Winnipeg Free Press - PRINT EDITION

Premiers' 'action' plan hackneyed

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CALGARY -- One thing wrong with the report on health care, From Innovation to Action, released during the premiers' conference held in Halifax last week, is how little innovation it contains.

We can only hope action receives as little attention, because implementing the recommendations will make things worse.

Should we be surprised? The report definitely contains ideas from the very best and brightest. Unfortunately, they are the same experts who produced our current problems. The result? Hackneyed ideas that have proven themselves counterproductive in practice.

What is disturbing is not that the ideas presented are so hopelessly out of date. It's that the people with responsibility for guiding our health-care system could believe the recommendations are actually good ideas. No wonder things are bad. If my doctor adopted a similar approach, he would be treating cardiovascular disease with voodoo dolls and rattles.

Fortunately, there aren't that many ideas in the report to act upon and most of them are motherhood feel-good fluff, populating the abundant white space where real content, or innovation, should have been.

For example, of the 12 recommendations in the report, three concern improving human-resource management. These include adopting principles such as "making informed decisions" (because the other types weren't working out), "premiers should work together" (not including an energy strategy) and, I'm not making this up, create, "a health human-resource website to facilitate better communication." A website. To facilitate communication. I bet no one thought of that before.

How will any of these improve health-care delivery or reduce costs? They won't.

But the report does provide plenty of professional management speak such as: "Analyze training capacity... in relation to current and projected health-care needs taking into account innovative delivery models across jurisdictions and acknowledging the need to share funding to provide high-quality training for 'low-critical-mass' programs."

I have no idea what that means. It could be trying to say we should use standardized web-based training. That's a good idea. Someone write that down.

Not all of the report is fluff. Some of it, in very clear language, commits the provinces to well-defined courses of hopelessly inefficient and ineffective action with long, demonstrated histories of wasteful results.

For example, "It is recommended that premiers direct ministers to... identify three to five generic drugs to include in a provincial/territorial competitive value price initiative that would result in better prices for generic drugs and initiate a national competitive bidding process by fall 2012."

The report noted the Canadian system pays up to 90 per cent more than the American system for generics and bulk purchasing would bring costs down. But wait, the Americans don't have a bulk purchasing program under their system. So how will expanding bulk purchases in Canada help? It won't. Bulk purchasing almost never works.

Why? Because the thinking behind it confuses price and cost. Bulk purchasing lowers the price, but increases the cost, while making for great PR (lower acquisition prices), transportation, storage, handling, spoilage and distribution costs rise.

For example, Alberta acquired H1N1 flu vaccine at very low prices through bulk purchasing, but threw most of the vaccine in the garbage, more than wiping out the cost benefit.

The report is not all bad.

Recommending a "lean" (continuous improvement) approach to removing waste and improving system performance is a good idea.

Having proposed it in papers, reports, and conferences for almost 20 years, I can't argue against it now.

Unfortunately, lean/continuous improvement is often treated as a bag of tools imposed on those in the trenches, unkindly referred to in the 'biz' as 'tool-head' lean.

In contrast, real lean means thinking about how the business is run and how the work gets done and is practiced from the top of the house to the bottom.

Current practice in health care is of the tool-head variety.

And, as is evident by the lack of lean thinking in the report's own recommendations, it appears tradition will be carried on.

There's plenty of innovation in health care. It's just that most of it is in the front lines, woefully ignored by this report.

Robert Gerst is a partner in charge of operational excellence and research & statistical methods at Converge Consulting Group Inc. He is author of The Performance Improvement Toolkit: The Guide to Knowledge-Based Improvement and numerous articles in peer-reviewed journals, including; The Decline of Health Services in Alberta.

Republished from the Winnipeg Free Press print edition July 31, 2012 A11

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