Business principles for health care
The last thing Brian Golden wants to do is take doctors out of Canada’s operating rooms. But he would like to show them how to spend more time saving lives and less time fighting to schedule surgery.
It would dismay the transplanted New Yorker to see American-style private health care come to Canada. But he would like to help his adopted country improve its underperforming public system.
He has no desire to reduce health spending. But he has plenty of ideas about how to do more with taxpayers’ money.
Golden is a professor of organizational behaviour at the Rotman School of Management at the University of Toronto.
He was recruited six years ago to apply the best business techniques to the health sector. His goal is to ensure that Canada’s hospitals, nursing homes, community care agencies and regional health boards are run as well as the world’s leading corporations.
Traditionally, MBA students have not been attracted to the healthcare sector. Golden is determined to change that.
“These are great jobs,” he says. “The work is exciting and fulfilling.”
Health institutions are the most complex form of human organization, he contends. They face insatiable demand. They have limited resources. They bring together autonomous professionals — doctors, nurses, pharmacists, administrators — in a delicate balance of independence and teamwork. They deal with life-and-death issues.
In addition to these institutional challenges, Canada’s next generation of health-care leaders will have to look beyond their own walls, Golden says. All of the provinces are shifting from hospitalbased medicine to decentralized health care encompassing everything from home care to high-tech surgery. To make this approach work, all the key players will need a system-wide view.
The young professor’s arrival coincided with the Ontario government’s drive to transform its disjointed medical system into a coherent whole.
Golden has become an enthusiastic participant in the process. He spends several afternoons a week at the Ministry of Health. He acts as an unofficial adviser to Health Minister George Smitherman, whom he describes as “a bit of a bull in a china shop — but he’s a quick study and he’s not afraid to say what he thinks. “I like the minister a great deal.” Working in collaboration with Queen’s Park, Golden recently launched an advanced leadership program for senior health executives. The three-week course is designed to supplement their specific skills with a broad understanding of the health-care system. It seeks to build links between professions; get surgeons talking to budget chiefs, nurses talking to policymakers, hospital administrators talking to social workers. And it offers participants the chance to test and adapt management tools from the corporate world.
“It’s a safe environment to make mistakes,” Golden says. “If you don’t make mistakes, you can’t learn.”
The course, which began in November, has 40 openings. More than 200 applications poured in. The February session is already so oversubscribed that the school has stopped taking applications.
To Golden, this indicates an openness to new ways of delivering and co-ordinating health care. It also suggests that Smitherman’s vision is gaining momentum.
Golden recognizes that, for many Ontarians, medicare remains incompatible with business principles. While understanding their apprehensions, he asks them to consider a few questions: 1Would they object to using engineering research to clear up blockages in the health-care system?
Do they oppose seeing patients treated like valued clients by health-care organizations?
Are they against providing specialized training for the chief executive of a $1-billion-a-year institution such as Toronto’s University Health Network?
Does it make sense to leave the management of Ontario’s healthcare system — which consumes 40 cents out of every provincial dollar — in the hands of harried doctors and hidebound bureaucrats?
Canada already provides worldclass clinical care, Golden says.
His job is to ensure that the talent and commitment of its medical professionals is matched by the training and dedication of its health-sector managers.
column appears Monday, Wednesday and Friday.