2015 Managing a Canadian Healthcare Strategy Conference ... · visualization. It has built internal efficiencies, operating on less than half of its funding base. And, most importantly,

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Managing a Canadian Healthcare StrategyCONFERENCE SUMMARY

May 6-7, 2015, Toronto

Managing a Canadian Healthcare Strategy: May 6-7, 2015, Toronto

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Managing a Canadian Healthcare StrategyCONFERENCE SUMMARY

May 6-7, 2015, Toronto

On May 6-7, 2015, the third Queen’s Health Policy Change Conference, Managing a Canadian Healthcare Strategy, brought together in

Toronto over 160 senior-level Canadian and international policy makers, organizational executives and thought leaders from government,

business, healthcare professions and academia to discuss the future of Canadian system-wide healthcare. The two preceding conferences

in 2013 and 2014 had identified potential structures and components of a system-wide Canadian strategy and the requisite pan-Canadian

collaboration to bring such a strategy to fruition. Those conferences and related white papers addressed the possible forms that a system-

wide strategy could take and the need for pan-Canadian strategies and programs in pharmacare, electronic health records (EHRs), health

human resources (HHRs), and integrated care for an aging population. The 2015 conference completed the three-part conference series

by exploring how measurement and monitoring can drive improved system management, and how the key stakeholders in Canadian

healthcare can collaborate as agents of change to bring about effective, efficient, accessible and sustainable reform.

Dr. Daniel Woolf, Principal and Vice-Chancellor, Queen’s UniversityDr. David Dodge, Senior Advisor, Canada and International Economic Advisor, Bennett Jones

Managing a Canadian Healthcare StrategyManaging a Canadian Healthcare Strategy

OPENING KEYNOTE: DRIVING HEALTHCARE MANAGEMENT IN CANADA THROUGH EFFECTIVE MEASUREMENT AND MONITORING

Existing Canadian Approaches

David O’Toole, President and CEO of the Canadian Institute for Health Information (CIHI), opened the proceedings with a presentation on existing healthcare measurement structures in Canada. With fourteen healthcare systems in place, effective measurement depends on building a shared approach to data collection, and agreement on what needs to be measured. The release of the hospital standardized mortality ratio in 2007 was CIHI’s first publicly released report and, despite initial controversy, has been a catalyst for improvements in acute care, particularly in reducing hospital death rates. It has shown the power of performance measurement for building transparency in public systems.

Two major CIHI initiatives in recent years have been, first, the wait times initiative in which CIHI has provided independent reporting and collection of data. Although initial uptake was slow, they now have over ten years’ worth of results, which have allowed policy makers to make significant advances in this area. Second, in 2012, CIHI launched yourhealthsystem.cihi.ca, a public platform for health performance reporting. While there are currently no pan-Canadian targets for these measures, the results are used by provincial governments and regional health authorities to drive accountability.

The challenge for healthcare performance measurement in Canada is to work towards standardization. All jurisdictions are facing fiscal constraints, yet want to deliver high quality services that reduce disparities between populations. The provincial and federal governments thus need to work together to build consensus on health priorities, and then set common targets. CIHI can help build and implement the tools that can illuminate areas in need of improvement, thus helping policy makers achieve their goals. CIHI can also work with key stakeholders, particularly patients and clinicians, to ensure that the right measures are in place.

David O’Toole, President and CEO, Canadian Institute for Health Information (CIHI)


Managing a Canadian Healthcare Strategy

MEDTRONIC KEYNOTES: GLOBAL APPROACHES TO HEALTH SYSTEM MONITORING The Commonwealth Fund, a U.S.-based private foundation established in 1918, is globally recognized for its work on international health system comparators. Commonwealth Fund Vice-President Robin Osborne discussed their approach to global system measurement in Mirror, Mirror on the Wall, their ongoing benchmarking of the healthcare performance of eleven developed nations’ systems. In place since 1998, the survey addresses both costs and quality of care. Despite operating under a a variety of different funding and delivery models, she suggested that all eleven participants have relatively similar goals for their systems, most notably access to care. Accordingly, their comparative measures highlight where a particular policy or model can help achieve or hinder progress on a particular aspect of care. Most recently, the survey has demonstrated the importance of a medical home through which patients receive comprehensive, coordinated primary care. Across all eleven countries, this has been shown to

reduce errors, improve patient-physician relationships and drive higher quality of care.

By comparing across systems over time, the survey shows where Canada is improving and where further work is needed. For example, results of the 2012 study on electronic health records data showed the U.S. and Canada to be moving forward on their previously lagging rates of EHR adoption. If integrated care is a goal for Canada, we have room for improvement. Only 23 percent of primary care physicians currently receive quality improvement feedback. Further, only 44 percent practice in a multidisciplinary context, a proven best practice for addressing chronic conditions. By comparison, in the UK, 78 percent do so, and their model includes the valuable integration of a case manager into the team.

The Commonwealth Fund’s ongoing work with cross-country comparisons has demonstrated the importance of health insurance design, from depth and breadth of coverage, through deductibles and co-payments, to the inclusion of dental and pharmaceutical care. Further, high performing systems have been shown to offer a medical home for after-hours care to ensure reduced burden

Medtronic keynote speaker Robin Osborn, Vice President and Director of International Program in Health Policy and Innovation, The Commonwealth Fund


Medtronic keynote speaker Prof. Peter C. Smith, Emeritus Professor, School of Business, Imperial College London

on emergency departments. Last, the global challenge is shifting from episodic care to integrated care systems. To build the systems of the future, transparency is critical to ensure accountability and allow for continued comparison across jurisdictions. Given the proliferation of indicators, countries should think not only about a broad array of measures, but also what measures might facilitate comparison against other systems.

Imperial College Professor Emeritus Peter Smith discussed lessons learned from the World Health Organization’s efforts on health system performance assessment (HSPA). The Tallinn Charter, signed in 2008, has established a commitment amongst the European members of the WHO to generate cross-system comparisons, despite a diversity of system goals (e.g., overall health vs. health system improvement). The purpose of such comparisons are, first, to enable better decision making, and, second, to foster inter-jurisdictional cooperation and learning, both goals that would translate well to the Canadian context.

He argued, in developing HSPA, three stages must be considered. First, what aspects of performance are to be evaluated? Second, how will the evaluation be

reported, in particular at what level and to which audiences? And, third, what will be done with the results? An attempt to compare hospitals in Scotland, for example, found that when results were published, only half of the doctors even knew of the evaluation, many of those that did were distrustful of the data’s validity, and there were no incentives in place to encourage use of the data. Improved understanding of how the program related to the three questions, above, would have improved physician engagement with the process and application of the results.

System evaluation and comparison thus needs to be developed with care. Aligning goals and measures can be difficult as, for example, policy makers’ targets can be difficult to measure (e.g., mental health goals) or the ultimate policy aims might go beyond what is trying to be measured. Data must be carefully considered to ensure it is of good quality and up to date. Further, it is critical to take external factors into consideration. Attributing outputs to a particular performance metric while ignoring the influence of other factors will result in the performance assessment being discredited. Policy makers must also recognize those areas where an institution is indeed unique and should not be compared against others.



SUN LIFE KEYNOTES: INTERNATIONAL EXAMPLES OF PERFORMANCE EVALUATION Dr. Diane Watson, CEO of Australia’s National Health Performance Authority (NHPA) presented successes gained since reforms in 2011 which, in addition to modifying the relationship between states/territories and the Commonwealth government for the delivery of healthcare, also implemented performance measurement processes through the NHPA. Toward its mandate of collecting information on health performance and reporting to the public and stakeholders, the Authority has built agreement across government on 17 measures for hospitals and 30 for primary care.

Effective reporting has been a key to the organization’s success. Reports are presented graphically with data often presented in maps to allow for quick understanding of regional differences. The NHPA aims to reach the majority

of the Australian public, taking “information systems that have been in the government and liberating them.” Early efforts have been fruitful, with one of their first report receiving coverage in 700 media outputs in the first month of its release. To that end, all senior staff members are given media training and spend up to two days per report working with the press.

The organization’s efforts are the product of a clear strategy which has sought to use technology and innovation to automate data collection, verification and visualization. It has built internal efficiencies, operating on less than half of its funding base. And, most importantly, it has kept an external focus, building agreement between all government partners on indicators, and building communications products with its customers as the key focus.

The Australian perspective was complemented by lessons from Dr. Else Smith, past director of the Danish Health and Medicines Authority. While still developing its reporting procedures, Denmark has made large advances in health data collection and infrastructure. A foundational step has been a clear focus on digitalization which has allowed key innovations including

Sun Life keynote speaker Dr. Diane Watson, CEO, Australian National Health Performance Authority


patient rights and access to their own records; improved communication between patients and healthcare staff; and monitoring of medicines, especially antibiotics.

Denmark has also had successes in balancing national targets with local implementation. With 80 percent of hospital budgets currently being used to treat chronic disease, local engagement in measurement is critical to forthcoming restructurings. Assessing hospital performance has had many effects. There has been an increased focus on quality and care coordination enabled both by reporting and potential de-accreditation for non-performing hospitals. For high-performing institutions, past successes have bred internal pride, which has resulted in further improvements for patients. In cancer care, it has led to improved patient flows and pathways which resulted in higher survival rates. A major goal for these hospitals has been to build centres of expertise around which a given institution can specialize. While this has resulted in some closures, particularly for smaller hospitals, it has had an overall effect of improving targeted metrics.

Sun Life keynote speaker Dr. Else Smith, former Director General, Danish Health and Medicines Authority

The next phase of Denmark’s health monitoring is to focus on patient expectations, particularly by targeting integrated care. With hospital resources shifting increasingly to chronic care, there is a common acknowledgement that the system requires change. At present, primary care is not monitored well and there are no plans in place to rectify this gap. Further, patients are often left to navigate the system themselves, rather than having clear pathways coordinated by primary care. The result is wasted time and resources. While gains have been made in hospital reorganization, political support is needed to strategize and monitor the nation’s primary care.



TABLEAU ROUNDTABLE WITH MORNING KEYNOTE SPEAKERS Following the opening presentations, Don Drummond, Stauffer-Dunning Fellow at Queen’s University’s School of Policy Studies, moderated a discussion with the keynote speakers on lessons for system measurement and monitoring in Canada. Commenting on the most recent Commonwealth Fund study, he asked, “wouldn’t Canadians be scandalized to think they are only 10th out of 11?”, and yet the majority of Canadians would be unaware of this standing. The discussion then highlighted Australia’s success in engaging the public, often disseminating five million copies of major reports in the first month of release. Their success has been gained through building ongoing communication with media outlets. Also, targeting hot button topics like immunization has increased the NHPA’s public profile. In developing reports, the NHPA works with at least two committees beyond a standard clinical advisory group to assist with the process, from research design through report layout. By engaging stakeholder groups (e.g., relevant cancer societies), the organization can leverage increased communications channels.

As noted by a representative for Ontario’s Institute for Clinical Evaluative Sciences, a challenge in Canada is that national-level comparisons can be problematic when policy is set at the provincial level. In Australia, national

comparisons have both raised the national standard while enabling those at the local level to identify and address underperforming elements of their jurisdiction. In Canada, David O’Toole noted, CIHI has a similar mandate to provide health system performance comparisons across provinces.

Mike Brennan, CEO of the Canadian Physiotherapy Association, argued that performance evaluation needs to be approached carefully. “Good, better, best” language can sometimes leave practitioners feeling de-motivated. Else Smith suggested that, for this very reason, some measures, such as physician immunization compliance rates, are better reported directly to practitioners rather than through aggregate public reports. Denmark has seen such approaches create notable improvements to desired health outcome targets. Prof. Smith also cited Sweden’s use of quality registers as a way to engage and motivate health professionals. These indicators are physician-led, rather than policy maker-led, and are used to help all professionals improve from their current state, providing a professional development, rather than system management, approach. Dr. Watson concurred, citing the collaborative nature of the NHPA’s governance, which integrates all of the nation’s governments. She believes the next wave in performance measurement will come from physicians and other healthcare professionals, much as Prof. Smith described earlier. In response to a question on the role of clinicians and research in setting performance targets, Prof. Smith proposed that improved monitoring creates improved data for assessing new interventions which can, in turn, promote local experimentation combined with system-wide learning from successes.

Tableau roundtable with morning keynote speakers moderated by Don Drummond, Stauffer-Dunning Fellow, School of Policy Studies, Queen’s University


CANADIAN NURSES ASSOCIATION PANEL: MANAGING CANADIAN HEALTHCARE From measurement and monitoring, the conversation turned to using such indicators to drive healthcare management. The topic was addressed by a panel featuring CIHI Vice-President Dr. Jeremy Veillard; New Brunswick Health Council CEO, Stephane Robichaud; University of Manitoba College of Medicine Dean, Dr. Brian Postl; and Health Quality Ontario Vice-President, Dr. Irfan Dhalla.

Dr. Veillard began the discussion by contrasting the duality of measurement in Canada. On the one hand, as studies like the Commonwealth Fund rankings show, “we are experiencing a value crisis in the health system… we are reaching the limits of what we are spending on healthcare.” On the other hand, while indicators point out where improvement is needed, they can also create “black boxes” which obscure pockets of excellence, such as the turnaround managed by Canadian Blood Services. Further, the lack of standardization in Canadian healthcare also results in a great deal of variance. Measurement-driven management must address these challenges.

Mr. Robichaud grounded the conversation in public expectations, namely, “that health services be aligned with their needs.” A sustainable health system, then, is one that will be sustainable for the next generation. New Brunswick has struggled in recent years, showing lower quality in some areas and overall higher spending than the national average. Health reporting has brought some improvements, but not the necessary level of sustainability. The province has begun comparing itself against other provinces using about 140 indicators and results range from “A+” to a failing grade, with overall average performance. Primary care is the biggest weakness. The way forward for the province is to improve productivity and address the variability in quality and access that exists across regions. “Measuring and monitoring,” he noted, is like, “scaling the mountain, it is helping us appreciate the challenge in front of us.”

A perspective on the impact data is having on health policy was then raised by Dr. Postl. He pointed out that the key indicators for Canada’s wait times were largely driven by politics rather than evidence. Improved access to data creates opportunities to change this approach. Wait times, however, have been a relatively easier area to measure and assess, whereas many of our challenges in Canada, particularly primary care, are driven by complex issues like the social determinants of health, that make clear returns on investment difficult to assess.

Dr. Dhalla spoke to the difference information is making at the clinical level. In the past, patients have had to rely on their GP’s recommendations when being referred to a specialist. With increased information, patients can increasingly do their own research and make better informed choices about the doctors that treat them. For physicians, access to data results in improved practice. Cardiac surgery is the best example of implementing performance measures. This has resulted in reduced mortality rates, from three to one percent, and doctors reorganizing their practices to assign difficult cases to the best surgeons. He

argued we should be wary, though, about pay for performance because, first, doctors know more about patients than funders, second, the approach suggests that providers aren’t doing the best they can because of pay, and, last, behavior incentives require a lot of money which result in paying people to do what they are already doing. The power of data, he contended, lies in providing detail to providers – as Health Quality Ontario is now doing, for example, by providing 50 indicators to family physicians – and broad indicators to the public. Mr. Robichaud concurred, citing New Brunswick’s work on diabetes as an example, wherein individual patient information allowed health authorities to work directly with doctors of the 0.5% of patients utilizing 20% of the resources, but also generated anonymized data that could be used to report progress to the public.

Moving healthcare reporting forward will mean resolving many tensions. Dr. Postl noted how physicians can be resistant to change, and can be quick to argue that data is too old or utilizes the wrong indicator, before implementing a new practice in response to data. Likewise, coordinating across governments requires addressing different provincial tactical styles, strategies, and interests. Ultimately, it will be public awareness that will force both providers and governments to change, and the democratization of data is an essential step in this process. Dr. Dhalla suggested that examples like the Swedish healthcare system reform indicate that clinicians must be central to the implementation of system measures as they are ultimately the ones who must use and respond to the data. This can help address the balance between provider- and public-level data. Dr. Postl highlighted how public disclosure of patient-level data can result in physicians and surgeons reducing their risk profile to avoid poor outcomes. Past Dean of Health Sciences at Queen’s University, Dr. David Walker, proposed that it is indeed a partnership of clinicians and patients which can jointly point the way forward for policy makers in determining the right set of indicators that will create transparency, accountability, and improved performance. Dr. Chris Simpson, President of the Canadian Medical Association, also proposed that effective healthcare indicators will help patients avoid the masses of poor information available through the Internet and popular media.

Dr. Veillard concluded the discussion by pointing to the links between data, strategy, and governance. Effective measures are ones that are both aligned with strategic priorities for policy makers and patients, but are also implemented in a context wherein governance structures ensure clinicians can respond to data outcomes and are empowered to lead change. Doing so requires the joint action of patients, governments and providers.

Canadian Nurses Association Panel: Managing Canadian Healthcare moderated by Dr. Jeremy Veillard, Vice-President, Canadian Institute for Health Information (far right). Panelists include: Dr. Brian Postl, Chair, Canadian Institute for Health Information; Dean, Faculty of Medicine, University of Manitoba; Dr. Irfan Dhalla, Vice-President, Evidence Development and Standards, Health Quality Ontario; and Stephane Robichaud, Chief Executive Officer, New Brunswick Health Council



Rx&D KEYNOTE: SETTING THE STAGE FOR NATIONAL CHANGE To introduce the theme of change, keynote speaker Nigel Edwards, Chief Executive of The Nuffield Trust (UK), provided principles on reforming healthcare at national and regional levels. National-level change, he proposed, is best suited to issues in need of fundamental standards, such as technology; that have technical functions, such as blood services; that require significant negotiations with industry on prices and policy, such as pharmaceuticals; or that involve public health. A national system functions well when there is agreement on goals and methods, and little expected variation in implementation. This results in many benefits including equity, the ability to address variation in services and outcomes, and wider economic development impacts.

Healthcare change, though, is often far more complex than these criteria allow. At their core, such reforms often require practitioners question deeply held beliefs; doing so, means change generally comes through experimentation. As the problems in healthcare generally lack both the agreement and certainty required for successful national implementation, the question then becomes, how might we approach local or regional change in a strategic way?

Rx&D keynote speaker Nigel Edwards, Chief Executive, The Nuffield Trust

HOW STAKEHOLDERS CAN CHANGE CANADIAN HEALTHCARE Following the discussions of healthcare management using improved system measurement and monitoring, the conference shifted to a discussion of moving healthcare reform forward. With previous speakers identifying the need to bring policy makers, patients, and providers together, the closing theme looked to how these stakeholders can work as agents of change. To that end, the concluding theme of the conference looked at approaches to national healthcare reform, existing Canadian healthcare delivery models, emerging approaches to change that can inform the Canadian process, and the particular role of patients, the public, the private sector, providers, and, ultimately, governments in renewing Canadian healthcare.


Unfortunately, there is no international consensus on what regional healthcare models should look like. It seems most countries organize into a different number of regions, only to then reorganize again into another configuration. Further, most countries evidence a cycle of local to national to local reforms, which suggests there isn’t a perfect answer to what reforms should be implemented in what way. An emerging trend, though, is the decentralization of both operations and chronic care.

Perhaps, then, the most important national components of healthcare are the development of vision, establishment of standards, and provision of benefits. In 1961, Enoch Powell cast a 15-year vision for the UK’s health system. This kind of bold leadership is often lacking in today’s health policy world. Such broad visioning is a powerful tool in developing local operational responses which work towards shared aims. Australia has done well to develop a national primary care strategy, which was a collaboration of the Commonwealth, state, and territorial governments, then implemented by regional and local players.

In building national change, healthcare leaders should adopt several principles. First, build strategies that take a population health viewpoint. Second, think about long-term health gains over short-term political wins. Third, build consensus across parties. Fourth, begin with big goals that are not too detailed. Fifth, ensure targets are patient-centred. Finally, involve clinicians in policy decisions to ensure consistency of purpose. While there are no right answers to the question, building cooperative work on a few key issues is a powerful way to move healthcare change forward.

SPENCER STUART CONCURRENT SESSION: NATIONAL AND PAN‑CANADIAN HEALTHCARE SYSTEMS

Although healthcare delivery in Canada is for the most part fragmented across provincial and territorial systems, there are examples of both national – those delivered by the federal government – and pan-Canadian – those delivered with joint cooperation across jurisdictions – systems which offer lessons for future changes. Contributing to the panel were Brigadier-General Jean-Robert Bernier, Surgeon General and the Commander of the Canadian Forces Health Services Group; Canadian Blood Services (CBS) CEO Graham Sher; Michael Green, President and CEO of Canada Health Infoway; and Shelly Jamieson, CEO of the Canadian Partnership Against Cancer (CPAC); with moderation from Fasken Martineau Partner, Lynne Golding.

The command-and-control nature of Canada’s military health system would not be appropriate in a civilian environment, yet it offers lessons that can be applied to the broader Canadian context. The Canadian Forces (CF) system operates much like a comprehensive provincial system, providing services through 126 treatment centres, although unlike the provinces, all outpatient dental, optical, pharmaceutical, paramedic, and all other health services, and patients with major activity-limiting chronic diseases are released to civilian life. The CF electronic health and management systems have excelled in linking data to clinical service, tracking some 60 performance measures. Its deployed operations quality assurance/improvement system does near-real-time clinical data analysis, such that it can modify clinical protocols weekly if indicated, resulting in a 98% survival rate for its Afghanistan operations. The CF’s emphasis on analysis and efficiency is driven both by the public and high-risk nature of its work as well as a culture of clinician responsibility for the entire health system generated by training its clinicians as leaders from a young age. B.Gen. Bernier noted this also works on an international scale among allied military health systems whereby the Surgeons General of NATO nations have established hundreds of organizational, process, and clinical standardization and policy agreements.

CBS, on the other hand, operates as a pan-Canadian entity and its success is a product of its governance. With an annual budget of over $1 billion, it manages the nation’s blood supply as well as other services including a stem cell program, biological drug procurement program, organ donation and transplantation services, diagnostic services, and it runs runs a Centre for Innovation, including basic research, product and process development and knowledge creation and dissemination. While funded by the provincial and territorial health ministries, the organization operates at arm’s length from governments and retains critically important operational independence in its decision making. P/T Ministers of Health serve as Members of the corporation, but do not direct any of the operations of the entity. An independent Board of Directors, to which the CEO is directly accountable, oversees the affairs of the corporation. In this manner, operational decisions are made to achieve the end goals of policy



makers (i.e., safe delivery of Canada’s blood supply) without ongoing political interference. Clear and transparent accountability measures are fundamental to maintaining this structure, and compensation is tied to performance measures. Examples like the $600 million saved through bulk pharmaceutical purchasing, or the development of national access standards, demonstrate that pan-Canadian cooperation is possible for at least key issues in Canadian healthcare.

Speaking on Canada Health Infoway’s (Infoway) organization, Mr. Green highlighted its independent status as a non-profit organization as a key to its design. Infoway’s mission is to accelerate the adoption of IT solutions across Canada with the goal of delivering better care. Despite being funded by Health Canada, it is overseen by a board of directors with mixed public and private sector representation. To achieve its aims, it focuses on strategic investments administered through a range of programs, each with clearly defined objectives, including replications of best practices and development of pan-Canadian standards so that the benefits of experimentation can be transferred Canada-wide. Key successes have been the uptake of the ambulatory health record (AHR) by over 91,000 professionals, the expansion of telehealth, and work on diagnostic imaging which has reduced procurement costs by $42 million. Infoway is also developing strategies to assist with collaboration including efforts on governance and leadership; privacy and safety; policy and procedures; financing; process change; resource capability; and business case benefits realization.

Ms. Jamieson pointed out that CPAC was funded by the Canadian government following a proposal submission by over 700 citizens. Funded entirely by the government, the agency focuses on convening groups of people, brokering knowledge and accelerating activities to address cancer. While its first five years emphasized convening experts and stakeholders, its second phase has worked to address system change. This has been accomplished through a range of initiatives including harmonizing 70 performance indicators nationwide, building a logic model with 30-year goals, and operating in provinces and territories across the country to encourage pan-Canadian cooperation.

To advance further national work, all four supported the notion of getting a few partners to work together and allowing others to follow suit. BGen Bernier noted this has also worked on an international scale where the CF worked with four other countries on a joint initiative which has now grown to a standard agreement with dozens more. Dr. Sher suggested that cancer care in Canada should serve as a model for other priorities, particularly chronic disease.

The panel also discussed how many of the common barriers to reform are often less challenging to address than they might seem. Ms. Jamieson illustrated how when CPAC found health human resources too complex and multijurisdictional to address, they also realized that there was little added value they could contribute compared to other organizations working on the issue. While a reengineered workforce would assist with cancer care, it has not been critical for CPAC to achieve its mandate. Likewise, the challenge of what should be federally or provincially mandated is often not important. It is important to identify what needs to be accomplished and if several parties can begin the work themselves, others, including governments, will come on board as momentum builds.

Spencer Stuart Concurrent Session: National and Pan-Canadian Healthcare Systems moderator Lynne Golding, Partner and Chair, Health Law Practice, Fasken-Martineau; and panelist Dr. Graham Sher, CEO, Canadian Blood Services

Spencer Stuart Concurrent Session: National and Pan-Canadian Healthcare Systems panelist Shelly Jamieson, CEO, Canadian Partnership Against Cancer

Spencer Stuart Concurrent Session: National and Pan-Canadian Healthcare Systems panelists: Brigadier-General Jean-Robert Bernier, Surgeon General/Commander, Canadian Forces Health Services Group; and Michael Green, President and CEO, Canada Health Infoway


TELUS HEALTH CONCURRENT SESSION: BOTTOM‑UP CHANGE IN CANADIAN HEALTHCARE Traditionally, healthcare reform has been driven by top-down models, both at the ministry and institutional levels. New forms of healthcare systems, particularly the rise of regional health authorities and collaborative governance models, provide opportunities for healthcare leaders to implement change at all levels of a system. To that end, representatives of an inter-disciplinary research team presented perspectives on systems leadership. The panel was moderated by Mark Rochon, Associate, Advisory Services with KPMG in Canada, and featured Paul Huras CEO of the South East Local Health Integration Network (SE LHIN); Dr. Jennifer Medves Vice-Dean (Health Sciences) and Director of the School of Nursing at Queen’s University; Dr. Kathryn Brohman, Associate Professor and Distinguished Faculty Fellow of Management Information Systems at Queen’s School of Business; Dr. Michael Green, CTAQ Chair in Applied Health Economics/Health Policy at Queen’s University; and Dr. Barbara Marcolin, Associate Professor in the Faculty of Management at UBC Okanagan.

Mr. Huras presented his experience of systems leadership from the perspective of a regional health authority. He noted that bottom-up change does not mean action independent of strategy; rather, it refers to the generation of ideas and new ways of doing things that align with a larger organizational vision. The development of regional health organizations, which began in Quebec in the 1980s and then spread elsewhere in Canada, including Ontario’s LHINs in 2005, has been helpful in offering localized management of healthcare. However, it is increasingly outdated as more people develop multiple chronic conditions and need well-integrated and coordinated care. He noted, “patients are mostly satisfied with the quality of their experience with their healthcare professional (i.e., doctor). Patients are generally satisfied with the healthcare organization (e.g., family doctor’s office, hospital). However, patients are not satisfied with

the healthcare system because it is not coordinated, not integrated, not efficient for the patient, and it does not function as a system of care.” To address these concerns, the SE LHIN is developing the concept of systems leadership. Fundamental to this concept, first, is building leaders who realize that one organization cannot fully satisfy patients’ needs; second, is empowering the internal team membership to recognize the external connections their patients need; third, is envisioning their organization as part of a larger regional system of integrated care; and fourth, is promoting the ability to act at all levels within the organization, be it at a visible level (e.g., executives, board members), or on the front line of care.

Dr. Brohman affirmed that systems leadership is not just a healthcare issue, but is indeed a challenge in every organization. The goal of the systems leadership research initiative is to consider how information can be used beyond measurement. In particular, how can organizations use data to facilitate learning and coordination? Initial work on the subject has framed systems leadership in terms of three types of leaders. First, operational leaders are those people who work one-on-one with people and whose job it is to connect patients with the right pieces of information. Second, advocates or communication leaders are those, such as policy makers, who remove the barriers that prevent others from enacting change. And, third, infrastructure leaders are those who put technology, communication, and structures in place to ensure change is lasting.

Dr. Medves’ work has found two helpful definitions of systems leadership. First, in his work on education, David Hopkins defines systems leaders as “those head teachers who care about and work for the success of other schools, as well as their own.” In this context, leadership is not only about empowerment, but about emancipation of front line workers. Idea-sharing forums are critical to their success. Second, systems leadership is, “the ability to manage change and empower others to influence clinical practice, in political processes both within and across the system.” These leaders don’t just see how things work normally (competency), but also apply their knowledge to new environments (capability).

Telus Health Concurrent Session: Bottom-up Change in Canadian Healthcare moderator Mark Rochon, Associate, Advisory Services, KPMG in Canada, Global Healthcare Centre of Excellence

Telus Health Concurrent Session: Bottom-up Change in Canadian Healthcare panelist Paul Huras, CEO, South East Local Health Integration Network



Dr. Green then discussed how these concepts play out in a primary care setting. He noted it is important in this model to think of a leadership team, rather than an individual leader, which can embody the different forms of systems leadership collectively. Thus, the operational leaders make day to day changes with resources from infrastructure leaders, and then such changes are spread throughout a system by communication leaders. He observed how different provincial policy tacks emphasize different types of leaders – for example, Ontario’s HealthLinks focuses on operational leaders while B.C.’s divisions of practice model focuses on communication leaders – but a healthy system will emphasize all three types holistically.

Dr. Marcolin suggested that the challenges experienced developing personal health records (PHRs) shows collaborative integration – getting people to work together – to be another key to enacting systems leadership. PHRs need to interoperate with both electronic medical records (EMRs) and electronic health records (EHRs), all of which are parts of larger systems. While the data in those records is important, it is just as necessary to build a process layer that can both interpret the data and manage its movement across systems. Getting stakeholders at different points in the system interactions to talk with each other requires understanding the different languages at play.

Doctors Nova Scotia CEO, Nancy Williams, commented that systems leadership requires a new skill set different from what makes a surgeon succeed in the operating room, or an engineer succeed in developing a new technology. The SE LHIN in Ontario is now running training courses for doctors, nurses and managers to teach them these leadership skills. Dr. Green encouraged educators to consider how such skills can be built into healthcare professionals from their earliest training. Dr. Brohman noted a shift from the old business model which separated “planners” from “doers”, to a new model which emphasizes integrated execution whereby technical experts are drawn into the managerial world.

The systems leadership approach requires a bigger perspective. It means tracking patient outcomes instead of just internal organizational metrics, which, Dr. Marcolin commented, requires building trust between organizations. Such relationships also require perseverance and the freedom to learn from mistakes together. Ultimately, though, they also require the alignment of frontline innovation with an organizational strategy. If these are not working together, then bottom up change will constantly feel like swimming upstream, resulting in frustration and low motivation. Structure, then, becomes a driver of sustainable systems leadership.

Telus Health Concurrent Session: Bottom-up Change in Canadian Healthcare panelist Dr. Kathryn Brohman, Associate Professor and Distinguished Faculty Fellow of Management Information Systems, Queen’s School of Business

Telus Health Concurrent Session: Bottom-up Change in Canadian Healthcare panelists Dr. Jennifer Medves, Vice-Dean (Health Sciences) and Director, School of Nursing, Queen’s University; Dr. Michael Green, Clinical Teachers’ Association of Queen’s Chair in Applied Health Economics/Health Policy, Queen’s University; and Dr. Barbara Marcolin, Associate Professor, Faculty of Management, UBC Okanagan


GSK CONCURRENT SESSION: THE ROLE OF BUSINESS IN THE CANADIAN SYSTEM While Canadians are rightly proud of their groundbreaking work in introducing universal, publicly-funded healthcare, little attention is paid to the role of the private sector in healthcare reform. With over thirty percent of Canadian healthcare provided in some form of private setting, and the private sector contributing elsewhere as suppliers and contractors, it is important to consider the role it can play in driving healthcare change. A panel moderated by Michael Watts, Partner at Osler, Hoskin and Harcourt LLP, and featuring KPMG in Canada Partner Georgina Black; Neil Fraser, President of Medtronic; Dr. Michael Guerriere, Chief Medical Officer for Telus Health; Dr. Jeeshan Chowdhury, co-founder of both Hacking Health and Listrunner; as well as Rx&D’s Executive Director of Health and Economic Policy, Dr. Brett Skinner, looked to address this challenge.

Ms. Black cited new approaches to healthcare around the world. Narayana Health and Health City in the Cayman Islands are developing niche specialties that can attract patients from around the world. In developing nations with booming populations, financial restrictions are encouraging the rapid adoption of innovative technologies that provide improved care at reduced cost. And Samsung in Korea is working to be the global leader in clinical trials. Such examples of creative approaches around the world should inspire Canada to

pursue ambitious healthcare strategies. In looking to implement big ideas, governments can look to support and expertise from the private sector.

Dr. Skinner discussed how the pharmaceutical industry views itself as an integral part of the healthcare system that strives to create new and better products that generate improved health outcomes. He proposed that the private sector in healthcare can be viewed as passive adaptors which respond to new market structures created by government policy decisions. The pharmaceutical industry can act as an ally for government as both a consultative partner and in advancing basic science, particularly through clinical trials. Its natural affinity to pursue technological innovation can drive efficiency gains across healthcare.

Mr. Fraser supported the notion of the private sector acting to disrupt healthcare in positive ways. Although devices only cost three percent of current healthcare budgets, there are opportunities for new device technologies to move beyond hospitals and to help address chronic diseases. He recommended that policy makers look to devices to improve access to care, as can be done with sleep apnea; build transparent procurement processes as has been done in the European Union; and build processes, that can integrate new technologies faster.

Information technology, Dr. Guerriere contended, presents several unique challenges for private-public sector relations. Connectivity is a non-negotiable in healthcare so if only some players change their mode of communication, the change won’t work. For this reason, healthcare continues to default to fax machines, single-handedly “keeping the thermal industry alive.” Further, the benefits of technology are often not realized until there is high market penetration. Thus, as Canada is falling behind in EMR adoption in primary care, we are missing out on payment incentive schemes that are being utilized elsewhere. Kaiser Permanente, for example, has leveraged technology in primary care to shift patient consultations to virtual conversations when a face-to-face meeting is not required. Last, while some areas of healthcare are not well-suited to a national strategy, information technology is because of its economies of scale. Without Canada-wide scale, we will fail to realize the full benefits of technology.

Drawing on his experience as an entrepreneur in both Canada and the US, Dr. Chowdhury has been surprised by Canadian misconceptions. First, despite having a public system, patient information is not generally shared for the common good; instead, managers often use “privacy” as an excuse to not participate. Second, many entrepreneurs have been surprised to find that even though there is one payer for each province, spending is largely decentralized, so it is hard for companies to get customers. As a result, local startups often find themselves locked out of local customers. Last, despite having one payer in each province, our systems are not interoperable. He has found the hospitals in California talk to each other better than hospitals in Canada. Clearly then, our public system is failing to foster the innovation we’d like to see because of widespread fragmentation.

GSK Concurrent Session: The Role of Business in the Canadian System panelists Dr. Brett J. Skinner, Executive Director, Health and Economic Policy, Canada’s Research-Based Pharmaceutical Companies (Rx&D); and Dr. Jeeshan Chowdhury, Co-Founder, Hacking Health and Listrunner



The discussion turned to the role of positive mindsets as an enabler of change. The private sector, and entrepreneurs in particular, adopt a “can-do”, problem-solving attitude quite naturally. Dr. Guerriere noted how he is beginning to see this with health IT as well. As more physicians adopt EMRs and other health IT technologies, there is a concurrent positive response from governments as well. A similar increase in engagement is needed with patients, suggested Ms. Black. In the UK, iwantgreatcare.org allows patients to review doctors the same way they would products and services. Such interaction is needed in Canada.

Changing roles for patients could also impact data privacy issues. David O’Toole noted how the Canadian Partnership against Cancer has created a database of individuals willing to share their health data for the purposes of cancer research. A step further, suggested Dr. Chowdhury, would be to put the info in the hands of the patient. Patient ownership of their data, as with bank data, would mean the individual decides who can access their data and for what purposes.

The conversation concluded with perspectives on how to move change forward. Ms. Black offered that with the advent of a technologically-driven healthcare system, policy makers need a new paradigm to evaluate new technologies. Mr. Guerriere suggested that while wholesale change may not happen right away, two or three things that can be realized should be identified, and the private sector and government should act together on these goals. Critical for such partnerships, Mr. Fraser contended, is for there to be transparency; it is this openness that will win the trust and confidence of patients and the public.

GSK Concurrent Session: The Role of Business in the Canadian System panelists Georgina Black Partner, National Health & Life Sciences Sector Leader, Management Consulting, KPMG in Canada, and Neil Fraser, President, Medtronic; with moderator Michael Watts, Partner, Commercial Chair, Health Industry Group, Osler, Hoskin and Harcourt LLP.


CANADIAN PHYSIOTHERAPY ASSOCIATION CONCURRENT SESSION: PATIENTS AS AGENTS OF SYSTEM‑WIDE CHANGE

The rise of the patient-centred care movement has given rightful attention to patients and their caregivers as active participants in their care. The advent of new communications forums like blogs and social media has further empowered patients to have an active voice in health policy conversations. With patients more involved in healthcare decision making than ever before, how can they move beyond isolated and fragmented activism toward a clear, cohesive voice as agents of change? Moderated by Dr. David Walker, past Dean of Queen’s University’s Faculty of Health Sciences, the question was considered by Dr. Sabrina Wong, Director of the Centre for Health Services and Policy Research at the University of British Columbia; Dr. Jay Handelman, Associate Dean of Research and PhD/MSc Programs at Queen’s School of Business; Patients Canada Advisor, Brian Clark; Dr. Réjean Hébert, Professor at Université de Montréal’s Department of Health Administration and former Minister of Health and Social Services for Quebec; and Peter MacLeod, Principal and Co–Founder of MASS LBP.

Building on ideas raised in her conference white paper, Dr. Wong highlighted how patients are an important part of measuring primary care performance, particularly in defining quality and reporting on their experiences. These experience accounts help build clear definitions, build democratic accountability, and can shape what services are delivered where. Increasingly, health policy research and evaluations are looking to patients to engage in both the quantitative evaluation of healthcare, for example through the use of patient-reported outcome measures (PROMs), as well as qualitative evaluation,

through the sharing of experiences. A pan-Canadian system would better enable nationwide sharing of patient feedback.

Speaking from an Ontario perspective, Mr. Clark argued that Ontario’s healthcare system is not truly a system because it lacks a common set of goals and objectives. Policy makers would do well to think about designing healthcare from the patient’s perspective which is not an individual interaction with a practitioner, but a whole process. He contended that, “most of the damage done to patients occurs when they transition from one silo to another.” A major difference will be seen as our systems become increasingly transparent, because what gets reported gets addressed. Last, for patients to truly be agents of change, providers need to help them manage their own care. In doing so, patients will become partners with their providers.

Healthcare can also learn from the rise of consumer activism in the private sector, proposed Dr. Handelman. Successful organizations have navigated recent social changes by embracing local knowledge. The travel industry has been revolutionized by the emergence of Trip Advisor and other similar websites that offer user-driven, rather than expert-driven, content. Initially, many companies aggressively pursued users who posted negative reviews, but this often backfires. Instead, healthcare providers should follow the example of leading organizations who embrace local knowledge. In a hospital context, for example, we are seeing patient advisory boards contribute to operational design. While there is a great deal of progress yet to be made, the big idea is to think about healthcare as a relationship where, “if you don’t also have organizational change to empower those who have local knowledge, that relationship can break down.”

Mr. MacLeod explored the concept of moving patient engagement to the next level, engaging not only patients but also the public more broadly. One aspect that needs consideration is the design of healthcare facilities, which are usually desolate, to be places which encourage “togetherness and healing.” There are

Canadian Physiotherapy Association Concurrent Session: Patients as Agents of System-wide Change moderated by Dr. David Walker, Professor, Emergency Medicine and Policy Studies, Faculty of Health Sciences, Queen’s University (fourth from left). Panelists include: Dr. Jay Handelman, Associate Professor and Associate Dean of Research and PhD/MSc Programs, Queen’s School of Business; Dr. Réjean Hébert, Professor, Department of Health Administration, School of Public Health, Université de Montréal; former Minister of Health and Social Services, Quebec; Dr. Sabrina Wong, Director, Centre for Health Services and Policy Research, University of British Columbia; Brian Clark, Advisor, Patients Canada; and Peter MacLeod, Principal and Co–Founder, MASS LBP



existing success stories in Ontario, like the coroner’s jury, the Ontario Health Accord, and in coming months the province’s mental health plan, wherein citizens and patients are randomly sourced to play an active role in the process. Such examples have demonstrated that 70 to 80 percent of such groups’ recommendations are enacted.

Dr. Hébert proposed that the key to enabling patients as agents of change is to empower them as decision makers, not only in regard to their direct care, but also about the management of their care. He noted three existing limitations that must be addressed to move the agenda forward. First, a challenge for policy makers is that there is little research and evidence on effective ways to engage patients or, more so, on the performance of patient-engaged systems. Second, there is an imbalance when it comes to public engagement on health policy, because public engagement informs political evidence, but can sideline scientific evidence, which can result in popular but ineffective reforms. Last, patient and public engagement can increase social inequities if they marginalize disadvantaged population groups. A successful strategy will use multiple channels to engage representatives from across the population, as well as integrate scientific perspectives.

The panel discussed the imbalance that exists between physicians and patients. Although patients are becoming increasingly informed, they may also be reluctant to question a physician for fear of being labelled a “difficult patient.” A cultural shift is needed, as Dr. Handelman referred to, whereby providers actively pursue both positive and negative feedback from patients so they can learn together. Dr. David Walker noted the tension that exists with patient rights. While patient-centred models affirm a patient’s right to master their own life, there are limits to what a healthcare system can provide and so, from a clinical perspective, a patient doesn’t always have the right to receive intensive care, for example, if such care offers no real benefit.

While such challenges do exist, the way forward is to think of engaging patients systematically. Patients Canada, Mr. Clark related, elicits patient learnings through workshops and then works with providers to develop related performance targets. Mr. MacLeod argued guidelines for patient advisory councils can help organizations synchronize feedback with implementation. Dr. Wong also cited the need for routinized and standardized data collection which captures patient stories. A helpful perspective can be to think of patients in groups or “tribes” with common values. By understanding the motivators behind different patient needs, providers can relate their care model to an individual patient’s understanding of quality.

Dr. Réjean Hébert, Professor, Department of Health Administration, School of Public Health, Université de Montréal; former Minister of Health and Social Services, Quebec

Peter Donnelly, President and CEO, Public Health Ontario


CANADIAN INSTITUTE FOR HEALTH INFORMATION PANEL: THE CANADIAN HEALTH PROFESSIONS: LEADING CHANGE IN CANADIAN HEALTHCARE Undoubtedly, the frontline workers in Canadian healthcare are key players in moving reform forward. To that end, Dr. Scott Carson, Professor and Director of The Monieson Centre for Business Research in Healthcare at Queen’s School of Business, moderated a discussion with Michael Brennan, CEO of the Canadian Physiotherapy Association (CPA); Dr. Karima Velji, President of the Canadian Nurses Association (CNA); Dr. Chris Simpson, President of the Canadian Medical Association (CMA); and Jane Farnham, Chair of the Canadian Pharmacists Association (CPhA), to address four questions:

1. What needs to be done at the pan-Canadian level to create a sustainable healthcare system for the 21st century?

2. What aspects of healthcare transformation are the focuses of your profession?

3. What can we do together?4. What has to happen next in order for us to move forward to create a

sustainable Canadian system?

Mr. Brennan highlighted electronic records as the highest priority for the CPA, because it will allow providers to learn from outcomes data. Further, it will enable improved primary care responsibility and the wider implementation of interdisciplinary primary care models like family health teams. The link between

physiotherapy and primary care highlights the need for the professions to work together. It is important to build common goals and share data across organizations to measure progress.

Dr. Velji affirmed the voices at the conference calling for audacious goals. She argued that a renewed set of national goals and values are needed to drive reform forward. In common with the CPA, she maintained that a reformed primary healthcare system would help rebalance healthcare for the chronic care age and inspire new thinking. Further, the CNA wants to partner with schools of nursing to develop new training standards that will equip workers for new demands in healthcare, particularly those related to seniors’ care. To move the agenda forward, the professions need to work together to engage and educate the public, as well as cooperatively evaluate and articulate different models of care.

The CMA, stated Dr. Simpson, is working on several priorities. First, we need clear patient outcomes. Second, we need a national pharmaceutical strategy that addresses equity issues across regions and incomes, as well as access issues. And third, we need a clear policy framework for chronic disease management, something the CMA has been working on with 35 organizations. He proposed that the professions should not only be partnering horizontally with other associations, but also vertically with the patients and the public on the one hand, and governments on the other. A key area of cooperation would be to create an impetus for change amongst decision makers by demonstrating to them the cost of patient care.

Ms. Farnham presented three priorities – demand, quality, and innovation – suggesting that healthcare reform requires a population-based approach, that policy makers need to evaluate value for dollar, and that there should be incentive-based funding for improved care models. The CPhA is working on

Canadian Institute for Health Information Discussion Panel: The Canadian Health Professions: Leading Change in Canadian Healthcare panelists; Jane Farnham, Chair, Canadian Pharmacists Association; Dr. Chris Simpson, President, Canadian Medical Association, Chief of Cardiology, Queen’s University; Dr. Karima Velji, President, Canadian Nurses Association; and Michael Brennan, CEO, Canadian Physiotherapists Association



providing patients with improved care quality, particularly by addressing access to care. Expanded scope of practice for pharmacists is shifting service demand away from more expensive channels into the wide network of pharmacies in Canada. Continued work is needed on this issue, as well as on electronic health and prescribing mechanisms. While joint effort is needed between the professions, movement forward requires the commitment and partnership of governments.

Dr. Carson asked the panel to discuss what alliances between the associations might look like. The panel discussed outcome evaluation and communication as a key function of joint alliances. As policy makers need evidence to make decisions, the standard for requests to governments is increasing. Thus, by pooling their resources – financial, research, and otherwise – the associations can work to build a better evidence base of effective healthcare solutions, which in turn will help them make a unified pitch to governments. While pharmaceutical policy was not a central theme of the discussion, this was raised as a potential issue where an alliance which both works towards providing improved access to information for patients, as well as a coordinated ask to governments, is needed.

Dr. Simpson noted that the associations are closer to each other than ever before. While there is some disagreement between the groups, it is over minor issues. All share the desire to work for improved patient outcomes, and an emphasis on health over healthcare. While financing models are always contentious, there was a shared call to build improved financial incentive models for professionals, particularly as they contribute to innovation.

Dr. Scott Carson, Professor and Director, The Monieson Centre for Business Research in Healthcare, Queen’s School of Business


KPMG CLOSING PANEL: REALIZING A CANADIAN VISION FOR HEALTHCARE The conference closed with a conversation between Health Canada Deputy Minister, Simon Kennedy; Dr. Bob Bell, Deputy Minister for Ontario’s Ministry of Health and Long Term Care; Dr. Peter Vaughan, Deputy Minister for Nova Scotia’s Department of Health and Wellness; and Doug Hughes, Assistant Deputy Minister with the Ministry of Health, British Columbia; moderated by Steve Paikin, host of TV Ontario’s The Agenda. The purpose of the discussion was to draw on themes raised at the conference and consider how governments can work together to address these challenges.

The discussion opened with existing examples of intergovernmental cooperation like the pan-Canadian Pharmaceutical Alliance and support for the Canadian Patient Safety Institute. Such efforts demonstrate a shared desire amongst governments to provide better value in healthcare, to empower patients, and to take a population health focus. While the different sizes of each province create challenges in aligning goals, they also offer opportunities. The small population bases of the Atlantic provinces has resulted in them developing regional partnerships on issues like procurement, and such cooperation could become a model for broader, national cooperation.

The role of the federal government was discussed widely. Deputy Minister Kennedy identified three key roles the federal government can play. First, it can convene the provinces and generate dialogue, as it is currently doing through the advisory panel on healthcare innovation, as well as intergovernmental discussions on prescription drug abuse. Second, it can deploy Canada-wide organizations, as it has done through CIHI and Canada Health Infoway. Last, it can work directly on certain issues through the legislated role of Health Canada, notably in the pharmaceutical approval process, and recent reforms to the drug regulatory system. The provinces look to the federal government for leadership on information management in particular.

There was discussion of potential quick wins in healthcare reform, with acknowledgement that the complexity of healthcare makes rapid change difficult. If we are to move to shared goals, that needs to be done through good consultation with the public, a view to patient outcomes and population health, and a commitment to long-term health gains, all of which require significant buy-in from each government. Public consultation, however, can help bring the public alongside and minimize political risk to decision makers.

Moving healthcare reform forward, they proposed, is ultimately a question of leadership, of laying out a foundation and setting a strategy. The potential to provide improved information to the public means there is an unprecedented opportunity to put power in the hands of citizens. Governments, then, have an important responsibility toward transparency, and ensuring the public has access to data. When information from CIHI begins to rank hospitals

against hospitals, or even provinces against provinces, it will speak to people’s aspirational nature. When one part of the system is lagging, it will by nature want to improve. Building some competition will drive practitioners to build better processes and create improved outcomes.

Another shared challenge faced across the country is limited funds for healthcare. All of the provinces, then, are facing the same opportunity, which is to develop cost effective solutions that will generate better care for less money. Proper incentives throughout the system will drive behavior, and effective use of data and a transparent reporting system will make it apparent when progress is happening.

Agreeing on a shared set of standards to evaluate Canadian healthcare, though, remains difficult. There was consensus that a common architecture is needed and that Canada already has a good starting point through CIHI. For indicators to be accepted across the country, though, there needs to be agreement on what gets measured and how that will be done.

When asked by Dr. David Walker to envision a healthcare system twenty years in the future, it was agreed that a great deal of care would be outside of the hospital, and with wait times under 24 hours. Further, patients would be confident in the safety and quality of their care, and would have access to their care provider’s performance ratings. Don Drummond asked what is preventing this from being realized and what can stakeholders do to help? The panel discussed how many parties have a vested interest in the status quo and again returned to the theme of leadership. Moving healthcare reform forward will require all parties – governments, providers, and others – to set aside their interest in the status quo and commit to new ways of operating. The most important stakeholder to involve, though, is the patient, and even they need to relinquish the status quo and accept that new modes of delivering healthcare are needed.

KPMG Closing Panel: Realizing a Canadian Vision for Healthcare moderated by Steve Paikin, Host, The Agenda, TV Ontario with panelists Simon Kennedy, Deputy Minister, Health Canada; Doug Hughes, Assistant Deputy Minister, Ministry of Health, British Columbia; Dr. Bob Bell, Deputy Minister, Ministry of Health and Long Term Care, Ontario; and Dr. Peter Vaughan, Deputy Minister, Department of Health and Wellness, Nova Scotia



SUMMARY COMMENTS AND THE NEXT CONFERENCE SERIES Managing a Canadian Healthcare Strategy brought the first three-part Queen’s Health Policy Change Conference Series to a close. Reflecting on the process, Queen’s University Chancellor Emeritus David Dodge noted that the vision for the series was to assume that healthcare reform is not dependent on government leadership and action alone, but instead “requires a collaborative effort of the broader Canadian community and concerned citizens, including the business community, researchers, and professional associations.” The conference series created a forum to build consensus among such stakeholders. Dr. Richard Reznick, Dean of the Faculty of Health Sciences at Queen’s University, also highlighted how the series sought to move beyond existing discussions by, “guiding outcomes and focusing on the processes and enablers of change.”

To that end, the final conference in the first series raised many issues that are critical for moving healthcare reform forward. In particular, it demonstrated the crucial role that effective data management plays in building transparent, accountable, and, ultimately, innovative health systems. The right indicators well communicated offer a powerful tool for advancing healthcare change: they provide evidence to decision makers in developing policy; they can guide the training, decisions, and actions of healthcare professionals; and they allow for better informed patients and citizens. Most importantly, a transparent system will empower the diverse stakeholders in Canadian healthcare to align goals and work together as agents of change.

The challenge that remains is to foster an environment for inter-jurisdictional comparison, learning, and growth. By building a common language and set of standards for comparing health system performance across Canada, we create the opportunity to not only improve outcomes locally, but also to raise the bar nationwide, for the benefit of all Canadians.

Beginning in 2016, the Queen’s Health Policy Change Conference Series will press forward to its next phase. In a new three-part conference series supported by research and publications, we will tackle the issues of a Canadian healthcare innovation agenda. With consensus around goals and measures in place, the priority becomes the spread of innovation. Thus, the second conference series will ask, “How should we bring together entrepreneurship, systems thinking, technology, integration, and strategic alliances between the public and private sectors to create the Canadian healthcare system of the future?” The series will be organized around three themes:

1. The Canadian Healthcare Innovation Agenda (Spring 2016). Exciting new policy frameworks are emerging for the federal, provincial, and territorial governments, allowing for new ways of thinking about healthcare. Major reports have been developed by Health Canada’s Advisory Panel on Healthcare Innovation (2015), the Council of the Federation’s Health Care Innovation Working Group (2012), and the Ontario Health Innovation

Council (2014). The first conference will explore the current state of healthcare innovation in Canada, what can be learned from leading international examples, and next steps for positioning Canada as a global health innovation leader.

2. Innovation Systems and Structures (Spring 2017). The second conference in the series will look to systems and structures that can foster innovation in healthcare. How do we overcome institutional and organizational barriers to spread new solutions across healthcare systems? What data solutions are needed to facilitate the transfer of learning across systems? How can organizational design create innovation-focused institutional cultures? What approaches to the management and organization of healthcare workers will spark creativity? How can healthcare leadership shift from top-down models to system-wide empowerment?

3. Innovation and Collaboration (Spring 2018). The final installment in the conference series looks to governance models in the new Canadian healthcare landscape. Healthcare is experiencing a shift from traditional top-down ministry leadership to collaborative governance models. How can policy makers accomplish provincial and national goals while also empowering regional and local leadership? What governance models are needed to encourage ground-up innovation while also ensuring system accountability?

The series will continue to create a forum for a unique, targeted audience of top-level policy makers, practitioners, and private sector leaders, along with leading academics and international contributors, to discuss practical ways forward for healthcare change. The events are Canadian in scope and seek ways that best practices and new models can be shared nationwide to the benefit of all Canadians. With governments seeking to generate improved value from reduced healthcare expenditures, innovation is the key to realizing a healthy future for all Canadians.

Thank You to Our Hospitality Sponsors

Queen’s University would like to thank the following organizations for their generous support of our hospitality service at Managing a Canadian Healthcare Strategy:

• Osler Hoskin and Harcourt LLP• Canadian Professional Accountants Association of Ontario• Fasken-Martineau• Canadian Pharmacists Association• Loblaws


DR. SCOTT CARSON// Professor and Director, The Monieson Centre for Business Research in Healthcare, Queen’s School of Business

DR. RICHARD REZNICK// Dean, Faculty of Health Sciences, Queen’s University

DR. KIM NOSSAL// Professor, Political Studies and Director, School of Policy Studies, Queen’s University

DAVID O’TOOLE// President and CEO, Canadian Institute for Health Information

JEFF DIXON// Associate Director, The Monieson Centre for Business Research in Healthcare, Queen’s School of Business

DR. KATHRYN BROHMAN// Associate Professor and Distinguished Faculty Fellow of Management Information Systems, Queen’s School of Business

DR. DAVID WALKER// Professor, Emergency Medicine and Policy Studies, past Dean (1999-2010), Faculty of Health Sciences, Queen’s University

DON DRUMMOND// Stauffer-Dunning Fellow, School of Policy Studies, Queen’s University

DR. MICHAEL GREEN// Clinical Teachers’ Association of Queen’s Chair in Applied Health Economics/Health Policy, Queen’s University

DR. CHRIS SIMPSON// President, Canadian Medical Association Chief of Cardiology, Queen’s University

CONFERENCE STEERING COMMITTEE



Platinum Sponsors

Gold Sponsors

Silver Sponsors

Bronze Sponsors

THANK YOU TO OUR CONFERENCE SPONSORS

www.kpmg.com www.canadapharma.org www.cma.ca

www.cna-aiic.ca www.cihi.ca www.scotiabank.com

www.sunlife.com www.medtronic.ca www.tableau.com

www.gsk.ca www.spencerstuart.ca www.telushealth.co www.physiotherapy.ca www.osler.com

www.loblaws.ca www.cpacanada.ca www.fasken.com www.pharmacists.ca

What would a pan-Canadian healthcare strategy look like? TOWARD A HEALTHCARE STRATEGY FOR CANADIANSA. Scott Carson, Jeffrey Dixon, and Kim Richard Nossal

Toward a Healthcare Strategy for Canadians is a thought-provoking case for a comprehensive, system-wide, made-in-Canada healthcare strategy. Drawing on thinking from the first two Queen’s Health Policy Change Conferences, Canadian and international contributors propose collaborative approaches to healthcare transformation. It includes strategies for health human resources, electronic health records, integrated care, and pharmacare.

Available on McGill-Queen’s University Press at http://www.mqup.ca/toward-a-healthcare-strategy-for-canadians-products-9781553394396.php

CONFERENCE WHITE PAPER WORKING DRAFTS

Available online at: queenshealthpolicychange.ca/resources.html

MEASURING AND MONITORING A HEALTHCARE STRATEGY

Using Performance Measurement and Monitoring for Performance Improvement Jeremy Veillard, Keith Denny, Brenda Tipper (Canadian Institute for Health Information), and Niek Klazinga (University of Amsterdam)

Harnessing Patients’ Voices for Improving the Healthcare System Sabrina Wong (University of British Columbia)

HOW STAKEHOLDERS CAN CHANGE CANADIAN HEALTHCARE

Harnessing Patient Engagement for Healthcare System Change Monica C. LaBarge, Jay M. Handelman, and Alex Mitchell (Queen’s School of Business)

The Role of the Private Sector in Canadian Healthcare: Strategic Alliances, Accountability, and Governance A. Scott Carson (Queen’s School of Business)

Health Policy Advocacy: The Role of Professional Associations Christopher S. Simpson (Canadian Medical Association) and Karima A. Velji (Canadian Nurses Association)

MOVING HEALTHCARE REFORM FORWARD

An Action Plan for Reforming Healthcare in Canada Don Drummond and Talitha Calder (Queen’s School of Policy Studies)

queenshealthpolicychange.ca : : Conference Twitter Hash Tag: #QHPCC

Managing a Canadian Healthcare Strategy: May 6-7, 2015, Toronto

Funded with generous support from the Joseph S. Stauffer Foundation.

queenshealthpolicychange.ca

Documents

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