Health and Health Care in Ontario' Finding the political will for real change

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Health and Health Care in Ontario.Finding the
political will for real change

• Pragma Council
• University of Waterloo
• 
  
  
• Carolyn Bennett, M.D.,M.P.
• May 30,2003

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Politics in Canada has always been the art of
making the necessary possible.
Peter C. Newman
Deciding what s necessary is political
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Quiz

• Who is your MP
• Who is your MPP
• Who is the Health Minister, party critics
• Have you ever written/called/emailed an elected
  representative
• Did you vote in the last election
• Do you belong to a political party
• Have you ever helped in an election

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Political Will

• What is it ?
• Knowing whats best and just doing it ?
• or
• Listening and responding..
• or
• Values based, evidence based strategy, education
  and effectiveness

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Nellie McClung

• Never retreat, never apologize,
• get the thing done and
• let them howl

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Leadership

• Vision
• Values
• Risk-taking
• Education, cheerleading, persuasion, inspiration,
  championing

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Shopping list ?? What ??

• Aging demographics chronic ds.
• Pharmacare
• Homecare
• Privatization P3s
• Health Human Resources
• Environmental concerns
• Mental health

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Non quo, sed quo modoWomens College Hospital

• Not what we do
• but how.
• Translation Patient centred care

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Only 1 Problem Crisis of Confidence
The sustainability of our publicly funded
health care system ultimately rests in the
confidence Canadians have in it.
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Good public policy is developed when the
policy-makers can keep in their minds eye the
people affected.
Jane Jacobs
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Our collective minds eye

• despite yesterdays CIHI data
• Were worried
• Will the care we need be there when we need it
  ??
• Will the public system, withstand the assault
  from the privatizing ideological salvation ?

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Only 1 SolutionGetting a System

• Health and health care in Canada has been a
  insurance plan for hospitals and doctors .NOT a
  health care system
• It's a patchwork quilt of non-systems
• In order to rebuild trust,
  we need a system !

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Building on Values

• Keeping More Ontarians healthier longer
• Double solidarity ..rich/poor and sick/well
• Keep listening
• Closing the Gapaboriginal people, rural
• Value for
• Health Human Resources valued

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WHY .

• Confidence in health care system/outcomes
• Timely access to appropriate care
• Replace repair shop approach
• Walkerton, SARS, West Nile

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Where Structure ?? Culture

• Prevention/Promotion
• Public Health infrastructure
• Empowered Patient
• Primary care
• Regional approach- accountable/integrated
• Home care, pharmacare, longterm care
• Centres of excellence in clinical research
• Infostructure

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WHO ?

• Ontarians
• Patient
• Advocate
• Citizen
• Professionals
• Government

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Nobody cares
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Ontarians 3 roles

• Empowered patient
• Advocate
• Citizen

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Underestimating our power. Well- meaning
fatalism. What can we do?
Michael Ignatieff
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Three mistakes
1. Stop talking like victims 2.
Stop assuming we all agree 3. Stop
underestimating our strength.
Michael Ignatieff
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Feel our strength. We cant go back to some
nostalgic paradise in the past.
Michael Ignatieff
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The medical profession is suffering from Mural
Dyslexia - they cant read the writing on the
wall.
The Professions
The late Dr. Adam Linton Past President of the
OMA
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Health reform
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Ontario Hospital Association

• Underlying problem is thoughtless, mechanical
  tinkering with the system in nearly every
  province
• In Ontario, there has been no assessment or
  review of the base financial condition of the
  hospital system, the role of clinical leadership,
  consumer wishes, or impact of change on front
  line staff, in particular nurses. These
  omissions are unforgivable.
• The crisis is rooted more in faulty planning than
  demographics, finance or technology. The good
  news is that this management crisis can be fixed.
  

Report to Finance Committee 98
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Political Will

• Monique Begin .. Knowing that the population is
  with you makes it easier
• CHAs Public Administration
• Good Governance

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Future Good Governance

• Only 1 problem
• Only 1 goal
• 10 recommendations to get there

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Good Health Through Good Governance A Vision
Statement

• The potential elements of such a health assurance
  system that integrates health care and public
  health
• A process for bringing about the required
  changes and
• The need to change from a system of illness
  management to a health assurance system
• Criteria and mechanisms for a system of
  governance that would sustain the new health
  assurance system.

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Key Elements for Good Health

• System does not need total overhaul, but rather
  key adjustments and a formal recognition of the
  determinants of health.
• Patients are the central reason for the health
  care system - they must be meaningfully engaged
  and treated as partners.
• Health infostructure is a key enabler for
  integration of health care and public health,
  improved data systems and governance.
• Good governance provides connectivity,
  leadership, innovation and accountability across
  the country.

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Need for Good Governance

• Sustainability
• Decreased demand
• Increased Confidence
• Stop fed/prov gridlock
• Encourage cooperation collaboration
• Democracy between elections
• Cost effectiveness cff cost containment

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Recommendations

• Ensure that the governance of health is fair,
  transparent and actively involves citizens to
  ensure the ongoing confidence of all Canadians.

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Recommendations

• Establish a common set of principles for the
  governance of public health and health care at
  all levels that reflect a learning culture and
  the feedback inherent in a complex adaptive
  system.

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Recommendations

• Measure population health status and service
  delivery outcomes. Data must be comparable from
  jurisdiction to jurisdiction and disaggregated so
  that vulnerable populations can be identified.
  Outcomes must include the broad determinants of
  health, not just disease or sickness indicators.

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Recommendations

• Establish accountability provisions whereby
  determinant-responsible ministries share the
  cost of health outcomes. Poverty, housing,
  literacy, violence and air quality are examples
  of determinants housed in ministries other than
  Health. These determinants substantially
  influence population health status, health care
  access and costs.

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Recommendations

• Invest substantially in health infostructure,
  creating a culture of evidence-based decision
  making, to make the public health and health care
  systems better integrated and accountable.
  Examples include comprehensive databases ensuring
  privacy for medical information, exemplary
  population health data, telehealth and
  telemedicine applications, drug use and disease
  surveillance systems.

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Recommendations

• Make patient empowerment a priority. The goal is
  to enable all Canadians to make better choices
  regarding their health situations and behaviour,
  use the health care system wisely, ask informed
  questions of practitioners, and compare their
  care to clinical guidelines.

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Recommendations

• Continually search for and remove perverse
  incentives that decrease quality and
  accessibility, as well as impede the integration
  of health care and public health systems. Learn
  from what works in the system already. Discern
  how incentives, explicit and implicit, new or
  existing, can motivate all involved in all areas
  of health to improve quality, accessibility and
  population health outcomes .

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Motivation and Incentives

• The folly of rewarding
• A
• while hoping for
• B

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Recommendations

• Establish a secretariat to support the
  collaboration of provinces and territories and
  the federal departments responsible for the
  direct delivery of health care and public health.
  A priority would be the rapid transformation of
  health non-systems into a coordinated system
  based on health infostructure. It would also be
  responsible for assessing best practices and
  allocating rewards from a performance pool of
  new federal dollars.

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Recommendations

• Create an inclusive, transparent and ongoing
  process for debating what is medically
  necessary, whats covered and whats not, using
  principles of accountability for reasonableness.
  Give more emphasis to prevention and health
  promotion. Citizens would be involved in priority
  setting and review of outcomes .

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Recommendations

• Devise with the genuine participation of citizens
  a living charter of pan-Canadian standards
  regarding expectations of our public health and
  health care systems, as well as specific goals
  and targets for improving the health status of
  all Canadians. The possibility of a Health
  Commissioner as an officer of Parliament and
  responsible for the Charter should be considered
  .

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Perfectionists
The enemy is ourselves We cant let the desire
for perfect get in the way of good. Le mieux
est lenemie du bien.
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Activists

• THOSE ACTIVELY WORKING FOR CHANGE
• THOSE ACTIVELY WORKING TO PRESERVE THE STATUS QUO

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Insanity is continuing to do the same thing and
hoping for different results.
Albert Einstein
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Absent real leadership,political will
magically arrives with increased civic literacy
and efficacy.
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Romanow demonstrated

• Canadians get it
• They are prepared to make the necessary trade
  offs
• They wont compromise their values
• They need to be involved.

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Ontario needs to lead

• Pan Canadian approach.VISA model
• IT and Governance.Health Council
• Public Health Infrastructure
• learn from Walkerton, SARS, West Nile
• Lead on Tobacco,
• Celebrate best practices across the country
• Cancer Care in B.C., Home care in Manitoba
• Deal intelligently with the social determinants
• Complexity theory
• Horizontally across government departments