After all of the reports and findings from reporters and the Auditor General of Ontario, more legislation has come down on Ontario hospitals. Bill 122 gives hospitals more regulations that they need to follow around the reporting of consultants, about governance and about freedom of information. The interesting part is around freedom of information. On January 1, 2012, hopsitals will be subject to requests for information by anyone in the general public. Obviously there are some restrictions on what can be requested (no patient records or confidential information like that), but it is essentially a free-for-all for anyone that wants to make a request. The interesting part is that the legislation makes requests retroactive for five years. Meaning that requests can be made for information that dates back to 2007, when none of this was even contemplated.

If you work in a hospital, things are about to change, so get used to it.

Last Wednesday, the Ontario Auditor General released his report on the use of consultants by Ontario hospitals. The report contained the standard fare: ridiculously high expense report claims, the hiring of consultants without any competitive process, follow-on agreements without any supporting documentation, etc. But what was interesting about this report was a comment from the report that will probably never make it into the public's perception of the dealings. The comment was made in relation to the standards that were being used to evaluate the performance of hospitals - "At the time of our audit, the hospitals were not required to follow the government’s Directive on procurement." Yet the report was auditing hospitals against that government standard. So holding hospitals to a standard they were not yet required to follow seems unfair.

Unfortunately, this comment will be diluted by the screams for CEO firings and mismanagement of public funds. Of course there is room for improvement and some of the stories are so ridiculous you might think they are made up, but why would anyone want to become a health care leader in this province if this is the way that we treat the people running our hospitals? A call for more regulations in an industry where the leaders' hands are already bound by so many different rules, is acceptance that we are not really trying to recruit the best and the brightest for our Ontario health care system, just the ones that play best by the rules. Public procurement requires some common sense and some discipline, it does not require a long list of policies that provide no flexibility.

I have many clients in the healthcare sector and have worked in it for years...there need to be some serious changes in the current model in order to keep it sustainable. Costs are going through the roof, it is hard to attract outside talent and money is being spent, and sometimes wasted, unnecessarily. There is no shortage of talented people in the industry, nurses are some of the most amazing people I have ever met, researchers trying to find ways to help people before they get sick, physicians helping them once they get sick...it is not a people problem, it is an institutional problem.

It seems like every initiative across the healthcare system takes too long and costs too much money. Hospitals have too many other organizations that are either providing them direction or trying to help them run more efficiently. Let's take Ontario for example. We all know the eHealth mess to try and get electronic medical health records and the rollout of a common IT platform has not even been discussed. A typical Ontario hospital has its own senior management team and board of directors to develop strategy and execute. There is also influence by major donors who want to help shape the direction of the organization. There is then, of course, the government who provides the majority of the funding to run the hospitals. Hospitals are also part of a LHIN (local health integration network) to whom they are accountable for certain things. Most hospitals are also members of a shared service centre that is responsible for providing supply chain support for backend activities and they are part of a GPO (group purchasing organization) to help them with tactical buying and managing contracts. I have not even mentioned all of the different associations, groups, organizations, etc. in which hospital employees participate. You can see why it is difficult to get anything done in the healthcare sector, there are too many cooks in the kitchen.

Hospitals should only have to focus on two objectives: helping patients get healthy and raising awareness for prevention. Stick-handling through bureaucracy and trying to figure out who holds the puppet strings are not productive uses of anyone's time. Especially those that are tasked with making society healthy.