2023: Memorable Discussions

HHR, medical travel, system financing, and competition beat out AI, virtual care, and a growing list of other topics. Here are my highlights from 2023.

January

Thought Leadership Roundtable: How could we institutionalize a sustainable culture of quality? "Employee-owned care organizations"

• The idea came from a discussion about institutionalizing quality improvement. Conventional QI initiatives felt rigid, transitional, and hierarchical. What could prompt a cultural change where improvement opportunities would be actively sought instead of passively reported?
• "We'd provide better care if we felt ownership in our workplace. Compensation should be linked to results. And our funding should be linked to improvement. People would take more responsibility for results and risks. We'd lose some people, but our practice would improve and the bureaucracy would be smaller."

February

The C. D. Howe Institute's Regent's Debate: Competition Will Save Canada's Broken Healthcare System

• While there's already competition throughout our system--in collective agreements, among product and service vendors, for research funding, among hospital foundations, for key hospital partnerships with private sector brands-- there's very little where we need it: among care facilities and organizations.
• Both sides interpreted competition to mean a system with private care delivery, and we heard horror stories of both public and private modelled systems. There was less said about competition within the public sector.
• Both sides agreed we need better system transparency and data-driven decision making. How else could we achieve value-based care delivery or assess opportunities for improvement?
• Senator Colin Deacon ???????? 's work in competition shines a compelling light on the nature of and need for more competition in Canada's industries.

March

Post-Conference Discussion: Shouldn't Homecare Be Further Ahead?

• After sharing a McKinsey article from 2011 about the potential in homecare, a client quipped, "Shouldn't we be further ahead?" I think we're further ahead than we realize, but there's still vast opportunity.
• Homecare continues to grow, offering more services than ever. Mental health, tele-monitoring, biologics and chemo, advanced wound care, and clinical trials are common home-based services. It is the most viable alternative to assisted living and long-term care facilities, many hospital procedures or visits, and a frequent innovation driver of alternative service-delivery models.
• Closing thought: Homecare doesn't just need funding, it needs trust and quantified case citations of its value to health-system integration, acute operations, and IHI quintuple AIM objectives...

April

Medical Tourism: A Necessity for Canada's Surgical Backlog Recovery?

• Medical tourism typically caters to cosmetic procedures, but now several global organizations are emerging as leaders in orthopaedic, women's health, and cancer surgery. Three or four caught my attention, having earned solid reputations as go-to destinations for international celebrities and dignitaries. One in particular provided surgeries to more than 3,000 Canadians last year.
• I visited three international hospitals in April and was awestruck by their facilities, cleanliness, services, and operations integrity. "We have capacity for thousands of orthopaedic procedures--don't you have waitlists?"
• We do. The estimated surgical waitlist in Canada is around 900,000. SecondStreet.org estimates more than 17,000 people died in a 12-month period while waiting for surgery (2022-2023).
• Closing thought: With Canadians waiting years for medically-necessary services, all available capacity should be explored. This was echoed during the Collision Conference in June (below).

June -- Double Header

1. Collision Conference: How Can Procurement Improve Innovation Adoption?* This year's Collision Conf (erence) featured innovative healthcare platforms (Sifio Health, Pendium Health, among others). They integrate well with enterprise systems and EMRs, but brought to mind something a client raised months earlier: how can we get procurement groups to reassess their evaluation models and open the door to innovation?* Procurement is often driven by highest-volume/lowest cost metrics as a proxy for value, and the successful proponent is often a single vendor. First, highest-volume/lowest price is antithetical to innovation, whose start-up costs, small volume production or limited revenue streams often preclude good products from tender evaluation.Second, "Canadians need every bit of available capacity in the system, so awarding one contract to one vendor is not only a disservice to other vendors, but to patients and providers, too."* Arlene Dickinson wrote about idle venture capital earlier this year. Could we employ that capital through public sector facilities and services? Let's call it collaborative venture. We lose too many products, entrepreneurs, and commercialization opportunities to other industries or markets.
2. Canadian College of Health Leaders--Post Conference Discussion at NLC: Does the College's (CCHL's) Mandate Serve the Health System?

• "Will partnerships, politics, and publicists solve the challenges we're facing?"
• In a nutshell: administrators' training, internships, credentialing, decisions and behaviours should be subject to the same rigorous standards as regulatory colleges such as the CPSO, CNO, etc.
• Should the CHE be a chartered designation, obligatory for managerial + positions in all care-providing facilities? Could the CCHL administer national examinations with modules for finance and accounting, operations management, procurement, HR, health law, epidemiology, facilities management, governance, project management, and analytics?

July

Workforce Dynamics: Competition is rife in Canadian Healthcare.

• With the retreat divided into three sessions -- recruitment and retention, barriers to effective practice, and inter-professional collaboration, teams explored provincial, regulatory, union, cultural, organization, and compensation factors in workforce trends.
• Points of consensus: competitive forces are strong. Front lines and managers are burnt out and actively seeking change. Provincial colleges should standardize all IEN/IHP/IMG assessments and licensing processes or make it a federal responsibility (prescient insight).
• Memorable quote: "one staff who just left for a private company told her director, 'I can't afford housing and still have student loans. What I need is a high salary and a better schedule, not a pension.'"
• The greatest concern was for professionals who left their professions altogether--especially the cohort with 5-10 years' experience. It creates a leadership gap that strains less experienced staff and their managers alike.
• Take-Aways: every organization needs to make career options and paths clear, overtime needs direct management not 'better policy', talent attracts talent (so choose directors and managers wisely), regulators need federal oversight. "You are competing for talent, whether or not you realize it."
• Sidebar: the US intelligence service is managing a similar problem.

September

Presentation at the Healthcare Financial Management Conference: Separating Myth from Fact -- What Sustainable Operations Need from Finance Teams

• Finance teams are among the most overlooked resources in healthcare, and rarely get to flex their skills. I presented lessons gleaned from 20+ years of clinical operations and corporate restructuring--specifically what gets overlooked in clinical operations and how finance leaders can support performance improvement.
• Brendan Kwolek, PMP gave a compelling acronym-light presentation on cybersecurity that had most of us taking notes. Astute insights from Cadieux Nathalie (HHR and talent attraction), Clifford Harvey (Capital Planning Niagara Health ), and former colleague Abhi Mukherjee CPA, CA, . The session was thoughtfully organized by Dee Perera, FCPA, FCMA and run like a metronome by Terrence Sooley and the Spark Team... thank you for having me.
• Lingering thought on the drive home: "How do we finance the next 20 years?" Which takes us to...

November

Reunion Dinner: Humble Leadership and System Sustainability

• With wildfires setting unprecedented damage across the country, Canada received international forest-fire brigades with open arms. The arrival of teams from South Korea, South Africa, Spain, Portugal, Chile, Costa Rica, and Australia were celebrated; the more the better.
• There was a lot to be heard in the comments from 40 fire chiefs about the physical and psychological toll the fires had taken on their teams.
• Voices from across Canada pled for similar relief and solutions in healthcare, but the use of out-of-county care received a lukewarm response.
• After a second trip abroad in October to assess cancer and orthopaedic surgery partnerships, it looked more convincing than ever that medical travel offers not only benefits to backlogged patients, but also relief to medical and clinical teams across Canada who are burnt out. There's a strong economic case for medical travel to complement the compassionate one of getting care promptly to patients in need.
• Canada's health-accessibility objectives are admirable. I want to see us continue succeeding in the standards of care, research, innovation, and education for which we once had a strong reputation. Our system-financing model is unsustainable for the population's needs and our socio-epidemiological profile. Since the beginning of the pandemic, our population has grown by 2.5 million--roughly the size of Montreal. Montreal is supported by more than 20 hospitals and tens of thousands of healthcare professionals. Have we added that capacity? We're also short about 30,000 LTC beds in Ontario alone...
• Closing thought for the year: we often turn to system-reorganization as a 'solution' to accessibility troubles. With a shrinking income-tax base to finance the increasingly expensive cohorts and service of healthcare, we'll need as much attention on system-financing reform.

Wishing my colleagues, clients, friends, and all patients across Canada a healthy and revitalizing New Year.