It is almost a certainty that in about 100 days, how health care is delivered in the province of Ontario will change dramatically as Bill 41 -- The Patient's First 2016 Act -- comes into effect.
The proposed changes will most directly impact home care, primary care, the Local Health Integration Networks (LHINs), and aspects of public health. Once fully implemented though, most parts of the health care system will be influenced by the broad structural changes proposed by this legislation.
The impending changes are not without controversy. Several health professional associations and patient advocacy groups have expressed deep concern about aspects of the legislation. There are also those who welcome these reforms and see them as potentially presenting solutions to well documented challenges.
Regardless of one's position, the next few months represent significant change for health care professionals and the millions of patients they serve. It will also deeply test the managers and leaders of our health care system.
How can we collectively and individually face these changes? I offer four thoughts:
First, lead with quality. The belief in needing high quality care is common ground among all those who work in the health care system and all those who need care. Quality should be: safe, effective, patient-centred, efficient, timely and equitable.
The implementation of Bill 41 should have a relentless focus on improving quality in these six areas. It should be consistently and publicly evaluated against them. The proposed changes should build the skills, commitment and ultimately the culture in health care that is needed for quality improvement.
Second, involve patients. Patients, families and unpaid caregivers should be involved in health care reform at all levels of the system ¬¬- from the front lines to the management and planning levels of the system. Involvement should be meaningful, sustained and inclusive of all patients including the vulnerable and marginalized.
Third, consider the impact on the front lines. Several professionals and professional associations are genuinely worried including physicians and the Ontario Medical Association. The existing pressure on health care professionals is well documented. Burnout, depression and even suicide are reaching unprecedented levels. Quality Improvement guru W. Edwards Deming said several decades ago that "People are Entitled to Joy in Work". This is at the core of delivering high-quality care.
We need to create the conditions where providers feel safe, engaged and empowered. Implementation of Bill 41 simply cannot be done without clinicians. We need their skills and experience so the system as a whole benefits and they can find joy in their chosen profession.
Finally, acknowledge failure and and learn from them. This is a huge undertaking, no one has all the answers and despite extensive planning things won't always go as planned. Champions and leaders of the changes will do everyone a disservice if they hide or deny problems as they emerge. Critics will do an equal disservice if they hold up each and every issue as proof that the change is impossible, or if they offer criticism without solutions.
Change of this scale needs to be evaluated early and often. There must be a willingness to pay attention to what is learned, address unintended outcomes and be nimble enough to adapt based on what we are hearing from patients, health care professionals, managers and leaders. What is found to work should be scaled and spread to other similar parts of the health care system. Just as importantly, what doesn't work should be adjusted or stopped.
The next 100 days represents the end of the beginning of a substantive change in our $51.8B health care system. What comes next is, in fact, more important than what has already occurred. No matter how we uniquely fit into this health care system we all need to be prepared to face, embrace and ultimately succeed in the change that is coming.
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