Essays March 2019

The Key to Success is in the Detail and the Implementation

Michelle DiEmanuele

Lego hospital

Transforming and modernizing any public service requires thoughtful planning, the ability to weigh competing interests in a diverse society and most of all courage to actually make the change. With the government’s introduction of Bill 74, The People’s Health Care Act, 2019, healthcare is poised for unprecedented change.

For the better part of the last three decades we have seen reports, reviews, committees, expert panels, legislative reform and stakeholders call for change to Ontario’s healthcare system, often in a specific area of interest or discipline. This is a real opportunity for comprehensive modernization of our 1950s designed system. Past attempts have been incremental and often resulted in further fragmentation or greater administrative burden.

All transformational change requires a compelling vision. The tabling of the first report by the Premier’s Council on Improving Healthcare and Ending Hallway Medicine laid out that vision. It features patients and families at the centre of the system and focuses on aligning the needs of patients and providers to create quality outcomes, accountable delivery and an excellent experience for all Ontarians. The People’s Health Care Act, the accompanying piece of legislation enshrines this vision in its preamble, including an aspirational goal to create better physical and mental health for Ontarians. This captures what decades of discussion have yielded.

Change by definition disrupts and this change will be no exception. Power structures will change, financial redistribution and resource realignment will be necessary and old redundant structures torn down and replaced with both technology and new foundations. Some will not like this as they are either vested in the status quo or self-interest. Many I hope, see this action as an important step to responding to calls for a complete system of care that works for both patients and those who provide care. These voices, now more than ever need to rise above the fray and help deliver on this bold vision.

As always, the key to success is in the detail and the implementation. More from the government to come in the weeks ahead. Here is my early advice with respect to implementation:

  1. Leadership matters, from the boardroom to the bedside. The government and Boards must choose wisely at all levels. While many believe they can lead change, this is a massive multi-year undertaking that requires adept understanding of new culture building, people management and re-skilling and a strategic discipline to deliver on the plan.
  2. The legislation contemplates high levels of collaboration and cooperation and therefore critical and meaningful engagement will be key at all phases. From patients, who can best articulate their needs, to frontline doctors, nurses and clinicians, who have the skills and know-how to develop new solutions to meet these needs. Engagement that binds rather than pitting us against each other.
  3. Do not lose sight of the “why”. This change will be hard work. It is important not to get distracted by the minutiae. Some areas of the province are already leading in innovative care models, such as the bundled care program at St. Joseph’s Health System in Hamilton and the e-consults program in eastern Ontario. By communicating and reporting along the way, sharing successes and milestones met and learning from our mistakes we will create a shared story. This story can serve to galvanize and inspire us throughout the journey and regularly remind us of our “why”.

Ultimately it requires courage to make change. Our patients demonstrate courage each and every day and this is now our call to action.

About the Author

Michelle DiEmanuele, President and CEO Trillium Health Partners @mdiemanuele


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