Harvard professor Michael Porter speaking at this year’s OHA HealthAchieve.
There was an epiphany moment at this year’s Ontario Hospital Association HealthAchieve when a hospital administrator responsible for patient surveys admitted that she had been doing it all wrong. The surveys were all about the hospital’s performance, not about the patient, she said.
We are in the age of continual measurement as administrators try to reduce the business of providing health care to a series of performance data tables. One could argue that surveying patients about their care is about improving the patient experience, so one has to wonder where the sophistry ends and where practical management begins?
At this year’s conference there was plenty of angst about the role of the patient in determining how health care is delivered.
Paul Corrigan, a former health advisor to UK Prime Minister Tony Blair, made a less than convincing case that health care providers should be basing their decisions around outcomes defined by the patient instead of the health professionals. Instead of a surgeon deciding a procedure has been a success, for example, that success should be defined around whether the patient achieves his or her goal to “walk to the shops,” for example. It’s perhaps a good thing that Corrigan didn’t encounter a patient whose goal was to play piano at Carnegie Hall.
“Hearing what patients are saying would be transformative,” says Corrigan, the implication being that we don’t.
Sir Nigel Crisp, a former senior manager in the UK’s National Health Service, ramped up the rhetoric by going as far as saying “professionals need to get down from their pedestals and patients up from their knees.” Seriously?
Continue reading →
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.
Continue reading →
KPMG’s Mark Britnell at the OHA HealthAchieve
Speakers at this week’s Ontario Hospital Association HealthAchieve say it’s important to transform health care, not cut it.
Don Berwick, former Administrator for U.S. Medicare and Medicaid Services, told the OHA conference the U.S. presently spends 17.6 per cent of its economy (GDP) on health care and is headed for 24 per cent, or almost one dollar out of every four spent south of the border.
In a later session in the afternoon, the UK’s Mark Britnell, Chairman and Partner of KPMG’s Global Practice, spoke about advanced economies being “increasingly burdened” by rising health care costs, a situation “exacerbated by the fiscal crisis.”
Britnell called economist and banker Don Drummond’s report on how to get Ontario’s house in order one of the best he’s read, even though many of Drummond’s projections have already proven to be wrong.
Neither Berwick or Britnell ever mentioned that for three consecutive years now Canada’s health care spending has dropped not only as a share of GDP, but also as a percentage of provincial spending. Britnell still shows charts claiming that Canada’s health care costs are going to rise by a staggering 2 per cent of GDP.
Continue reading →