Innovate or decline: how Canada’s healthcare system needs to change
Take a sprawling $50 billion enterprise under severe budget constraints. Add a looming collision with rising costs and other-worldly expectations. That’s the Ontario health care system, as it confronts an aging population and a government that demands improved service at the same cost, or less. The answer is: Innovate or decline. And do it without the heavy profit incentives of private business – or the U.S. health system.
“In the years ahead, we have to innovate,” says Alex Drossos, an engineer, former healthcare manager and now a resident in psychiatry at McMaster University. “Without it, we will not be able to maintain the level of health services we desire inside the public system.”
The innovation issue is one of the great managerial challenges of this century – not just in Ontario but in public health networks everywhere. There is growing recognition that innovation comes in different packages – from new technologies to process tweaks that save precious dollars to plough back in improvements.
According to DeGroote MBA’s who are working in the system, the people who drive this innovation may be doctors and nurses, tech savants, or administrators with an eye on the big picture, but also on day-to-day tasks that create efficiencies.
On the technology side is Jeff Doleweerd, who has helped develop a software product allowing clinicians to book immediate appointments for patients inside the community care networks. For Doleweerd, now an entrepreneur but formerly a public healthcare manager, the spark came from watching clinicians wrestling with an unwieldy appointment process that depended on the ancient technology of faxes.
“A light bulb went on and I decided I wanted to solve something that helps disadvantaged parties – practitioners and patients.” He has found a nice niche for his private company, CareDove. But to innovate, he needs the support of change-embracing managers in the system. The driver is often managers’ realization that “I have to provide excellent service or we’re in trouble,” Doleweerd says. “That is where innovation thrives. It is really about some new idea that makes something better for a party that needs it.”
So, for innovation to thrive, there must be managers who are willing to tap new thinking, wherever they find it.
“I am the person who takes other people’s good ideas and figures out how to make them real,” says Karyn Lumsden, vice-president, patient care services quality and safety at the Central West Community Care Access Centre in Brampton.
Inside the team, she says, she tries to ask the tough questions, “and create the atmosphere so people feel safe, take some risks, and throw out creative ideas.” That means hiring the right people and then getting out of the way. “It’s really about stepping back, letting the team run with the good ideas and providing strategic oversight.”
Lumsden understands how innovation can happen – often through a conversation about a process challenge. Recently, the centre where she is a leader – a hub for community health services — has been working at aligning its care coordinators with primary physicians in the area.
It took a comment by one of the team — Why couldn’t they reorganize care around the physicians? — to ignite fresh thinking. The organization spent a year restructuring, which will yield efficiencies and, most importantly, strengthen relationships across the continuum of care.
In any system, however, there is a natural inertia. People have ingrained ways of doing things, and resist any prospect of change. Combine that with the turf-protection impulse that stalls new initiatives. And health care managers are often sidetracked by the politics around funding while losing sight of the internal innovation imperative.
The new model of healthcare leader is often a clinician who has added management training, perhaps an MBA. It is a good model, says Drossos, but leaders must rise to be twin champions — of good clinical outcomes and patient care, and of change and innovation.
“They cannot be standing down and getting pushed around when it comes to facing resistance to change.”
And in the end, just being more efficient can be a powerful motivator in itself, argues Mike Heenan vice-president for quality, strategic information and performance systems for St. Joseph’s Health Centre in Toronto.
He says a lot of people define innovation as only new technology, but he would also spotlight the little things — how, for example, nurses might wrap a wound differently to make sure it doesn’t easily come undone, thus using up supplies and exposing the patient to infection. Or, say, how many times a patient is turned in the bed.
“We all think innovation is space ships and robots but there are innovations in practice, in how we treat patients who are in our care. It is better for everyone, and great for the system, because it means not wasting resources as before and we can reinvest those dollars.”
Drossos also believes the system can innovate without profit as the overriding priority. “The incentive is we should have a sustainable system – in my view, a public system– given the aging population. That should be incentive enough.”
He worries though about the risk-averse nature of the system. Sometimes, he says, you just have to do innovation, and bypass the pilot project stage. As a manager, he discovered that “health care in Ontario loves pilot projects and they often get nowhere – so many of them just stop.”
The high rate of voided pilot projects creates a sense of self-fulfilling inevitability that often defeats truly good ideas before they get started, he suggests.
Tim Berezny, Jeff Doleweerd’s partner in Caredove, says the public system’s impulse is to do everything, making it challenging for outsiders to carve out a place. The system, he says, tries to be self-sufficient which crowds out some private people with great ideas.
“I think it has to change,” he maintains, because when the public sector cedes some room, innovation is much faster. It allows more companies like Caredove to emerge, and be totally focused on building their specialized products and services.
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