Monday, December 5, 2016

It Ain't Rocket Science

An object lesson in public policy for Ontario health care, drawn from the world of education.

My wife and I spent our formative years in medicine - residency for both of us, early practice years for me - in Nova Scotia. Though those early years were murder at times, the culture and pace of life in Atlantic Canada are far more relaxed than in Ontario. Except for the periodic spells of shit weather, rarely are people out east in an uproar over much.

That's changed in recent weeks, as Nova Scotians deal with a major shit-storm, this time having nothing to do with the weather, but rather education. In a nutshell, the school system in Nova Scotia is bordering on a shambles. Working conditions have gotten so bad, with no end in sight to the province's bad-faith bargaining, the teachers voted 96% in favor of a work-to-rule strike action that commenced today.

(In a comical twist, the province locked the students out today, for fear of their safety without the free supervision by teachers. The move blew up in the government's face, pissing off an already irate public while teachers showed up for work in empty schools.)

I'm not going to go into the details of the teachers' dispute, since I have little experience with the education system and none with Nova Scotia's (we moved to Ontario before our son turned three). But I would direct people to this letter to the editor from a former school administrator, spelling out in pretty straightforward terms the policy decisions that heralded the onset of the downward slide. In brief, those decisions were: earlier age of entry; a no-fail policy; total integration of students without adequate support; and a flawed discipline policy. The author further argues that the major problems with discipline essentially flow from the no-fail and integration policies.

The point isn't whether the author is correct or not. Who am I to know? The point is that someone with first-hand experience is providing a prima facie connection between poor outcomes and the policies that contributed, if not outright caused the problems. It probably wouldn't take more than a few hours to decide if the argument holds water - review the history and rationale for the policies, compare outcomes before and after - and voila! The solution stares you straight in the face.

Why is it so hard to apply this logic to health care?

In 2005, the Ontario government brought in the LHINs, its version of regional health authorities, to provide community-based oversight of hospital and home-care services. It didn't work. As in, the Auditor General largely crapped on the whole endeavor as a waste of money and top-heavy mismanagement, in particular as it pertains to home care.

And yet, here we are, watching the province plow ahead with the Patients First Act, that will create another layer of bureaucracy, and re-hire the exact same people who made a mess of home care to do so again.

We have front-line care providers (I don't count these days) raising basic concerns about the rationale, viability, and justification of Patients First that are being duly ignored. Meanwhile, the Ministry is doing bafflegab backflips to make the plan seem like a no-brainer, touting anticipated savings in administrative costs - from an added layer of bureaucracy! - that can be reinvested in patient care.

Perhaps we now live in an Evil Mirror Universe, where basic logic no longer matters when it comes to public policy, and government plows ahead with ill-conceived plans because...uh, because, um...because reasons! To me, the entire Patients First mess - and it is a mess, as are the LHINs, and it will fail to meet its goals - is so past the point of stupidity and hubris it's just depressing.

Why depressing? Because the people who will suffer from this failure to learn from simple mistakes aren't the legislators, or managers, or administrators, or even front-line care providers. It will be the poor and the sick...struggling with unhealed wounds because of misplaced paperwork, waiting for un-returned phone calls from administrators "tied up" in teleconferences, mystified to see their benefits arbitrarily slashed, and so on. But facts and logic no longer matter in the public sphere, nor do the views of those directly affected by government decisions.

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