Insights October 2013

Unravelling and Reconfiguring 100 Years of Tradition

Dr. Chris Hayes and Hugh MacLeod

Today on this very alive “balcony of personal reflection”, Hugh MacLeod and I discuss that it has been nearly 100 years since our governments began publicly funding healthcare for the ill and physicians partnered as “consultants” to deliver fee-for-service within those walls, while the hospitals provided the necessary resources, staff and facilities for such care to transpire.

Not missing an opportunity, the Ghost of Healthcare Consciousness offers the following:

“Not much has changed in those 100 years. Physicians are still mostly ‘contracted’ in fee-for-service arrangements; remuneration is paid by a third party not the institution where the physician works and where the physician has a significant contribution to work. Hospitals are concerned with the budgets necessary to hire staff, and the purchase of equipment, technology, etc. to support physician work.”

But that traditional system has been challenged, and a new model is emerging in which hospitals are now accountable for the patient experience and patient outcomes, and physicians are expected to play a more synergistic role in the hospital’s overall agenda to improve the quality of the care it provides.

Stories are emerging of successful partnerships between hospitals and their physicians that are leading to improved healthcare processes, efficiencies and patient outcomes.  This is encouraging as there is no question that fully aligned efforts are required if true system improvement is to be achieved.

The Ghost of Healthcare Consciousness returns and says:

“I have heard of these stories myself … few, scattered and not sufficient to achieve the change that you desire. I see the traditions still present, where physicians are funded to provide independent services, unaligned from the hospital’s agenda and self-guided around their own clinical practice. Although there is greater attention to the quality issues of healthcare within the medical profession, the pace of change is too slow and the resistance too strong.”

It is true that, although such reports are encouraging, much more alignment and participation is required with physicians to see the quality agenda accelerate towards its mission. But this takes time. There are now many more opportunities for physicians to seek the training necessary to understand quality and the science of improvement (training that currently lacks within the traditional medical training curriculum). There are many and increasing numbers of physician champions who are advocating for, participating in and leading quality improvement initiatives, working side-by-side with their hospital partners and working to spread the agenda amongst their peers. There are growing numbers of physician leaders directing the quality agendas within their organizations and forging plans that call for and achieve greater alignment between its medical staff and the hospital’s quality plans.

Changes are also present at the professional level. Greater attention to the need for quality in physician leadership is at the forefront of discussions at the national level with the creation of increasing opportunities for practising physicians to gain the knowledge, skills and attitudes to actively participate in health system quality reform. Greater participation with national physician organizations and others committed to improving healthcare is taking place and synergistic plans to advance are being forged.

But at its current pace, real system-wide improvement will be a long time coming.  Perhaps we need to spark new conversations that accelerate the transformation agenda.

Three recommendations for your consideration: 

  1. Patient safety and systems thinking competencies are fully integrated into the training of physicians. 
  2. The role of physicians as partners within the healthcare system will become explicit, defined and realized.
  3. A system improvement approach from the profession will become visible, aligned and acted on.

Although change is occurring, we need to invest the time and effort to unravel and reconfigure 100 years of tradition. The challenges of seeking and gaining physician partnership in creating the “new model” of a high-quality healthcare system are real.  But if a true aligned focus is created that galvanizes all in the pursuit of better outcomes and experiences of our patients (one that seeks input from physicians and all healthcare providers), then true change will come with physicians playing a key and continued role.

We close with a comment posted by Dr. Charles Low on the essay “Accountability for Performance”:

“… Don’t ignore the tremendous system which has been carefully crafted over many years in response to healthcare needs. The people on the ground often know very well what they’re doing!

“Would that benefit from more of an overview? Certainly!

“Would that overview benefit from a sincere, pervasive, multi-directional engagement with all levels of the system, most definitely including the care providers? Most definitely!”

The voice of management to our conversations is important. 

Join the conversation posted today: Three Care Provider Voices -  Art of Caring With the Science of CureWhere Has the Voice of Nursing Leadership GoneUnravelling and Reconfiguring 100 Years of Tradition

Join next week’s conversation titled: Three Management Voices: A New Dynamic – Both Our Minds and Our Hearts, Why Is It So Hard To Admit a Mistake and Can We Achieve Wholeness in Healthcare?

Click here
 to see the First Series of Ghost Busting essays.

Click here to see essays from the Second Series: The Ghost of Healthcare Consciousness.

About the Author(s)

Dr. Chris Hayes, Medical Officer of the CPSI and Medical Director of Quality & Patient Safety at St. Michael’s Hospital in Toronto.
Hugh MacLeod, CEO, Canadian Patient Safety Institute … Patient, Father, Husband, Brother, Grandfather … Concerned Citizen.


The Canadian Patient Safety Institute (CPSI exists to raise awareness and facilitate implementation of ideas and best practices to achieve a transformation in patient safety. We envision safe healthcare for all Canadians and are driven to inspire extraordinary improvement in patient safety and quality. To help address many of the challenges mentioned in the essay above the Canadian Patient Safety Institute has tools and resources such as: Patient Safety Incident Analysis and Canadian Disclosure Guidelines. If you would like information about Patients for Patient Safety Canada – please contact  


Low, C. 2013. Web site posting on essay: “Accountability for Performance. Longwoods Ghost Busting Essays. 


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