Health Council Model

1
Health Council Model

• Recommendations
• from
• The Good Health
• Through Good Governance
• Working Group
• March 21, 2003

2
Good Health Through Good Governance Working Group

• Health Council Model Sub-Group
• Richard Alvarez, Carolyn Bennett, Adalstein
  Brown, Raisa Deber, Sholom Glouberman, John
  Godfrey, Wade Junek, Jan Kasperski, Marion Lyver,
  Antony Marcil, Matthew Mendelsohn, Hugh
  O'Brodovich, Ray Rupert, Peter Singer, Harvey
  Skinner, Brenda Zimmerman, David Zitner
• Other Working Group Participants
• Haig Baronikian, Andrew Bevan, Murna Dalton, Theo
  D'Hollander, Mary Eberts, Myrna Francis, John
  Frank, Brian Gamble, David Heath, David Imrie,
  Carol Kushner, Joel Lexchin, John Maxted, Patrick
  McNamara, Nancy Miller-Chenier, Tim Murphy,
  Gordon Riddle, Janice Gross Stein, Bill Sutton,
  Peter Warrian, Bill Young

3
FMM Accord 4 areas to be interpreted/strengthen
ed

• Quebecs Council on Health and Welfare, with a
  new mandate, will collaborate with the Health
  Council
• would monitor and make annual public reports on
  the implementation of the Accord, particularly
  its accountability and transparency provisions
• would publicly report through federal/provincial/
  territorial Ministers of Health
• would include representatives of both orders of
  government, experts and the public

4
Recommended interpretation/strengthening
1. Quebecs Council on Health and Welfare, with
a new mandate, will collaborate with the Health
Council. Means that all data will be made
comparable and available and that the mandate of
the national Health Council includes reporting on
the performance of health and health care in a
pan-Canadian manner that includes Quebec.
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Recommended interpretation/strengthening

• 2. Monitor and make annual public reports
• Means that the Council is free to report on
  anything relevant to the health of Canadians, not
  only that which is explicitly mentioned in the
  Health Accord.
• 3. Publicly report through FPT Ministers of
  Health
• Means that a truly independent and trustworthy
  Council reports publicly, leaving to the
  governments the dissemination of the information
  to their constituents.

6
Recommended interpretation/strengthening

• 4. Include representatives of both orders of
  government, experts and the public
• Means that although governments select
  representatives, they are not government
  officials, elected or non-elected. They are
  government nominees who act independently and are
  faithful to the terms of reference of the
  Council. (as the Council of Maritime Premiers
  chooses regional appointees )

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A Vision for a Health Council

• An independent, trusted body that advises
  Canadians on the state of their health and on the
  performance of their health care system.
• The Council earns moral authority by celebrating
  excellence, pointing out opportunities for
  improvement and by telling the truth.
• Makes recommendations, not policy.
• Is more than just our collective conscience.
• The Council asks for good quality data
  encourages a learning and a collaborative
  culture and promotes on-going dialogue.

8
Our Vision (contd)

• All Canadians must know that the Council
• uses information of the same quality and
  reputation as that of Statistics Canada
• interprets it with the Auditor Generals rigour
• makes recommendations as important as those of
  the Bank of Canada and

9
Values of the Vision

• All Canadians must see that
• The Health Council of Canada
• has an important
• mediating effect
• on the F/P/T and inter-sectoral tensions that
  hinder progress towards an integrated system of
  health maintenance and care in which the public
  good and cost-effective, world-class results are
  paramount.

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Trusted Data (a)

• There must be a separation between the data
  gathering (e.g. by CIHI) and
  data interpretation by the Council
• The Council evaluates, interprets and reports on
  the data presented and
• makes requests for data (e.g. from CIHI) or for
  research (e.g. from CIHR), not currently available

11
Trusted Data (b)

• The indicators in Annex A of the Health Accord
  are a good roadmap, as long as they evolve and we
  add others such as
• accessibility to health care in French in ROC
  or English in PQ
• accessibility to Deaf language interpretation
• access to midwifery care, acupuncture,
  complementary care
• Measuring the progress of our connectedness in
  our health care system, and thereby the ability
  to measure as we go, will be imperative to the
  overall effectiveness of the Council

12
Collaborative Culture

• The Council collaborates with all stakeholders
• The Council is not big brother
• The FG is at the table as the 5th biggest
  provider of health care in Canada (Aboriginal
  health, military, veterans, and correctional
  services)
• Inspiration should be taken from the VISA model,
  in which inherently competitive institutions
  developed a governance structure and common
  information and communications technology (ICT)
  that is good for the public and the users because
  it works and is trustworthy

13
Learning Culture

• The Council recognizes the complex nature of
  health and health care
• The Councils strength comes from its ability to
  view health as a complex adaptive system
• The Council facilitates the feedback loops that
  enable the continuous improvements and the
  remediation inherent in a learning culture
• The Council turns the measurements of others into
  knowledge and suggests changes, the results of
  which are measured again.

14
Ongoing Dialogue with Canadians

• The Council safeguards Canadians confidence in
  health care, a critical goal of a publicly funded
  system
• The Council maintains a continuous dialogue and
  acts upon the concerns and priorities of
  Canadians
• Council tracks and adapts best practices
  worldwide for consulting and engaging civil
  society in general, citizens, patients, medical
  and public health professionals, wellness and
  other practitioners, educators and all other
  stakeholders

15
Legislative Framework

• Council needs a legislative framework, a clear
  terms of reference, significant budget and a
  strong secretariat to make optimal use of
  Councils decision-making skills
• Health Council legislation should replace the
  current voluntary framework with compulsory
  reporting, adopting Romanows sixth principle,
  accountability, without re-opening the CHA

16
Carrots instead of sticks

• The Health Council illuminates opportunities for
  improvement and may set appropriate goals
• The Council yardsticks are the measures of the
  performance of peers
• The process of change carries rewards
• The Council hosts annual conferences at which
  best practices are announced and presented
• The Council grants performance funding for top
  tier results, for the most improved, for
  innovation, for risk and for diffusion of
  methodology

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AppendixPossible Council Structure

• 14 members,
  including 7 government nominees
• 5 regional, 2 federal
• 1 aboriginal, 3 expert/provider and 3 civil
  society
• Plus, an eminent Chair/Spokesperson who would be
  untouchable in fairness, transparency and
  credibility, representing an irrefutable interest
  in the public good

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AppendixIllustrative 2nd Table (organizations
providing information and interpretation)

• Assembly of First Nations
• Association of Canadian Medical Colleges
• Canadian Council on Health Services Accreditation
• CIHI, CIHR, CHSRF, CCOHTA
• CMA, CNA, CHA
• College of Family Physicians
• Federation of Medical Licensing Authorities
• Health Charities Council of Canada
• Health Infoway
• Patient Safety Institute
• Royal College

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Appendix Possible Nominating Process

• The provinces and federal government choose a
  chair
• Aboriginal, Federal and Regional nominees
  appointed
• This group develops an open and transparent
  process for adding the non-governmental
  representatives
• Caveat - This approach risks losing the
  confidence of civil society, practitioners and
  professionals unless they are able to select
  their own nominees
• The legitimacy of the Council hinges on each
  community or stakeholder feeling a sense of
  ownership of the process of selection and thus,
  in the ultimate composition of the Health Council
• Overall composition of the council reflects a
  balance of expertise, demographics, private
  sector, civil society