KEY OPPORTUNITIES IN THE BUSINESS OF HEALTH
Brian Golden, the Rotman School’s resident health sector strategy expert, describes the power of markets in the quest for population health.
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.