09/14/2012 05:31 EDT | Updated 11/14/2012 05:12 EST

To Fix Healthcare, What About a Hospital Hub?


The job of streamlining Ontario's costly and cumbersome health care system starts with a question: "How do people actually use health care in Ontario in the 21st century?"

Consider an older person with a chronic illness. She might need support in her home from a nurse -- say, to ensure she's following her drug regimen or to change bandages. Or primary care from her doctor. Or help at the hospital. Maybe all three, at varying times. It's up to the patient to navigate this complex journey through the system, which, as too many Ontarians know too well, often means being bounced from pillar-to-post to get the right support, in the right order, at the right times -- where everyone involved is talking to everyone else. Too often, if you have a loved one somewhere in the system you have to fight like hell to get anything done.

How to integrate the many disconnected pieces of the system is the chief focus of "Paths to Prosperity: Patient Centred Health Care" -- the Ontario PCs' latest white paper. It was released Monday and is already generating debate, just like the prior two PC papers on affordable energy and modernizing Ontario's labour laws. In it, we've gone looking for the best ideas to "de-layer" middle management and empower local health professionals to treat people -- not push paper.

It proposes to give patients a single pathway through the system -- not a run-around through multiple layers of bureaucracy. And its goal is to deliver on the Triple Aim approach, as defined by the Institute for Healthcare Improvement: to enhance patient quality and satisfaction, improve the health of the population and reduce the per capita cost of health care.

To do all these things, we need to build off what already works -- and avoid institutionalizing weaknesses in the system by just tinkering with underperforming Local Health Integration Networks, or "LHINs." These regional bureaucracies were created by the current government in the hopes of coordinating and integrating the various parts of our health care system in different parts of the province.

Six years on, they have precious little to show for it. On the contrary, there is overwhelming evidence that they are a costly failure: reports were released in July on the performance of all 14 LHINs. Each one of them fails to attain provincially-set targets. The numbers add up to a 77 per cent failure rate across the network. And the government says it's making progress?

The fact is, continuing to tinker with this system is like shoring up a crumbling foundation with a two-by-four: It may hang together for a while, but it's bound to collapse eventually. Instead, we propose bold change, through the creation of hospital-based health hubs. Instead of more bureaucracy, these hubs would build off of what's already working in our system, high-performing hospital infrastructure and expertise. The hubs would be governed by volunteer, skills-based boards, directly linked to physicians.

The reason hubs would be able to better integrate care is because, for the first time, there would be a single platform for planning, procurement and performance at the local level, instead of carrying on with the current, fragmented system. For example, given some room to innovate based on local circumstances, a hub might locate a nurse-practitioner clinic beside a hospital emergency room, so people with less urgent problems could be seen more quickly.

Similarly, one in six hospital beds are filled by people who don't need that costly level of care, and could be in home or long-term care, which are better settings for them. But a lack of coordination prevents this from happening. Our reforms would empower front line health workers to deal with this issue in new ways "on the ground."

We need to break down these barriers and eliminate middle management like LHINs, clearing away the separate layers patients now have to deal with, to give them access to a seamless array of services in their communities. We must also remember that our health care system is for providing care, not for creating or sustaining well-paid managerial jobs for its own sake

Ontario can again have confidence in a world-class health care system, but only if we build on its existing strengths while closing down costly bureaucracies and using the money to directly serve patient needs.