Brian Golden, the Rot­man School’s res­i­dent health sec­tor strat­egy ex­pert, de­scribes the power of mar­kets in the quest for pop­u­la­tion health.

Rotman Management Magazine - - FRONT PAGE - In­ter­view by Karen Chris­tensen

Peter Drucker re­ferred to health­care or­ga­ni­za­tions as ‘the most com­plex form of hu­man or­ga­ni­za­tion that we have ever at­tempted to man­age’. Do you agree?

I do, for a num­ber of rea­sons. First, there are so many well-in­ten­tioned peo­ple work­ing within the health­care sys­tem, but they don’t en­tirely agree on what the sys­tem’s goals are. Some be­lieve the goal is ‘to ex­tend life’, full stop; oth­ers be­lieve it’s ‘to ex­tend life, given the re­sources avail­able’. There are also gen­uine dis­agree­ments about how to achieve th­ese goals. When­ever you have lots of well-in­ten­tioned peo­ple fram­ing a chal­lenge dif­fer­ently, you get com­plex­ity.

An­other rea­son is that health­care or­ga­ni­za­tions have lots of mov­ing parts, but they’re not ma­chines — they’re so­cial sys­tems. As a re­sult, when you change one part of the sys­tem, you of­ten un­in­ten­tion­ally cre­ate prob­lems in an­other area. For ex­am­ple, in­vest­ing to solve a cur­rent chal­lenge such as ‘wait-times in emer­gency de­part­ments’ will draw re­sources from other is­sues that would pay off fur­ther down the road — such as in­vest­ing in im­prov­ing pri­mary care to avoid the spread of chronic dis­ease.

A third as­pect of health­care’s in­her­ent com­plex­ity is that we still don’t en­tirely understand the science of Medicine — and to com­pli­cate mat­ters, there is also an art to it. As a re­sult, when­ever we suc­ceed, we have to learn from it; and the same is true when we fail. The chal­lenge then be­comes dif­fus­ing all of that learn­ing across the sys­tem. A real ad­van­tage of hav­ing a cen­trally-funded sys­tem in Canada is that it pro­vides an in­cen­tive to spread knowl­edge; how­ever, do­ing that re­quires ro­bust knowl­edge-dif­fu­sion sys­tems, which are are dif­fi­cult to cre­ate.

This re­lates to the fi­nal as­pect of health­care’s com­plex­ity, which is gov­er­nance. When I came to Canada from the U.S. back in 1996, I naively thought, ‘The sys­tem here is co­or­di­nated by each prov­ince’s Min­istry, so nav­i­gat­ing it should be a breeze’. How­ever, no Amer­i­can who has come to Canada has found that to be the case. When I was in the U.S., we at least un­der­stood that there were mul­ti­ple cor­po­ra­tions and struc­tures in play — some for-profit, oth­ers not — and that they were all work­ing with dif­fer­ent in­cen­tives.

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