Is it time for change in our hospital board?
OPINION NOVEMBER 5, 2017 Doppler
It may well be time for our local hospital board (MAHC) to contemplate whether it is properly constituted to most effectively represent, understand and respond to the wishes of their constituency. A recent overview of elected entities and community representative boards suggests a broader trend underway – that elected bodies and community representative groups increasingly need to be structured to hear and respond more directly to their constituents. Justin Trudeau spent a good deal of time talking about better proportional representation during his successful campaign, the new federal NDP leader Jagmeet Singh has electoral reform as one of his key four strategic pillars and our District of Muskoka Council has a review underway to study its size and composition.
It is puzzling that our local hospital board seemingly ignores the broad community view that acute healthcare services continue to be provided through a two-site operating model. The protests and backlash in many Muskoka communities concerning this issue over two years ago has already caused intervention and actions by the Local Health Integration Network and Ministry of Health.
The fact that healthcare needs to be delivered efficiently and effectively is well understood. However, the hospital’s four percent annual budget deficit should be viewed for what it is – the result a relatively new Ministry funding formula that disadvantages medium-sized hospitals. The Ministry is studying this matter currently and while the issue needs resolution asap, a single-site hospital, 15 or 20 years down the road, does nothing to solve the funding issue today, or into the future.
On MAHC’s assertion that a one-site solution furthers long-term healthcare sustainability, the fact is that no one can accurately project how healthcare will be delivered 20 years downstream. Some possible changes and needs are emerging – more services will be done out of the hospital inpatient venue through day clinics/outpatient services, by community and allied health provider services and illness prevention. Hospitals are likely to have less inpatient beds. Evolving cost headwinds will continue to expand healthcare service demands (and costs) due to demographic shifts, new drugs and technologies, rising obesity, drug addiction, mental health and more. Future hospital decisions must have the flexibility to adapt to continuing and evolving change.
A big-bang, single-site new hospital plan is less flexible than a plan that provides incremental upgrades at the hospital’s two existing sites.
So an important question remains – how can the hospital board both organizationally and governance-wise get to a place where their communities are able to know and trust that their decisions properly reflect and represent a consensus view of the constituency serviced?
Some relevant questions that could use clarification:
- Are served community areas appropriately represented on the board?
- Is there an appropriate balance between hospital-affiliated representatives versus unbiased and non-hospital affiliated individuals on the MAHC Capital Plan Development Task Force now underway?
- Are there good board governance practices in place for selection of board leadership positions?
- Does the board demonstrate appropriate public transparency and openness in how it conducts its business?
- Is the current board vested to the single-site decision made two years ago?
The questions clearly go beyond the MAHC Capital Plan Development Task Force, and the answers have long-term implications. If the broader public users are truly the shareholders of publicly funded healthcare, aligning accountabilities of the board is essential and should be expected. Healthcare in the community is of primary importance to all, and therefore everyone is encouraged to let their views known.
Authored by:
Dave Wilkin, (former) MAHC director,
Retired bank & IT executive
Ross Maund, (former) MAHC director,
Career health services corp. executive.