The Ontario Hospital Association’s HealthAchieve is one of the major health care conferences on our annual calendar. Here are 10 revealing moments from this year’s three-day event:
1. Metaphors really stick. Don Berwick, former administrator of the U.S. Medicaid/Medicare program, spoke about the Choleteka Bridge in Honduras. An engineering marvel, it was considered one of the strongest bridges in the world. The year after it was built, Hurricane Mitch struck and washed out more than 150 bridges in the country – but not the Choleteka. The only problem is, the hurricane actually moved the path of the river to render the bridge obsolete. Speaker after speaker picked up on this metaphor in relation to health care delivery.
2. Performance pay is a stupid idea. OHA hospitals have been moving towards “performance” or “at risk pay” in recent years. It essentially means that a portion of an executives’ pay is contingent on the hospital reaching certain pre-established goals. Not only does this demean the executive by suggesting they would not act in the organization’s best interests otherwise, but means the goals get dumbed down – or what Berwick says “makes timidity logical.” Berwick says he prefers goals that are difficult to reach. When Berwick said he is not a fan of performance based pay, a significant portion of the packed audience broke into spontaneous applause. The OHA may want to revisit this policy.
3. “Benchmarking is the cream of the crap.” – Mark Britnell, Chairman and Partner, KPMG Global Health Practice. Say no more.
4. Several speakers emphasized the importance of “Senior Friendly Hospitals,” including the importance of early mobilization. Getting seniors mobile in hospital can shorten the length of stay, shorten duration of delirium and improve the return to independent functioning. Nobody mentioned that many Ontario hospitals are presently eliminating physiotherapy positions to balance their budgets.
5. “Pilot Project-itis.” Dr. Ben Chan, President of Health Quality Ontario spoke about hospitals having difficulty focussing when faced with a multitude of pilot projects.
6. Patient surveys may not be all they are cracked up to be. Stacey Daub, CEO of the Toronto Central CCAC, spoke about real change involving “experience-based design” – in other words, talking to real patients. She said surveys are often an inaccurate reflection of patient experience. Many patients are reluctant to complain for fear that their ongoing care will suffer.
7. Incentives to skimp on quality: Moving towards a more patient-based model of funding, the question is, at what rate should hospitals be reimbursed for certain procedures when the present costs significantly vary? The province wants to benchmark its payments on the best performing hospitals. Chan warned this could be an incentive to “skimp on quality.” See item number three.
8. Great leaders aspire to be the dumbest person in the room says Jim Collins, author of Great By Choice. We won’t comment on the OHA’s success in this regard, but note Collins’ observation that humility makes a great leader. Collins said leadership is a combination of fanatic discipline, empirical creativity, and productive paranoia. Collins said that the business model is the wrong answer for the social sectors.
9. How much change works? Collins was one of the few speakers to suggest that change should be limited, that organizations that undergo massive change seldom succeed. How much change works? According to Collins – no more than 20 per cent. Collins also notes that when you do a “to-do list,” you should also develop a “stop doing list.”
10. Paul Corrigan, a former health advisor to Tony Blair, spoke about the importance of trust in transforming health care. Trust is often a major issue that prevents change. Corrigan noted that while the public is frightened of not having a hospital, they are more than happy not to go there. In Ontario we are frequently told that services being cut in hospitals will reappear in the community. The problem is, they seldom ever do, and when they are, the service is insufficient as a replacement to what was lost. Even worse, the new service can be subject to a user fee, such as the recent loss of rehab services from community hospitals. Is there a community left that “trusts” such transformation?