Reporting on Ontario Healthcare

[Michael Hardner]

New Report on Ontario Healthcare in Globe & Mail

Almost half of Ontario patients who require urgent cancer operations don’t get them within the recommended two weeks or less. One quarter of nursing home residents don’t need to be in long-term care, while many of those who do spend months waiting to get in.

A new report of the Ontario Health Quality Council suggests one of the most costly health care systems in Canada – consuming 46 cents of every program spending dollar – is squandering precious resources due to inefficiency.

Key words and phrases:

1. almost half of Ontario patients don't get required care

2. this came out in a "new report"

3. there is both lack of service AND inefficiency in the system

So the system isn't meeting goals, and is failing in key areas. It's expensive and inefficient. These problems have been going on for years yet, somehow, we need a one-off report to tell us this ?

The people of Ontario need to start getting upset about the system NOW. It takes years to turn things around and the system seems to be getting worse (seems to, because these spotty reports can't be counted on to be accurate) by the year. By the time it starts breaking altogether, the politicians will start throwing money at it.

Here's a typical sentence:

“The lack of access to family doctors is surprising, given the supply of health professionals has been increasing steadily,” said Ben Chan, the chief executive office of the quality council, a government-funded independent agency.

My issues with this quote:

Problem #1 - the CEO is a doctor. This issue pervades the healthcare system - the lack of experience in delivery of services, management and business.

Problem #2 - it's "surprising" - How so ? These trends likely move slowly, don't they ? Was there a spike for some reason ? It's unclear. If the public was given regular statistics, then we wouldn't be surprised, we would see the graph slowly increasing and demand something be done.

Problem #3 - The report was produced by "The Quality Council". How many Ontarians even know what this agency is ? Another example of too many chefs, I think. I have been writing about these issues for years now, and I have never heard of it.

Problem #4 - Check out this phrase, oxymoron of the year: " a government-funded independent agency."

Their solution seems to be to base the pay of hospital CEOs on performance. What will this mean ? My blind guess is that they'll create a new set of bonuses for relative performance, and award these to the top 50% of performers *relative* to the bottom half. Whether or not the goals are reached are utterly beside the point - the top performers will be recognized, and anyway the public will be fast asleep until the next one-off report is released.

We'll have to wait years, of course, to find out if this works. And it won't.

[Shwa]

Wow.

Almost half of Ontario patients who require urgent cancer operations don’t get them within the recommended two weeks or less

This appears to be treated as a key performance indicator that can be used for performance measurement, yet in your "Key words and phrases" you state:

1. almost half of Ontario patients don't get required care

Exactly how did you get from such specificity to making such a general and completely fabricated statement? Can you point out in the article where it says that "half of Ontario patients don't get required care" please?

2. this came out in a "new report"

Did you miss the line in the article that says:

The report is being closely read by hospital chief executives. The quality council is slated to obtain expanded powers – to make recommendations on clinical practice guidelines, among other things – through the government’s Excellent Care for All Act, which passed third and final reading on Thursday.

So the government quotes another report that basically states the requirements for an Act that has already passed it's final reading.

More from the Ontario Health Quality Council:

REPORT FINDS PROGRESS, IDENTIFIES WHERE MORE IS NEEDED

3. there is both lack of service AND inefficiency in the system

This is a common refrain from every manager and above regarding her/his organization. It is a flag for change which, according to the government and it's new Act, is on its way. However, pick most any other institution or national/international organization and you will find lack of service and inefficiencies. I am confident when I go to my local hospital, but not so much when I call Bell or Rogers to resolve a problem. And I pay each of them roughly $75.00 per month for their services.

The people of Ontario need to start getting upset about the system NOW.

Gosh, Michael, did you actually read the article or are you stumping on a headline or brief from the Globe and Mail? If you would have read the article and followed the path over to OHQC and read what they have to say and realize that their whole purpose is to apply performance measurement and reporting, I am sure they are saying what you are advocating for.

There is one thing to be aware of though - if you want improved services and efficiencies, get ready to pay for it because bureaucratic performance systems cost money. If you think a doc makes big bucks, wait until you see the bill for the management consultants.

[Michael Hardner]

Wow.

This appears to be treated as a key performance indicator that can be used for performance measurement, yet in your "Key words and phrases" you state:

Exactly how did you get from such specificity to making such a general and completely fabricated statement? Can you point out in the article where it says that "half of Ontario patients don't get required care" please?

I was highlighting key phrases in the paragraph I clipped. I wasn't summarizing or restating the argument, and didn't intend to convey that 1/2 of all patients in Ontario didn't get required care.

I highlighted general areas of concern, which are still so broad that they defy parsing them in the way that you're attempting to do.

Did you miss the line in the article that says:

So the government quotes another report that basically states the requirements for an Act that has already passed it's final reading.

Yes, I did miss that. I'm not comforted by what it says, though.

More from the Ontario Health Quality Council:

REPORT FINDS PROGRESS, IDENTIFIES WHERE MORE IS NEEDED

This is a common refrain from every manager and above regarding her/his organization. It is a flag for change which, according to the government and it's new Act, is on its way. However, pick most any other institution or national/international organization and you will find lack of service and inefficiencies. I am confident when I go to my local hospital, but not so much when I call Bell or Rogers to resolve a problem. And I pay each of them roughly $75.00 per month for their services.

You shouldn't feel confident when you go to your local hospital, depending on what you go for.

This new report tells you why.

Gosh, Michael, did you actually read the article or are you stumping on a headline or brief from the Globe and Mail? If you would have read the article and followed the path over to OHQC and read what they have to say and realize that their whole purpose is to apply performance measurement and reporting, I am sure they are saying what you are advocating for.

There is one thing to be aware of though - if you want improved services and efficiencies, get ready to pay for it because bureaucratic performance systems cost money. If you think a doc makes big bucks, wait until you see the bill for the management consultants.

This is the refrain of people inside the system: it's so complicated that it will have to get MORE complicated to fix it. They don't realize that they are inside the system, and can't see it objectively. I spoke to one healthcare worker, who explained to me that she had to spend time filling out three separate reports, and wished that another group could come in and manage that for her. Then when that group got too busy, they could hire another group etc.

The solution to the complexity is simplicity. The time has come for people to fight and the key for for the people of Ontario to say 'enough' to increasing costs and complexity.

(To answer your question, I only read the G&M summary and some of the report. Those statistics would be enough for any private sector managers to declare an emergency. As it is, the McGuinty government - who hasn't achieved anything yet - has, really, more of the same as a solution.

I'll read the link now, in case there are actually some rays of hope but I doubt it.

[Michael Hardner]

Now that I have seen the OHQC website and read a bit of their conclusions, it's pretty clear that they are not independent.

If they were, they wouldn't include point-form issues, and use terms like "needs improvement", and finish their little web page off with a section called "Success Stories".

It's all lame, and Ontarians need to demand better or it will get worse, and costs will increase.

[Shwa]

Are you critiquing the media for such a wishy-washy portrayal of the issue or inventing such a view yourself? If the former, then this is the right place for this post; if the latter then perhaps it should be moved to Ontario politics.

I was highlighting key phrases in the paragraph I clipped. I wasn't summarizing or restating the argument, and didn't intend to convey that 1/2 of all patients in Ontario didn't get required care.

You didn't intend to misrepresent what was written or re-arrange the words in such a way as to remove specificity in favour of an opinion of a general condition? Fair enough. At least the G&M have editors.

I highlighted general areas of concern, which are still so broad that they defy parsing them in the way that you're attempting to do.

I am not trying to parse anything. I am trying to point out to you that it appears - from the content of the article and subsequent follow-up from the OHQC website - that the Ontario government is in the midst of applying modern management practices to health care in Ontario. If anyone is trying to parse something, it will be the government in the health care sector with the implementation of performance indicators.

You shouldn't feel confident when you go to your local hospital, depending on what you go for.

But I do. I have taken myself, my family and friends to Ontario hospitals for anything from minor sports injuries to major surgeries and the quality of care has been very good, the staff always efficient and care-ful and the service excellent. Is it perfect? No. Can it be improved? Of course. Just like anything else in any of our institutions.

This new report tells you why.

This is the refrain of people inside the system: it's so complicated that it will have to get MORE complicated to fix it. They don't realize that they are inside the system, and can't see it objectively. I spoke to one healthcare worker, who explained to me that she had to spend time filling out three separate reports, and wished that another group could come in and manage that for her. Then when that group got too busy, they could hire another group etc.

This is a two-parter.

You say that those inside the system cannot see "objectively" and so the same likely holds true for those outside of the system because they are not aware of all the details, the plans, the statistics, etc. So we have two silos operating on different perspectives. The problem with this view is that you give no evidence for those "inside the system" no being able to see things objectively. Do you have a cite for this or reports that you can back this vie wup with? Because from what I see of the OHQC, they seem to understand aspects of the problem enough to apply performance management principles, which are generally seen as "'objective.'

The solution to the complexity is simplicity. The time has come for people to fight and the key for for the people of Ontario to say 'enough' to increasing costs and complexity.

Who said that it is necessarily going to be more complex? When sound management principles are applied in an effort to achieve standards, this usually results in less complex processes. We are talking about checklists, knowledge retention, data management, automation etc. How will the process for efficiency make things more complex? And of course there will be some front loading of costs, but in the long run when inefficiencies are repaired that results in savings that can be utilized elsewhere, usually in underfunded or underserviced areas.

My big beef with such management practices is that they trend towards a lower standard overall to address disparate standards in various regions. Such that the 97% efficiency rate at North York General can go down if lowering it means the efficiency rate at Toronto East General or Centenary in Ajax wil be raised. That is a "change" that demanding people rarely expect.

[Shwa]

Now that I have seen the OHQC website and read a bit of their conclusions, it's pretty clear that they are not independent.

If they were, they wouldn't include point-form issues, and use terms like "needs improvement", and finish their little web page off with a section called "Success Stories".

It's all lame, and Ontarians need to demand better or it will get worse, and costs will increase.

OHQC is a provincial agency, whioch you noted in your OP and which is clearly marked out on their website under the "Mandate" section:

The Ontario Health Quality Council, established in September 2005, was created under The Commitment to the Future of Medicare Act, 2004. The Council is an Operational Service Agency that reports to the Minister of Health and Long-Term Care.

They are no more independent than the Animal Care Review Board, a Police Service Board, or the Travel Industry Council of Ontario. However, the use of the word "independent" is from the Globe and Mail article.

[Michael Hardner]

Are you critiquing the media for such a wishy-washy portrayal of the issue or inventing such a view yourself? If the former, then this is the right place for this post; if the latter then perhaps it should be moved to Ontario politics.

I debated putting it in Ontario politics, but my point of view is that we don't have a media vehicle for public access to proper performance statistics. In this information age, that's unforgivable.

I would say that that requirement is a requirement of media, though it likely should be new media.

You didn't intend to misrepresent what was written or re-arrange the words in such a way as to remove specificity in favour of an opinion of a general condition? Fair enough. At least the G&M have editors.

I said... here are the key phrases from the highlighted paragraph, which presumed that the person read the paragraph. In short, those were the areas that highlighted the root problems for us to look at, the key points of discussion.

And, yes, I posted it quickly without anticipating that it could easily be misinterpreted.

I am not trying to parse anything. I am trying to point out to you that it appears - from the content of the article and subsequent follow-up from the OHQC website - that the Ontario government is in the midst of applying modern management practices to health care in Ontario. If anyone is trying to parse something, it will be the government in the health care sector with the implementation of performance indicators.

Then, let's review where we are with these problems.

McGuinty said in the campaign against Eves that he was going to measure and improve wait times. That didn't happen right away, and the agency that was charged to do it was redefined as eHealth. Then 1 year ago we had the eHealth scandal. Now, we have this new approach. And none of these approaches are particularly radical or appear to apply urgency.

They can't get the guidelines met so now they're going to legislate them ? It will take years for that to result in anything, and then what ? The early retirement of hospital administrators who couldn't do the job, to be replaced by new individuals who came through the system in the same way.

But I do. I have taken myself, my family and friends to Ontario hospitals for anything from minor sports injuries to major surgeries and the quality of care has been very good, the staff always efficient and care-ful and the service excellent. Is it perfect? No. Can it be improved? Of course. Just like anything else in any of our institutions.

This new report tells you why.

1/2 of cancer patients don't get treatment quickly enough.

That is far worse than unperfect. Can it be improved? You're not upset, so why should it be?

If 60, 70, 80 percent of cancer patients can't get treatment quickly enough will you be upset then, or will you say "I'm ok"?

You say that those inside the system cannot see "objectively" and so the same likely holds true for those outside of the system because they are not aware of all the details, the plans, the statistics, etc. So we have two silos operating on different perspectives. The problem with this view is that you give no evidence for those "inside the system" no being able to see things objectively. Do you have a cite for this or reports that you can back this vie wup with? Because from what I see of the OHQC, they seem to understand aspects of the problem enough to apply performance management principles, which are generally seen as "'objective.'

Those inside the system - the workers - need to call for change like the rest of us. People 'inside the system' traditionally don't have a wide view. That's just normal. The wide view should be with top level managers ane executives, but they are political animals.

I took a class with a bunch of middle level managers with a large corporation. We had a group case study to complete, on how to handle a problem where the staff was too busy to answer phones, and so the phones rang and rang.

One of the managers gave his solution: pass a rule saying "all phones to be answered immediately". But, the problem was that they were busy with other priority issues that prevented them being able to answer the phones. This guy was a manager making 6 figures, and didn't have a wide view.

What are they doing, where is the time going, how much does it cost, how does it get better.

Every year, you should be lowering costs, streamlining, increasing or keeping level your client satisfaction and your internal employee satisfaction.

Edited June 6, 2010 by Michael Hardner

[Michael Hardner]

Who said that it is necessarily going to be more complex? When sound management principles are applied in an effort to achieve standards, this usually results in less complex processes. We are talking about checklists, knowledge retention, data management, automation etc. How will the process for efficiency make things more complex? And of course there will be some front loading of costs, but in the long run when inefficiencies are repaired that results in savings that can be utilized elsewhere, usually in underfunded or underserviced areas.

This is the quote:

"There is one thing to be aware of though - if you want improved services and efficiencies, get ready to pay for it because bureaucratic performance systems cost money. If you think a doc makes big bucks, wait until you see the bill for the management consultants."

Management consultants are people that bad managers hire to do their jobs, and then they don't apply the results.

I'm ok with a one-time bump in costs to restructure, followed by a long slow decline in costs and increase in service levels.

My big beef with such management practices is that they trend towards a lower standard overall to address disparate standards in various regions. Such that the 97% efficiency rate at North York General can go down if lowering it means the efficiency rate at Toronto East General or Centenary in Ajax wil be raised. That is a "change" that demanding people rarely expect.

This sounds like an example an insider would know of, and is therefore quite useful. Let's hear it.

[Michael Hardner]

OHQC is a provincial agency, whioch you noted in your OP and which is clearly marked out on their website under the "Mandate" section:

They are no more independent than the Animal Care Review Board, a Police Service Board, or the Travel Industry Council of Ontario. However, the use of the word "independent" is from the Globe and Mail article.

Ok. Those other boards manage things that the province doesn't deliver, though.

[Michael Hardner]

By the way, the importance of performance statistics isn't my idea, but one that is accepted in government and business everywhere, and that has been for decades, including this:

http://www.health.gov.on.ca/english/public/pub/ministry_reports/pirc_02/pirc_02.html

To realize their vision of health, the First Ministers have made three commitments :

* To continuously renew health care services by working with other governments, communities, service providers, and Canadians to meet emerging needs;

* To share information that helps contribute to continuous quality improvement and efficiency of health care services;

* To report regularly to Canadians on the health status, health outcomes, and the quality of service received from publicly funded health services.

From 2002 !

[Michael Hardner]

And I have found another resource on this topic from the University of Windsor:

http://web4.uwindsor.ca/units/leddy/leddy.nsf/HealthStatistics!OpenForm

Also, ICES:

http://www.ices.on.ca/webpage.cfm?site_id=1&org_id=26

Not to mention CIHI which is still the primary source of information.

I keep finding these, and updating this post.

http://www.healthsystemfacts.com/Client/OHA/HSF_LP4W_LND_WebStation.nsf/page/System+Performance

That last one is good, as it's the first site I have seen with costs broken out on the front page.

And THIS:

http://www.slidefinder.net/m/mis_overview_reporting/standards/525215

Is an essential read to understand why performance reporting is essential. These aren't controversial ideas, but they need to be pushed by the public more.

Note on page 14: "No timeframe for implementation."

Edited June 6, 2010 by Michael Hardner

[Michael Hardner]

An interesting excerpt here from the Toronto Star - June 1st.

http://www.healthedition.com/memberhome.cfm

Dr. Evans identifies medical imaging and laboratory testing as the major sources of cost escalation, although he says the benefits of this activity is unknown. As an example, he notes that utilization of ultrasounds for low-risk pregnancies is up 50 per cent in the past decade.

He also says patterns in medical practice and hospital use vary widely across the country without any apparent reason. He says groups such as Ontario’s Institute for Clinical Evaluative Sciences have tracked some of these variations “but they are largely ignored.”

Another reference to ICES there. It seems that these organizations (I found another called healNET) come and go. This is why the ministry itself needs to establish a persist, accurate, independent set set of performance statistics.

[Shwa]

I debated putting it in Ontario politics, but my point of view is that we don't have a media vehicle for public access to proper performance statistics. In this information age, that's unforgivable.

I would say that that requirement is a requirement of media, though it likely should be new media.

Really? What if there is only raw data and no one in the media to synthesize those into information the public will comprehend given the context? (The public finds out the unemployment rate from EI; but I am sure there is some number crunching going into that data before we say 8% is unemployed.) Or what if the data exists in several different formats, some of it proprietary like a PeopleSoft database or something? Or... {gulp} what it the data has never really been collected in a comprehensive form?

I said... here are the key phrases from the highlighted paragraph, which presumed that the person read the paragraph. In short, those were the areas that highlighted the root problems for us to look at, the key points of discussion.

And, yes, I posted it quickly without anticipating that it could easily be misinterpreted.

All you did was spin the words to suit your own argument. In fact you did not quote one single phrase at all, but paraphrased some words into the spin. And you want "new media" to do what?

Then, let's review where we are with these problems.

McGuinty said in the campaign against Eves that he was going to measure and improve wait times. That didn't happen right away, and the agency that was charged to do it was redefined as eHealth. Then 1 year ago we had the eHealth scandal. Now, we have this new approach. And none of these approaches are particularly radical or appear to apply urgency.

Radicalism from the Provincial Liberals? Are you kidding me? If you are waiting for a radical approach, you are not going to see this in mainstream Canadian politics, at least not for very long. LOL, I think they adressed the eHealth problems with some urgency though. Political expediency if you will...

They can't get the guidelines met so now they're going to legislate them ? It will take years for that to result in anything, and then what ? The early retirement of hospital administrators who couldn't do the job, to be replaced by new individuals who came through the system in the same way.

That is just pessimism. And I am not certain they can't meet "thge guidelines." Again, you want radical change.

1/2 of cancer patients don't get treatment quickly enough.

Again! You are completely fabricating facts to suit your argument. One more time now:

Almost half of Ontario patients who require urgent cancer operations don’t get them within the recommended two weeks or less

That is far worse than unperfect. Can it be improved? You're not upset, so why should it be?

Your representing the facts "is far worse than unperfect." You it be improved? You're not upset, so maybe it is your intention to continue to misprepresent what has been said?

If 60, 70, 80 percent of cancer patients can't get treatment quickly enough will you be upset then, or will you say "I'm ok"?

So now an appeal to emotion eh? Come on now...

Those inside the system - the workers - need to call for change like the rest of us. People 'inside the system' traditionally don't have a wide view. That's just normal. The wide view should be with top level managers ane executives, but they are political animals.

And this is different from other institution, corporations and organizations how? Do you want change to the Ontario Health System with more performance oriented management techniques or do you want an overhaul or organization psychology?

I took a class with a bunch of middle level managers with a large corporation. We had a group case study to complete, on how to handle a problem where the staff was too busy to answer phones, and so the phones rang and rang.

One of the managers gave his solution: pass a rule saying "all phones to be answered immediately". But, the problem was that they were busy with other priority issues that prevented them being able to answer the phones. This guy was a manager making 6 figures, and didn't have a wide view.

You are giving me a personal anecdote about middle level managers with a large corporation and applying that as a template to the Ontario Health System? You're kidding me right?

What are they doing, where is the time going, how much does it cost, how does it get better.

Every year, you should be lowering costs, streamlining, increasing or keeping level your client satisfaction and your internal employee satisfaction.

So then what is it about updating management practices, using key performance indicators, moving to a JIT serivce model, etc., that does not apply to what you are seeking? Seems to me that what you want in the above quote is the same sort of thing that is being acted upon right now.

[Shwa]

This is the quote:

"There is one thing to be aware of though - if you want improved services and efficiencies, get ready to pay for it because bureaucratic performance systems cost money. If you think a doc makes big bucks, wait until you see the bill for the management consultants."

So where in this quote does it indicate more complex? Generally, improved services and efficiencies result is less-complexity wouldn't you say?

Management consultants are people that bad managers hire to do their jobs, and then they don't apply the results.

Management consultants are usually hired to give a somewhat objective view/advice/report of the current management practices in a given organization. This may be temporary or it may be an on-going initiative during a change window. WHen projectizing organizations was the rage, there were many project management consultants. Sometimes they are hired to get an org up to ISO standards. Other times ITSO standards. Often "management consultants" are former employees hired back on contract so that there is a continuity of organizational knowledge.

I'm ok with a one-time bump in costs to restructure, followed by a long slow decline in costs and increase in service levels.

Me too.

This sounds like an example an insider would know of, and is therefore quite useful. Let's hear it.

People have an expectation of the end results when there is a change window. But not everyone reads the manual (RTFM) and when the change is finally initiated, they get all pissy because it isn't what they expected. I mean, who decides what colour to paint the corridors of hospitals anyways??

[Shwa]

Ok. Those other boards manage things that the province doesn't deliver, though.

If I understand correctly the province doesn't deliver health care either except in limited situations like remote postings and internal health care to provincial staff. My local hospital is part of a large corporation called Lakeridge. How about yours?

[Shwa]

By the way, the importance of performance statistics isn't my idea, but one that is accepted in government and business everywhere, and that has been for decades, including this:

http://www.health.gov.on.ca/english/public/pub/ministry_reports/pirc_02/pirc_02.html

From 2002 !

The importance of performance statistics and key deliverables has been a part of modern management practices for the past few decades. They are just making their arrival in the public bureaucracy within the past decade. I didn't really notice them until engineering project management practices started to become the rage within corporate management. The timing of this phenomenon coincides with the emergence of modern computing technology, the Internet and Government 2.0.

Now, there's an interesting little tidbit of history: engineering project management practices being generally applied to social program delivery. I wonder what term we could use to refer to this phenomenon...

[Michael Hardner]

Really? What if there is only raw data and no one in the media to synthesize those into information the public will comprehend given the context? (The public finds out the unemployment rate from EI; but I am sure there is some number crunching going into that data before we say 8% is unemployed.) Or what if the data exists in several different formats, some of it proprietary like a PeopleSoft database or something? Or... {gulp} what it the data has never really been collected in a comprehensive form?

You can always add askerisks and small print explaining how the numbers are calculated. But assuming the criteria don't change, a good graph can provide simple and easy-to-read information.

There's also the opportunity to add notes explaining spikes and so forth.

If the data has never been collected then maybe it should be.

All you did was spin the words to suit your own argument. In fact you did not quote one single phrase at all, but paraphrased some words into the spin. And you want "new media" to do what?

Yes, I paraphrased three areas of the excerpt that I wanted to focus on.

Radicalism from the Provincial Liberals? Are you kidding me? If you are waiting for a radical approach, you are not going to see this in mainstream Canadian politics, at least not for very long. LOL, I think they adressed the eHealth problems with some urgency though. Political expediency if you will...

Radical meaning different from the business-as-usual approach.

If they addressed the problems, then what happened ? They spent a billion dollars and I don't see anybody talking about the achievements of eHealth.

That is just pessimism. And I am not certain they can't meet "thge guidelines." Again, you want radical change.

Yes, because we have seen no improvement, and given the flaccid reaction to all of this including the eHealth debacle (talking about the lack of results here, not the consultant who got fired for billing for tea) then - YES- I want major changes.

Why don't you ?

Again! You are completely fabricating facts to suit your argument. One more time now:

Almost half of Ontario patients who require urgent cancer operations don’t get them within the recommended two weeks or less

Ok. I stand corrected.

Your quote is correct.

Now, don't you think that this is a major problem ? That the liberal government hasn't made adequate process ? The evidence is there.

Your representing the facts "is far worse than unperfect." You it be improved? You're not upset, so maybe it is your intention to continue to misprepresent what has been said?

So now an appeal to emotion eh? Come on now...

And what point will you become upset, is my question ? Why are you not upset now ?

And this is different from other institution, corporations and organizations how? Do you want change to the Ontario Health System with more performance oriented management techniques or do you want an overhaul or organization psychology?

It's not different from other organizations in that way. I want performance oriented management techniques now, and an overhaul too - starting soon. The stats will tell the public whether it is working far better than one-off reports.

You are giving me a personal anecdote about middle level managers with a large corporation and applying that as a template to the Ontario Health System? You're kidding me right?

It's a story about how managers can be, in general.

So then what is it about updating management practices, using key performance indicators, moving to a JIT serivce model, etc., that does not apply to what you are seeking? Seems to me that what you want in the above quote is the same sort of thing that is being acted upon right now.

Acted upon how ? They're legislating service levels. Do you think that's going to fix our problems ? I don't. Legislating service levels is like the manager who says "answer all phones immediately".

The Ontario governement sounds to me like they're saying "fix it".

If we had regular reports on service levels then we could see trends on how these things are doing.

[Michael Hardner]

So where in this quote does it indicate more complex? Generally, improved services and efficiencies result is less-complexity wouldn't you say?

Yes, I would say.

Your quote was something like 'get ready to pay more for management consultants and bureaucratic performance systems'. I got 'more complexity, and more expensive' from that.

But if they pulled the system apart and did it right, they could consolidate the systems that already exist, or replace them.

Management consultants are usually hired to give a somewhat objective view/advice/report of the current management practices in a given organization. This may be temporary or it may be an on-going initiative during a change window. WHen projectizing organizations was the rage, there were many project management consultants. Sometimes they are hired to get an org up to ISO standards. Other times ITSO standards. Often "management consultants" are former employees hired back on contract so that there is a continuity of organizational knowledge.

I'm aware of that.

People have an expectation of the end results when there is a change window. But not everyone reads the manual (RTFM) and when the change is finally initiated, they get all pissy because it isn't what they expected. I mean, who decides what colour to paint the corridors of hospitals anyways??

People initiate change all the time, and don't pay attention to what they have signed off on. That's a failure and the person signing off and not reading what they're paying for should get dinged for it.

Sure, failure happens, but knowing that - we should always be pissed off when things fail. That's our job. We can expect some failure, but we should only be happy with continuous improvement.

That goes for workers, managers, executives and customers too.

[Michael Hardner]

If I understand correctly the province doesn't deliver health care either except in limited situations like remote postings and internal health care to provincial staff. My local hospital is part of a large corporation called Lakeridge. How about yours?

It's within their area of responsibility, though. As such, they have an interest in making themselves look better than they are, so self-reporting isn't the best idea.

[Michael Hardner]

The importance of performance statistics and key deliverables has been a part of modern management practices for the past few decades. They are just making their arrival in the public bureaucracy within the past decade. I didn't really notice them until engineering project management practices started to become the rage within corporate management. The timing of this phenomenon coincides with the emergence of modern computing technology, the Internet and Government 2.0.

Now, there's an interesting little tidbit of history: engineering project management practices being generally applied to social program delivery. I wonder what term we could use to refer to this phenomenon...

It's the same thing, though. It's the delivery of services. The stakeholders are more numerous, and the importance of these things is higher, IMO.

That's why we need to do it, and not be satisfied with Rogers Cable type service.

Furthermore, if we do this properly - if we empower some smart people to make some major changes and explain their goals clearly then we will be able to fix healthcare. I'm convinced of that.

[Michael Hardner]

Shwa, unlike others who have posted on this topic, you have a lot of knowledge about management and apparently about healthcare although you've been more coy about that.

I am enjoying this discussion, but several posts replying will become tiresome. I think you get the gist of my argument. I'm still mystified as to why you're satisfied with the way things are, especially because you seem to understand engineering management practices.

What is your take on this, then ?

How would you improve things ?

I would spend a billion, give billion, or more to make these things better but I can't trust the government to make change happen. They have already tried, and failed and I don't see why the same people will do better a second time.

[Shwa]

Shwa, unlike others who have posted on this topic, you have a lot of knowledge about management and apparently about healthcare although you've been more coy about that.

I am enjoying this discussion, but several posts replying will become tiresome. I think you get the gist of my argument. I'm still mystified as to why you're satisfied with the way things are, especially because you seem to understand engineering management practices.

What is your take on this, then ?

How would you improve things ?

I would spend a billion, give billion, or more to make these things better but I can't trust the government to make change happen. They have already tried, and failed and I don't see why the same people will do better a second time.

I agree, keep it to one response.

Firstly, I have no quarrel with your ideas, which are worthy and noble. But I do have issue with your method - especially the parts where you mis-quote, mis-state or plainly fabricate. I think you do a disservice to your argument by resorting to these sorts of tactics and it borders on hyperbole. There is a sense of irony - and a little sense of confusion - as to you starting this thread in the 'Media and Broadcasting' section. It is difficult to decipher if you are talking about the media presentation of the issue, or your own. So there is an argument on two levels - yours and that of the G&M.

I am not "satisfied" with the way "things are" with our current health system and I never said that. I said I was confident going to a hospital for treatment and the service and treatment were always very good and then I qualified that statement by saying that it isn't perfect.

So... the health care system is not perfect, but we cannot simply stop it for a few weeks or few months to re-tool like is done in some manufacturing sectors. So any work that has to be completed, has to be done during production time (24X7). We can sit back and prognosticate, but the front line of this institution does not have that luxury. And despite any party stripe, we are all more or less liberal in our outlook and that means carefully managed incremental changes to institutions. There will never be any radical changes to the health care system in Ontario, it can only consist of modifications, tweaks and course corrections.

Now I fully agree that modern reporting techniques should be applied, but the scope of those reports and the scope of the stakeholders access to those reports is something that needs to be altered. The Excellent Care for All Act 2010 appears to be moving those goals in the right direction, yet you have not touched on this active legislation at all. It appears to address some of the things you are concerned about.

Now whether you "trust the government to make change happen" is a titch absurd or near-sighted or both. Look at the long term results of changes to Ontario institutions and that view becomes untentable. Liberalism is about small incremental changes over periods of time; it isn't radicalism and the health care system cannot afford this view nor the inherent risks. And it doesn't matter if you are NDP, Lib or PC, the managerial aspects are more or less the same.

Edited June 7, 2010 by Shwa

[Michael Hardner]

Firstly, I have no quarrel with your ideas, which are worthy and noble. But I do have issue with your method - especially the parts where you mis-quote, mis-state or plainly fabricate. I think you do a disservice to your argument by resorting to these sorts of tactics and it borders on hyperbole. There is a sense of irony - and a little sense of confusion - as to you starting this thread in the 'Media and Broadcasting' section. It is difficult to decipher if you are talking about the media presentation of the issue, or your own. So there is an argument on two levels - yours and that of the G&M.

Please believe me, I'm not interested in misstating or fabricating. Most of the time my posts on this topic are ignored. If I were intending to deceive, then I wouldn't have quoted the original paragraph so close to my misquote would I ?

I was intending on highlighting areas for concern.

I really think we should get past this. If you think I'm being deceptive then we should just stop discussing, anyway.

And as to which section this belongs in... not that intersting a discussion either.

I am not "satisfied" with the way "things are" with our current health system and I never said that. I said I was confident going to a hospital for treatment and the service and treatment were always very good and then I qualified that statement by saying that it isn't perfect.

I'm underwhelmed by your response. I will ask again, more to the point: why are you not upset ?

So... the health care system is not perfect, but we cannot simply stop it for a few weeks or few months to re-tool like is done in some manufacturing sectors. So any work that has to be completed, has to be done during production time (24X7). We can sit back and prognosticate, but the front line of this institution does not have that luxury. And despite any party stripe, we are all more or less liberal in our outlook and that means carefully managed incremental changes to institutions. There will never be any radical changes to the health care system in Ontario, it can only consist of modifications, tweaks and course corrections.

No one is suggesting stopping it.

It shouldn't consist of modifications, tweaks and course corrections. If we don't get upset about the situation, then privatization will be forced upon us, period.

Now I fully agree that modern reporting techniques should be applied, but the scope of those reports and the scope of the stakeholders access to those reports is something that needs to be altered. The Excellent Care for All Act 2010 appears to be moving those goals in the right direction, yet you have not touched on this active legislation at all. It appears to address some of the things you are concerned about.

I have actually mentioned it several times: they are legislating service levels are they not ? I even called back to the analogy of the manager who mandated all phones to be answered immediately, not recognizing the problems that his staff was facing.

Simply put: this just appears to be more of the same, a continuation of the non-results that the eHealth agency has given us.

Now whether you "trust the government to make change happen" is a titch absurd or near-sighted or both. Look at the long term results of changes to Ontario institutions and that view becomes untentable. Liberalism is about small incremental changes over periods of time; it isn't radicalism and the health care system cannot afford this view nor the inherent risks. And it doesn't matter if you are NDP, Lib or PC, the managerial aspects are more or less the same.

You are satisifed with the status quo, which is decline, obfuscation, self-reporting and increasing costs.

Given that you're the most knowledgable person on the topic I've discussed it with, your opinion represents a key segment of stakeholders - and, I'm afraid, you alone are making me wonder if two-tier is the only way to go.

I am somebody who marched against Harris, who signed petitions, and who not only voted for the NDP, but worked for them over 4 decades.

I'm disgusted with the complacency that is pervasive in the health sector and in Canadian society in general, and you personify that complacency.

Again, my questions:

- Why are you not upset at the results of these reports ?

- At what levels will you become upset ?

[Shwa]

Again, my questions:

- Why are you not upset at the results of these reports ?

- At what levels will you become upset ?

"These reports" Do you mean this one?

Satisfaction indicators:

Percent of population that rates hospital services received as good or excellent (2007):

81%

Percent of population that rates health services received as good or excellent (2007)

84.7%

Percent of population that rates medical care received as very good or excellent (2007)

75%

These percentages are more or less in line with the rest of Canada.

So, what reports are you specifically referring to that indicates that active legislation is a sign of complacency?

[Michael Hardner]

I'm not that impressed with those numbers, the one marked as

Percent of population that rates medical care received as very good or excellent (2007)

is at 75%, for those who have a regular doctor.

Will you answer my question next ?

Edited June 7, 2010 by Michael Hardner