Janet Davidson uses her fingers to describe how thick her hospital’s accountability agreement with the Local Health Integration Network is. “If everything is important, then nothing is important,” she says. “Pick a few and drive it.”
Speaking in conversation with Saskatchewan health policy consultant Steven Lewis, the CEO of Trillium Health Care was featured January 24 at Longwood’s Breakfast with the Chiefs. Davidson is also the Vice-Chair of the Ontario Hospital Association, and will be Chair next year.
Davidson describes herself as “a fan of better integration,” but had hoped Ontario’s regionalized model would have been better than it is.
“I don’t think we’ve allowed it to be what it can be,” she told the forum. Davidson said that the focus has been on structures. “We don’t need structures, what about incentives?”
When Davidson was the assistant deputy minister of health in Alberta, she said “Alberta created regions that wouldn’t talk to one another.”
“I think we have to spend more time understanding what it takes to get integration, cooperation and coordination,” she said.
Asked about PC Leader Tim Hudak’s promise to scrap the LHINs, she asked, “what are you going to replace it with?”
She said her LHIN was successful in reducing the alternative level of care (ALC) rates in hospitals to the lowest in the province. She said the effort could be taken further than hospitals, including long-term care and rehab. She also said consolidation of services within her region could not be possible without the LHIN.
Davidson questioned what the province’s health care strategy was. “Without a strategy on health it becomes difficult to know exactly what we are trying to do,” she said.
She gave Ontario’s diabetes registry as an example. While the province was trying to deal with the downstream effects of diabetes, at the same time it dumped upstream prevention through Participaction and gym class in our schools.
She also called for a greater hand in determining what health professionals were being turned out by Medical schools, but cautioned this would be difficult given there is no agreement among provinces.
In response to a question about whether hospitals should even try to be everything to everyone, Davidson said “anybody who comes in our door deserves the best quality we can give them.”
Dr. Michael Rachlis asked about the role of public health in a regionalized health system.
“Public health drives me bananas here,” she said. “The fact that public health is separate. They provide a perspective we just don’t have.”
Davidson said you can’t create a system where people are healthier without the involvement of public health. She spoke about the prevalence of C-Difficile in the community and the impact it is having on hospitals. “You have to have public health to resolve it.”
Saskatchewan’s Steven Lewis was asked about the role of small and rural hospitals and the province’s closure of 52 hospitals in the early 1990s.
Lewis said the hospitals closed by the province were very small – some as few as four beds. Every town of 15,000 felt they deserved a hospital. These closures “changed the political landscape forever, creating a rural urban divide that exists to this day.”
He said it comes down to capacity of the system, pointing out that small hospitals could do some things better. Decanting work upwards had two problems – larger hospitals tended to be high cost places, and patients often had difficulty navigating more complex environments.
To watch the Longwood’s video of this full presentation, go to: