Big changes are afoot in Ontario’s health-care system. Spearheaded by Ontario’s Ministry of Health and Long-Term Care and its minister, George Smitherman, the plan is to improve service in two ways: by reforming the way doctors provide front-line care (so they are rewarded for working in a team context with other front-line health professionals), and by creating 14 local health integration networks (LHINs) that will eventually be responsible for allocating funds to health agencies in their areas. The creation of LHINs is meant to ensure that funding only flows to agencies that work in partnership with other agencies to meet the needs of patients, rather than working in isolation in their areas.
These initiatives are laudable and overdue, but several recent developments suggest the government may be mismanaging the transformation in terms of human resources in the highly labour-intensive health-care system.
First, the government botched negotiations with the Ontario Medical Association about how doctors will provide services in future. A tentative fee-setting agreement with OMA was rejected by doctors, largely because older physicians who are accustomed to working solo rather than in a team context saw too little financial gain in the agreement. While the agreement did call for fee increases for solo practitioners, these were loaded in the second half of the contract’s time frame rather than at the beginning. As well, the agreement’s proposal to reward doctors for reducing unnecessary prescriptions was seen by many physicians as an intrusion into their ability to make independent clinical judgments.
Frankly, despite the government’s cash shortage, it would have been better to bribe solo practitioners (who aren’t going to accept team practice anyway) into accepting the agreement so the government could proceed with the deal’s incentives to change practice patterns for those doctors (often younger and female) who are willing to change practice patterns. Providing a little extra sugar now would save bags of it in future, since new practice patterns also happen to be the most cost-effective ones.
As well, Smitherman didn’t do himself a favour by appearing aggressive and combative in reaction to the agreement’s rejection by doctors. The minister’s short fuse won’t help build bridges to the most influential health profession in the system.
Second, the ministry created a public relations and HR disaster by accepting hospital budget control plans that would lead to the elimination of more than 700 nursing jobs, at a time when the province is trying to attract more nurses to work in Ontario. So while
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ran the Jan. 17 headline, “Aging nurses spell trouble,” about concerns that too many nurses will soon leave the profession, a few weeks later it finds itself reporting on layoffs of the very same professionals.
While the minister argues many of these nurses will transition into other nursing positions, many of the 700 may simply decide it isn’t worth continuing to work in a system that treats them like fodder. And even those who continue to work in health care may approach their remaining careers with suspicion — not a good basis for creating cohesion within the system. With more than 50 per cent of Ontario’s nursing workforce eligible to retire within the next 10 years, a disaffected workforce will lead to early retirements, subtracting skilled nurses from the system. In fact, many hospitals are responding to the fiscal requirement to lay off nurses by offering retirement packages, accelerating the loss of experienced practitioners.
Third, the minister abolished Ontario’s 16 district health councils, local planning bodies whose work is overseen by boards of local volunteers. While this action affects the smallest number of workers of these three examples (less than 200 professional planners and support staff), it may be the most ominous indication of how this government perceives change.
The 14 LHINs, about to start operation early this year, will have planning as their prime initial function. Logic suggests that the talent found within 16 district health councils could have been folded into LHINs to give them a head start on planning a system that has thousands of programs in operation in each LHIN area. Instead, their planning staff have been turned loose to find other jobs at the very time when their talents and accumulated wisdom will be most needed. Some may be hired by LHINs when they get around to hiring, but many will have found other jobs by then, and North America’s largest single pool of talent in community-driven health planning will have dissipated. What will be lost includes the intimate knowledge they have about the details of creating change as well as stability in their communities, and about opportunities for — and impediments to — change and stability.
The government offers no defense for this action, other than saying that, “Since the mandate of the LHINs includes the planning and related functions currently with the 16 district health councils, the government has decided to end the operations of DHC.”
The reason may be as simple as a statement by the health minister that he wants to foster a “new culture” in health care. But a new culture is not created by tossing out existing experience and wisdom as if they were old shirts. Change in a system as complex and valuable as health care involves carefully introducing new elements while preserving the best of what already exists.
So Ontario may enter the second quarter of 2005 shorn of its main community-based planning capacity, with disaffected doctors and with cynical nurses willing to flee from their profession because of evidence that they remain undervalued. It doesn’t sound like much of an HR plan to me, nor much of a basis for a “new culture.”
John Butler, president of the Agora Group, a Markham, Ont.-based HR and health-care management consulting firm, is a regular contributor to Canadian HR Reporter’s Insight Section. He can be reached at (905) 294-9762 or firstname.lastname@example.org.