    Emergency Room / Appropriate Level of Care (ER / ALC)

  • Hudson suggested that there was initial push back by some who challenged that ER and ALC were related. He appeared to suggest that the debate was over, and the connection is accepted.
  • “There have been three parts to the strategy:

    1. Demand Control – “In 10 days I’m going to the Premier to talk about the budget”.

    2. ER / Flow – “We have seen remarkable progress as much as 20% reductions with organizations like UHN and St. Joe’s”.

    3. ACL – “We have to move people out of emergency … getting the people out is the key … people are waiting and there are no spots available”.

  • “ER measuring systems are critical to decision making … the data needs to be reviewed for integrity, then signed off on” … “We want to have results posted by February”.
  • “With ALC, we are a year behind … there was no budget”.

    How the Organizations and the System is Performing:

  • “Some people don’t get it … they just keep asking for more money … 50% of the health organizations are not up to the task”.
  • “There are questions that I ask myself when looking at organizations in the system:

    1. “Who is running this place … there is often a lack of understanding of accountability”.

    2. “There is a lack of use of data … there is data everywhere, like CIHI or ISIS, yet boards don’t have access to the data … they don’t ask themselves: how are we really doing? … some do not know what data they need”.

    3. “Then there is quality and safety… I can see the pupils dilating when I bring up this topic … I ask hospitals: do you know your mortality rates … who is responsible … some say ‘the docs’, or ‘I don’t know’ … how can you run the place without knowing the results”.

    4. “The relationship between the board and CEO is critical to well run hospitals … there is only 1 employee of the board; the CEO”.

    5. “The relationship between the board to the caregiver … that is important in knowing what is really going on in the organization”. He was referred to the need for the grassroots to feed information, issues, and challenges to the senior decision makers within the organization.

    6. “I look at ARA … access, responsibility and accountability … I see confusion in the system between the LHIN and the CCAC and their ARA … there is confusion on reporting and relationship … it is not clear by some … that needs to be addressed”.

    7. “The skill sets of the board members have to be enhanced … board members need to be comfortable managing the people and dealing with large sums of money … the board needs to be able to coach the CEO … boards need super experts in areas of finance and organizational behaviour”… “boards need to be governing, not managing … otherwise, they would be the CEO”.

    8. “I have some general remarks … it is often common that with large state run enterprises there is political interference … this is not the case with our health system … the lack of interference is very positive”.

    Governance:

  • “For boards, I have a key question … do you have confidence in your CEO?”
  • “For CEOs… do you have confidence in your Board?”
  • “I’ve seen situations where contracts have been broken due to failing performance … I have had to walk in and take the money away … the board will look at me and say ‘why are you doing this’ … I show them the agreement that their CEO signed to deliver services, then I can tell by the look on their faces – so, what else did the CEO not tell you about?”.
  • “We need to look at these failures and figure out what went wrong … why did it not work out?”
  • “When I ask what is your biggest barrier, some tell me the physicians … but what is their function?”
  • “Weak boards and weak management create a union”.
  • “There needs to be a democratization of knowledge” … “When I got into the profession, it used to be about secret language, secret handshakes, secret knowledge, secret everything … but that has changed today”.
  • “The move is towards consumerism … unfortunately, health is the only system that is still set up to serve the producer … we need to make a whole system move to help the patient”.
  • “The way we are addressing this is through performance management”.
  • “Performance management is in the common interest … for the patient … for the physicians … no one wants to work in a failing hospital”.
  • “Some try to say that they cannot put the system into play … they say ‘how they don’t feel like it’, ‘when they feel like it’, or ‘if they feel like it’”.
  • “Yes, there is an ethical resource allocation issue … there are challenging times ahead”.
  • “Consumers want to see what is happening with their money … also they do not want to wait … they don’t wait at a line up in Loblaws”.
  • “Call England… ask them what their wait times are … they have an answer with a push of a button”.
  • “I say to the LHIN’s, what is your ALC … none know”.
  • “This is all about horizontal integration of services.”
  • “Now we need to integrate data systems”.
  • “What should the wait times be? … We need the right metrics … we need the right data ... and expert panels set up to advise”.
  • “There is a key question about responsibility … what is top down, and what part is bottom up” … “The government and LHIN are the top down … and the expert panels provide us with the bottom up”.

    Leonard Domino & Associates’ Suggestions and Advice:

    The McGuinty government’s commitment to transforming the health care system is moving ahead. Strong and senior voices, like Dr. Hudson, certainly give us an understanding of how organizations need to be best prepared to exist and success within the new LHIN environment.

    Minister David Caplan is a strong Minister that will surely see the system move forward.

    Questions that you might want to ask yourself about your organization:

    1. Does your organization understand the expectations of your organization by the various levels of government decision makers?

    2. Does your organization have good relationships horizontally within the health care system of providers and vertically with decision makers such as the CCAC, LHIN, MoH, and senior political decision makers?

    3. Do your relationships with the various parts of the health care system and the government decision makers provide you with a clear understanding of what specific actions, strategies and tactics are necessary to get your organization to be best positioned within the system?

    4. Does your organization have enough broad based information about the new health care system including the agendas and plans of the decision makers to effectively understand the bigger picture of where government is going, so that your organization can strategically fit in to the new direction?

    5. Is your organization being understood by the government in a positive manner to be a leader that can help establish sector best practices? Or, are there historical or sector issues that may be hampering your organization’s ability to succeed within the context of the LHIN environment?

    Leonard Domino & Associates regularly helps executives and boards to answer these types of questions, which enable their organizations to be better aligned with the government, while achieving their own goals and priorities.

    If you have any questions, please call us at 416-860-6244 or visit us at www.leonarddomino.com