Dr. Michael Guerriere is back. The Managing Partner of the Courtyard Group recently appeared at a Longwood’s forum with his own prescription for changing the health care system. Guerriere is known recently for being at the centre of the e-Health scandal.
Now Courtyard is engaged on a six-point platform they are promoting for changing the health system. As Globe and Mail reporter Andre Picard once wrote, “politicians can hire consultants that share their political bent and then marvel at their ‘independent’ advice.” Given the connection between Guerriere and the McGuinty government, his comments are worth taking note of.
Guerriere says the health system is operating “massively below its potential” with a potential to remove 20 per cent of the costs from that system.
Guerriere says managers in the system are “ill equipped,” with appallingly little invested in management development. His first plank is to invest in management, including a province-wide institute for excellence in health management where managers would spend at least 10 days a year learning the finer points of such topics as financial literacy, data analysis and HR management. He would also like to see managers rotating through the health system, so hospital managers would have experience with other health settings.
“We have thousands of managers in the system with no financial training and we wonder why so many hospitals run deficits,” he said.
Guerriere suggests at least 20 per cent of management compensation should be based on a bonus system – “if you don’t hit targets, you don’t get a bonus.”
He says compensation should be more rational with the establishment of executive compensation guidelines. Guerriere also advocates for more detailed disclosure in the sunshine lists. Those lists should begin at $150,000 per year to be meaningful.
For front-line workers he suggests all new contracts should be based on inflation, nothing more – this despite criticism of the effects of poor morale within the system and the effects it had on the departure of needed health care professionals during the Harris government.
The Courtyard consultant also believes that administrative overhead could be reduced, including reducing the size of the Ministry of Health by as many as 2,000 employees – a figure he says would be more comparable proportionally to Alberta.
While critical of the size of the Ministry, Guerriere sees a bigger role for the Local Health Integration Networks. While he agrees the LHINs have not had much impact, he says they need a clear mandate, including direction from government.
He sees the LHINs organizing centralized facilities for hospitals, including one lab, one IT department, one data centre, one HR department and one management reporting office.
Guerriere defends the newly proposed volume-based funding formula, although admits that the last time it was tried resulted in failure. He says the government needs to look back at what went wrong and fix the problem. Once a formula is developed, all other funding would be amalgamated into it, including wait time incentives.
“Bailouts of hospitals have a pernicious effect on the formula,” he says. He argues that bailouts should only be one-time events, and not permanently added to the operating budget.
“We need to distinguish between underfunded hospitals and poorly managed ones,” he said. “At present neither the LHINs or the Ministry can tell the difference.”
If hospitals are unable to balance their budgets, he says supervisors should be appointed with one difference – poor performing hospitals could be merged with more efficient ones.
Other ideas he offered including
- Cancer Care Ontario would take on diabetes management
- An Annual $100 million restructuring fund
- Ban hand-written prescriptions by 2015 and paper prescriptions by 2018 to reduce adverse drug reaction
- Ensure system data is timely and accurate so managers are not making decisions on information that may be two years old
- Install electronic medical records in every community-based practice
- Accelerate the creation of Family Health Teams
To see a video of Guerriere’s full presentation, go to http://www.longwoods.com/events.php?mode=past&selected=119&series=2009/10
OPSEU Diablogue 
I’m sure the gentleman has no vested possible conflict of interest as to who would provide the needed skills training for managers. But it is nice to hear that managers might bear some responsibility for the problems in the system- not just the overpaid workers.