Is There Accountability in Health Care A Governance Perspective on Systemic Reform

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Is There Accountability in Health Care? A
Governance Perspective on Systemic Reform
Institute of Public Administration of
Canada Toronto Region

• Notes for a presentation by Denis Desautels,
  OC, FCA
• Centre on governance
• University of Ottawa
• April 4, 2003

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Outline of Presentation

• Recent trends in governance and accountability
• Health Care an enormous governance challenge
• The current delivery system
• Why Canadians want accountability
• Gaps and obstacles
• Avenues for improvement
• Conclusions

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Defining Governance

• Governance is the framework of practices and
  structures which govern decision making and
  implementation in organizations and structures
  where power and information are shared. This
  applies to a country, a society or an
  organization be it private, public or civic.

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Defining Governance (contd)

• From the more simple to the very complex
• A private corporation
• A public company
• A state-owned corporation
• A hospital
• A ministry
• A health care system

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Evolution of Governance in the Public Sector

• Factors which encouraged innovation
• Globalization
• Technology
• Horizontal management
• Factors which imposed innovation
• Crisis in public finances
• Political ideology

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Evolution of Governance in the Public Sector
(contd)

• General direction (attributes of new systems or
  models of governance)
• Less hierarchial
• More inclusive
• More distributed
• More horizontal
• Decentralization and empowerment

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Accountability and Governance

• Good governance is not an end in itself
• Good governance contributes to effective
  accountability
• Effective accountability leads to superior
  performance, but
• Governance and accountability are becoming more
  complex

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Impact of this Evolution on Accountability

• Modularity and need for coherence between
  accountability and management systems
• Less hierarchical accountability (more between
  equals)
• Emphasis on results
• Shared accountability
• Can lead to better accountability
• Need for experimentation and learning
• Soft accountability

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Governance Accountability in Health Care

• The public interest challenge is accountability
  to Canadians
• A conceptual challenge
• High public expectation for information on the
  state of the health care system

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Governance Accountability

• In Health Care, being accountable to Canadians
  raises questions
• Canadians as stakeholders in society?
• gtgtaccess/coverage/equity
• Canadians as users of health care system?
• gtgtperformance
• Canadians as taxpayers?
• gtgtspending

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Do we have Accountability?Gaps and Obstacles

• Data Gathering
• Coordination
• Incentives
• Legislation
• Funding and increasing costs
• Acceptance of open evaluation

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Avenues for improvement

• Committing to accountability and transparency
• Building the foundation for accountability
• Technology
• Service integration
• Joint oversight

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Conclusions

• Resolving F/P/T tensions
• Providing accountability to the public
• Meeting the true challenge of creating a
  continuum of services locally