Insights (Essays)

Insights (Essays) April 2014
“I Have a Dream”

Reflections on the Health Council of Canada

Dr. Dennis Kendel


I had the bitter-sweet privilege of serving as a Councillor with the Health Council of Canada (HCC) from the fall of 2010 to its demise on March 31, 2014.

It was a truly sweet experience to serve with a highly committed cohort of fellow Councillors from across Canada and to work with the incredibly talented staff that had been drawn to the HCC team.

It was a bitter experience because, with the notable exception of the late-joining Government of Alberta, none of the Provincial governments displayed any real interest in or commitment to the HCC throughout these latter years of its life. Although the Federal government faithfully sustained its funding commitment to the HCC, and senior Health Canada staff demonstrated interest in the agency, the Federal government has largely withdrawn from any collaboration with Provincial/Territorial governments in respect to all facets of healthcare.

I’ve also the great privilege of continuous service on the Board of the Health Quality Council in Saskatchewan since its inception in 2002. The opportunity for concurrent engagement in organizations with a provincial and pan-Canadian commitment to healthcare quality improvement has prompted in me considerable hope for the future, tinged with regret about missed opportunities for greater inter-jurisdictional collaboration.

I do wish to share some reflections about the potential power I perceive in pan-Canadian inter-jurisdictional collaboration on healthcare quality improvement and issue a challenge to FPT governments to create a mechanism to facilitate and support such collaboration.

Each of the six provincial Health Quality Councils are making positive contributions to healthcare quality improvement in their respective jurisdictions. Each are structured somewhat differently and are pursuing their improvement work in different ways.

The Health Quality Councils in BC, Saskatchewan and Ontario do host annual conferences which showcase their work. However the registrants at these learning events are predominantly local. There is no optimally effective mechanism to facilitate inter-jurisdictional knowledge translation.

The HCC sought to facilitate pan-Canadian innovation spread through the creation of its Innovation Portal. At its final national conference convened in Toronto in October 2013, the HCC also sought to foster dialogue between the provincial Quality Councils and several national organizations about a more effective mechanism for inter-jurisdictional learning about innovation in provincial healthcare systems.

 The outcome from this dialogue was disappointing. I came away from the dialogue with a perception that each provincial Quality Council is so preoccupied with its respective local improvement work that they have no capacity to share the lessons they are learning with others across the country.

In my opinion, it will be tragic if we allow ourselves to remain so parochial and insular in our approaches to innovation and improvement in healthcare in Canada.

Four years ago, the Health Quality Council in Saskatchewan convened an eighteen month intensive shared learning experience for all the Regional Health Authorities (RHAs), the Cancer Agency, and the Ministry of Health called “Quality as a Business Strategy” (QBS). The QBS experience enabled all Saskatchewan healthcare leaders to learn about high performing healthcare systems around the world. At the conclusion of this intensive learning experience, these leaders reached a firm consensus that sustaining the status quo was not an option. They made a commitment to work collaboratively to transform the culture of the healthcare system in Saskatchewan to one in which continuous improvement is part of every healthcare worker’s daily work.

These leaders realized they could not achieve system-wide change if they continued to work in isolation from each other, without shared purpose and clear goals. So, they made a commitment to “think and act as one”.

The healthcare system in Saskatchewan is now two years into an exciting improvement journey based upon this commitment to “think and act as one”. There are very encouraging signs that this strategy is achieving positive changes that heretofore would have been impossible.

Though the twelve RHAs, the Cancer Agency, eHealth, 3s Health, the Ministry of Health and the Quality Council each have some distinct quality improvement goals, they annually identify one or two shared “big dot” goals that are designated as “must do – can’t fail”. This concerted strategy is proving to be a very powerful change tool.

So, might it be possible that FPT governments in Canada could identify one or two “big dot” healthcare improvement goals and agree to “think and act as one” in shared pursuit of those goals. Might it be possible the existing provincial Health Quality Councils, and new comparable agencies that might emerge, would work collaborative to facilitate and support achievement of these pan-Canadian improvement goals.

I have a dream that this could happen in Canada. Does anyone else share that dream? How might we work collaboratively to make it a reality?  

About the Author(s)

Dr. Dennis Kendel is a past Registrar of the College of Physicians and Surgeons of Saskatchewan, a member of the Board of Trustees of the Canadian Health Services Research Foundation and Chair of the Finance Committee on the Medical Council of Canada. Dr. Kendel also participates on the Board of Directors of the Saskatchewan Health Quality Council. He was a a Councillor with the Health Council of Canada (HCC) from the fall of 2010 to its demise on March 31, 2014.


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