Longwoods is approaching several of our leaders and asking them to share their thoughts and opinions on what is happening in the Canadian healthcare system in the summer of 2022. Read here what is on the minds of our health system leaders. We hope that these quotes will give you something to think about; help you realise you are not alone in your concerns; and open up pathways of conversation. Note: This is a live document and will be updated when new content arrives. Up to date as of August 22, 2022.

Comments from our health leaders:

Governments are likely exasperated with [the] national and local media coverage of problems in the healthcare delivery system – almost all of the problems were present before [the] COVID [-19 pandemic] and are unlikely to relent through fall and winter. Provinces’ healthcare mandarins don’t have an easy job because there are no tools to quickly fix the problems. Provinces will have to balance two competing problems: manage today’s localized emergencies [and] push forward with ways to transform the health system into something better, making painful reforms in the hopes of better outcomes and value for public spending in the future. In my opinion, governments are trying to dance on the head of a pin, and it’s going to be messy for a while and mistakes are going to happen. I just hope people don’t die because of it.
Jason Sutherland, Director, Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC

Most of the “solutions” being put forward are about investing in more of the same: more doctors, nurses, hospitals, [long-term care], etc.  The Ontario plan announced today [August 18, 2022] is largely just about more and more, which we know is not sustainable - although I accept that in the short term we do need to address the immediate shortfalls

When we do talk about innovations, we quickly get sidetracked into discussions about [the] private sector and its role; I would like to see more discussion about innovations that could be introduced regardless of where they are coming from – if the private sector has a solution that is better quality and lower cost we should adopt it in our publicly funded system – that is NOT privatization.

The silos and incentive structures in our health systems remain an impediment to adopting patient-centred innovations that will improve quality and/or lower costs.  There is often a mismatch between the payor for an innovation and the beneficiary.  For example, a hospital has to pay for a surgical innovation that results in better patient experience.
Vivek Goel, President, Vice-Chancellor, University of Waterloo, Waterloo, ON

Which of our current health system struggles are surprising (or unique)?  Access challenges? Equity across different geographies or demographic groups? Burn- out? Increasing costs?  None, of course; all were predictable and all are solvable – though not immediately. I hate to be so blunt, but so many of our current challenges are due to a short-term, putting-out-fires orientation and misaligned incentives. We continue to hope for A, while paying for B. The job of our health system leaders is to (1) be perfectly clear about goals - we know what they should be; just look to other higher-performing health systems, (2) ensure that our providers (individuals, organizations and the partnerships among organizations) are supported and capable of delivering on these goals, (3) incent and reward fairly to achieve these goals and (4) monitor performance at micro and macro levels to reallocate resources, if practical, to providers [who] are best able to support system priorities. Twenty years ago, I worked with the Veterans Health Administration in the US.  It was the worst major publicly funded health system in the world, and a half dozen years later it was the highest performing [system] and a model for others for well over a decade - though in recent years, due to neglect – or the failure to focus on the four points above – it has faltered.  This is all simpler said than done, I know, but we only have to look to other systems that get closer to what’s possible.  This is hard work but not rocket science.
Brian Golden, Sandra Rotman Chair, Health Sector Strategy and Academic Director, GEMBA Healthcare and Life Sciences, Rotman School of Management, University of Toronto, Toronto, ON

The Canadian healthcare system should be performing better than it is. The reasons it is not are multifactorial and the default is to blame it all on [the] COVID [-19 pandemic]. The pandemic revealed all of the festering bumps and warts that have existed since 1971. The universal, tax-funded approach remains the right model but we keep driving a 1971 edition. At seven grand a person, we could do so much better; but, to have a high-performing health system, it would need to be a top priority for all governments, every care provider and each recipient.
Tom Noseworthy, Professor Emeritus, Community Health Sciences and O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB

My own rant these days is about the opportunity before us to fix fundamental problems in the system in addition to the short-term actions being undertaken, such as today’s [August 19, 2022] ‘Plan to Stay Open’ in Ontario.  None of the proposed short-term fixes will have much impact in our fragmented, siloed, non-systems of care.  Now is the time to implement new funding, governance and accountability models and to build evidence-based learning systems.  We need substantial change and innovation in how our systems are organized and managed, yet I see no coherent plans to do so (or even plans to make plans) beyond the sterile debate about private healthcare.
Anonymous, Senior Health System Leader

Today’s strains in healthcare bring risks for patients and healthcare providers. Safe care happens by design, not by luck. Leadership to enable safety, front-line actions to deliver safe care, learning practices that reinforce safe behaviours, and partnering with patients and care partners are more important than ever. 
Jennifer Zelmer, President and CEO, Healthcare Excellence Canada, Ottawa, ON

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