1. Murray J. Bryant Richard Ivey School of Business November 26, 2001
Management Issues in Health Care Delivery: Evidence from Pioneers and Innovators
Murray J. Bryant
Richard Ivey School of Business
November 26, 2001 W

2. The health care system Is the system failing?or
Is the management of the system failing?

3. The traditional health care system in Canada
Pre 1970’s
Largely hospital based
Family practitioners as the gatekeepers
Preeminent role of physicians in the system
Relatively low technology
Increasing real budgets

4. The traditional health care system in Canada
Pre 1980’s
Increasing cost and use of technology
No structural changes
Still rising budgets

5. The traditional health care system in Canada
1980’s and 1990’s
Reduced spending in the sector in real terms
Attempts at restructuring the system “physicians gained, nurses lost”
The approach is mechanistic
Research in health care is based on clinical trials conducted in a scientific manner
Who is accountable
Fiscal accountability
Clinical accountability

6. What lessons learnt from the 1980’s and 1990’s
Hospitals closed
More outpatient procedures
No real reform of the management of the system
Generation of nurses lost
Health care came back into the public debate

7. The health care sector A set of non-integrated silos
Lots of data, no information for coordination and integration
The problem is not just the incentive scheme for physicians
Little use of managerial tools at the macro or micro level in the sector

8. The challenges The health care system is: The system today needs
Characterised by knowledge workers, how do you manage knowledge workers?
Is focused on specialties, not an understanding of processes
Lack of accountability
The system today needs
A clear vision, a system that is patient focused, integrated, makes clear choices and is accountable for outcomes both fiscal and clinical

9. The tools the health care workers of today need:
Technology
Information systems
Communication
Team work
System thinking and process understanding
Leadership

10. What can management theorists/practitioners provide?
Effective strategy formulation
Effective planning systems
Design of appropriate delivery mechanisms
Systems thinking

11. Some of the evidence: Markham – Stouffville Hospital
Pilot of an integrated health care delivery, from family physician (rostering) linked to hospital
Healthy Connections
Linkage of community-based support organizations
St. Catharine's General Hospital
Clinical accountability, fiscal responsibility and quality

12. Erewhon Community Hospital
Formalized community based planning
Orthopaedic and Arthritic Hospital
“focused factories”
Cataract Surgery in CHRA
Need for systems thinking
Appropriate planning and link between cataracts and other health issues

13. Where to? Vision at the political level
Management practices at the operational level
Need for new organizational structures, not just “privatizing” parts of the system, although a dual system is probably inevitable