Canadian Health Care Information

The first step towards any solution is the honest appraisal of the situation. Refereshingly, Steven Lewis, a Canadian health policy professor has done just that in his "Afterword" of the recent book, High Performing Healthcare Systems. The book examines excellent healthcare organizations from around the world and includes two such examples from Canada.

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Lewis labels our healthcare system expensive and mediocre. Worse, apparently this label is becoming our reputation throughout the world. Lewis relates the story of the UK that "did not want to end up looking like Canada" where so much money has been spent to achieve so little.

He points out, "In 1997 total Canadian healthcare spending was $79 billion. Ten years later, the tab had reached $160 billion. Yet that decade of spending increases,far above the rate of inflation, did not fundamentally improve performance".

He questions, " Are we in the end a learning-disabled nation, frozen by tradition, paralyzed by the power of vested interestes, as complacent as Canadian hockey prior to the wake-up call of the 1972 summit series?"

He tries to answer his own question by setting out the Canadian variety of healthcare challenges and opportunities. He clearly names such issues as backward federal-provincial arrangements, backward incentives, and stakeholder groups that have more power than accountability. Yet he sees reason for optimism if we go beyond what he calls "pretend management" to deal with the real problems; if we embrace the information revolution to fuel our engines of analysis; and if we choose to learn from the best so that we can apply those learnings.

I think his best suggestion is this bold one:
Let people experiment, fail, regroup and improve. Let them organize their own work. Once they have embraced the culture of performance, the need to instruct, cajole, persuade and intervene vanishes.

My own idea goes further. Let's choose and invite a healthcare organization of proven excellence to temporarily take over one of our health care regions. They would bring their structures, their systems, their culture. We would supply our own people to work and learn. Such a pilot project, with all the appropriate deliverables could show us much if we were not too stubborn or full of hubris to do it.

Janet Walker
February 8, 2009