How we set goals and how we measure them has an amazing impact on their achievement. I attended a speech given by Deb Matthews, the Ontario Minister of Health on Friday. Dr. Matthews is responsible for $100 billion of health care spending in the province of Ontario annually, about 25% of the provincial budget. Attended by 150 professional women, many of whom work in child care, education and health care, this speech was fascinating. Dr. Matthews pointed out that the first waves of the baby boomer tsunami are now crashing on our health care shoreline. The system is not sustainable. Period.
We have a room full of smart, experienced women, who have knowledge of the system and lots of ideas about how to fix it. So what were the solutions? Fund more, spend less on roads and infrastructure, and other “manly” things. There was very little discussion about the creative ways to solve this problem.
Perhaps because of the way health care is funded in Canada. We fund based on the number of procedures, and the number of sick people we take care of. Thus, for health care administrators, the way to success is to have more patients which increases costs. Our rewards system is reinforcing inefficient behaviour.
For example, a couple of years ago, I had a frozen shoulder. The doctor sent me for an ultrasound test to ensure that I hadn’t torn a rotator cuff. A couple weeks later, the doctors’ office called and asked me to come back in to discuss the results. At the appointment, he told me that the rotator cuff was fine, and asked if I would like physiotherapy. Did this extra visit improve the quality of my experience? No, I actually had to spend more time and effort to learn something that could have been communicated more efficiently. Why did they require that I make an appointment instead of making a two minute phone call? Because, the funding formula is based on the number of patients each doctor sees in his or her office. The doctor is dis-incented to be more efficient.
What if we changed our funding formulas to reflect health not sickness? What if we challenged hospitals and the health care system to find creative ways to save money? And, in order to incent health care workers to do this, what if we let them keep some of the savings in the form of a bonus? And what if we developed some type of results benchmarks to ensure that outcomes for patients weren’t jeopardized by this cost cutting? Some kind of balanced score card for health care. We need the energy, intelligence and experience of the people closest to the problem working on solving it. Caring health care professionals need the incentives and support to make the system work both effectively and efficiently. Let’s give them what they need.