Busting the myth of bloated government bureaucracy
Over the past 41 years I have enjoyed a variety of clinical and administrative positions in Ontario healthcare, including working as an emergency room doc, a general practitioner, trauma team leader, orthopaedic and cancer surgeon, cancer center leader and hospital CEO.
While I was CEO at University Health Network (UHN), our leadership team developed a strong interest in lean performance improvement and we took pride in instituting nimble and streamlined management teams that maximized the value of healthcare expenditures.
A common theme throughout the healthcare system seems to be the chronic devaluating of healthcare management, with many seeing it as “bloated bureaucracy” or perpetuating the false idea that the ministry and partners responsible for managing the healthcare system are over-staffed and under-delivering. When I assumed the role of Ontario’s Deputy Minister of Health and Long Term Care in June 2014, I wondered how I would fare working in government bureaucracy and assumed that I might be frustrated at being unable to “lean out” the bureaucratic teams that I would lead.
But two and a half years into the job, I know that any suggestion of “bloated bureaucracy” in our Ministry is simply a myth.
In the past 13 years, the health ministry budget has almost doubled, increasing from about $30 billion to $52 billion in government spending, while staff have fallen by half, to 3,053 people as of December 2016.
About 2,700 of those staff reductions resulted from the divestment of provincial psychiatric hospitals. Another 500 moved from the Ministry to Public Health Ontario and about 150 staff left the Ministry when Local Health Integration Networks (LHINs) were initiated.
Currently, 1,256 staff, or more than 40 percent, work in direct service to Ontarians, operating ambulance call centers responding to 911 calls, assisting Ontarians in drug or assistive device claims or inspecting long term care homes.
A further 630, or 21 percent, are responsible for maintaining and operating the IT systems that run OHIP and other claims systems for doctors, pharmacies and patients, as well as maintaining our various databases and analytic capacity.
About 500 public servants are responsible for policy development and implementation across public health and health promotion, emergency preparedness, hospitals, quality improvement, primary care, home and community care, public drug programs, long term care, indigenous health, laboratories, provincial programs, negotiations, health workforce planning and regulation, communication, strategy development and planning.
Nearly 550 corporate service staff provide oversight to the financial systems and accountability agreements that provide controllership in our system.
As every Ontario hospital CEO knows, the Ministry carefully (some might say obsessively) counts the numbers of surgeries, MRIs, cardiac catheterizations and other services provided in our hospitals and community services. If the contracted service is not provided, the money is reconciled to the tax payers’ benefit. About 90 staff manage and approve the substantial annual spend made on capital projects in hospitals and community.
The Ministry team, as well as our partners in government agencies, bring real value to the system, including:
• The organization and standardization of provincial cancer care by managers at Cancer Care Ontario has contributed to Ontario’s internationally leading results in cancer survival.
• Similarly, the management and triaging of patient acuity on cardiac waiting lists by Cardiac Care Network has resulted in a very low risk of mortality in patients waiting for cardiac surgery.
• Staff working in the Public Drug Plan Division worked with colleagues across the country to negotiate a reduction in the cost of Hepatitis C drugs, savings that will allow us to afford treatment for all patients with hepatitis C when diagnosed rather than waiting for them to develop liver damage.
• The Health System Funding Reform team has worked with expert clinicians, hospital managers and the Ontario Hospital Association to institute funding reform changes which shortened the length of hospital stays, both reducing patient risks and improving cost effectiveness.
• The Health Policy and Strategy Division supported the report of the Provincial Territorial Expert Advisory Group on Physician-Assisted Dying which enabled consistent implementation of Medical Assistance in Dying across the country .
The lean approach to management in our Ministry extends to our partners who plan and administer health system delivery across the province. Ontario’s 14 LHINs employ about 510 permanent staff. Integration with Community Care Access Centers (CCACs) will reduce management and administrative staff by 10 percent through the sun-setting of CCAC boards and management structures. This will save about $10 million from the administration budget, which will be reinvested in clinical services.
As mentioned above, I have worked across many different parts of Ontario’s health system from primary care, to emergency departments, operating rooms and Executive suites. I have been proud to be a colleague of the wonderful doctors, nurses, health professionals and service workers who provide care to Ontarians in our hospitals and communities in a variety of roles.
Colleagues in these clinical areas are absolutely committed to their jobs helping Ontarians. Public servants working in our Ministry share a similar dedication and commitment to ensuring that our health system serves Ontarians well.
Bob Bell is an orthopedic surgeon and Ontario’s Deputy Minister of Health & Long-Term Care