The Ministry of Health’s New Proposal: Lacks transparency, direction & focus on quality

Last week Ontario’s Ministry of Health released a proposal for major changes to how healthcare is structured in the province. You can find the News Release here and the Full Proposal here.

Here was my reaction after reading it.

Lacks transparency

First thing I thought – it wasn’t worth reading the whole proposal. I found myself annoyed because 90% of it was fluff.

The entire proposal can be summarized in 3 sentences:

  1. Put LHINs in charge of home care.
  2. Put LHINs in charge of primary care.
  3. Put LHINs in charge of public health.

(LHINs, or Local Health Integration Networks, are the regional health authorities in Ontario responsible for planning, integrating and funding public healthcare services)

Instead of saying it like it is, the Ministry of Health delivered an unnecessarily long 24-page proposal to “cushion” those 3 points of contention.

This is an example of what’s wrong with the culture in our healthcare system. We can’t be effective if we don’t have 100% transparency.

The Ministry of Health is asking for feedback on the proposal – okay, then tell me what you’re really after in as few words as possible, and let’s go from there!

Lacks direction

Organizations need a clear sense of direction. Everyone on the team needs to what know the overall goal is. If they don’t, it’s a failure of the leadership team. I’ve learned that the hard way.

If the Ministry of Health is to lead healthcare in Ontario, they need to define where our healthcare system needs to be. If “X” marks the spot – what does that mean for us?

A great leader determines where “X” is and communicates that to the team. A great team will figure out how to get there – but a team can’t be effective if they don’t know where to go.

That’s the problem with this proposal and with the Ministry of Health. This proposal still doesn’t solve the problem of not knowing what “X” is for healthcare in Ontario. The proposal is telling us a “how” (i.e. putting LHINs more in control), but it doesn’t tell us where this is all heading.

I do believe an integrated healthcare system in theory is much better. Ontario has one of the most fragmented healthcare systems in Canada, and it is hurting us badly.

BUT how am I supposed to give constructive feedback on this proposal if I don’t know where we are headed? It’s like asking if the directions on a map are correct without telling me what city we are going to.

We are fixing things in the wrong order, and that’s just not effective.

Figure out where you need to go first. Communicate that to your team. Then figure out the best way to get there.

Lacks focus on quality

So what direction do we need to head in?

Without a question, the #1 problem in our healthcare system is the outdated reimbursement model. The shift from volume-based funding (e.g. fee-for-service) to quality-based funding (e.g. pay-for-performance) isn’t happening fast enough.

So what shocked me most about this proposal was that it had nothing about quality, accountability or performance.

Ontario still lacks ambitious, measurable targets for better quality healthcare.

You know what’s ambitious? Publicly announcing country-wide goals of

  1. Tying 50% of publicly funded healthcare payments to non-Fee-for-Service models
  2. Tying 90% of publicly funded healthcare payments as a whole to quality or value in some way

Oh, and to tell the world you will achieve this within 3 years.

Unreal right? Well the U.S. did that 12 months ago.

Do you think they actually have a plan for this yet? Of course they don’t. But by setting public targets, every stakeholder in the system (government included) will be held accountable to them.

Lack of transparency.
Lack of direction.
Lack of focus on quality.

That sums up not just this proposal, but also what’s wrong with the way our healthcare system functions.

P.S. Not to mention that it’s pretty ridiculous (a.k.a. bad) to propose major structural changes while you are in the middle of a fight with the 26,000 doctors in your province.

You can’t lead major structural change if 26,000 people on your team don’t believe in you.

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