Monday, June 13, 2016

Rewarding Failure

Yes, I went through the pain of watching the replay of that Patients First teleconference.

A couple of months back, I argued that the province's delay in shutting down the CCACs represented a serious lapse in governance. To recap, Ontario's Auditor General issued a scathing report on the CCACs in late 2015, citing CEOs and managers given exorbitant raises while services were curtailed for clients.

Minister of Health Dr. Eric Hoskins announced that major reforms were coming down the road, including closure of the CCACs with a transfer of home care responsibility to the LHINs.

This past Friday, the Ministry hosted a last-minute teleconference with Dr. Bob Bell, Deputy Minister (DM) of Health, and his ADM to go over the ins and outs of Bill 210, the legislation giving the go-ahead to Patients First. I've discussed Patients First in detail in a number of prior posts, so there's little point in rehashing my thoughts here.

For those unfamiliar with the workings of a Health Ministry just about everywhere, the elected Cabinet Minister has relatively little power as compared with the DM. While Eric Hoskins is the "public face" of the Ministry, Bob Bell holds chief administrative authority over the ten thousand plus bureaucrats that actually make the health care system function.

While much of the teleconference consisted of Dr. Bell eating up time with a needlessly plodding discussion of the details of Patients First, there were two major announcements slipped into the talk that eluded both scrutiny and justification.

First, many of the CCAC managers (not just the frontline case workers) - yes, the ones that got big, fat raises while diverting money earmarked for clients - are going to be employed in the same jobs at their respective LHIN.

Moreover, when the Ministry expands the LHIN boards in accordance with their expanded responsibilities, the "first place [they'll] look" for new board members are from the ranks of the old CCAC boards. 

I'm not even sure what word is adequate to sum this up. The very same managers responsible for the Auditor General's scorn are simply being relocated without any apparent consequences. Worse still, the boards that were delinquent in their oversight of the woebegone CCACs, and saw fit to award raises to the CEOs (that they're fighting tooth and nail to hold onto) are going to be returning to positions of governance.

Much as Canadians fret over never wanting U.S.-style health care, they are alarmingly passive on corrupt U.S.-style governance of public institutions. 

None of these people - not the managers, not the CEOs, not the board members - have any business getting a second chance to screw up home care. 

For acute-care needs (wound dressing, IV antibiotics) and OT/PT assessments, these can be prescribed by doctors and NPs in hospital or the community, with direct billing by the providers to OHIP. It works fine for optometrists and can't really be "gamed" as the politicians always fear. As for the basic personal care, rebuild the system from scratch. There are examples everywhere of better home care's not quantum physics.

As for the managers and board members that have yet to be held accountable for this debacle, even a moron knows what to do with them. Since I'm no moron, I'll defer to an expert.

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