The Ontario government deserves applause for tackling global funding for hospitals. “Global budgets provide[d] little incentive for hospitals to focus on efficiency, innovation, improving access, coordinating care across facilities and sectors or improving quality.”
In 2012, the Ontario Ministry of Health announced its commitment to patient-based funding. It promised to deliver patients:
• Shorter wait times and better access to care in their communities
• More services, where they are needed
• Better quality care with less variation between hospitals
Deb Matthews, Minister of Health and Long-Term Care, said
“Our current funding model for hospitals is out of date and doesn’t reflect the needs of the communities they serve. As part of our Action Plan we are implementing a system that funds hospitals to increase services where needed, deliver quality care more efficiently and serve more patients.”
Patient-based funding promised to “breathe new life into hospitals” and move hospitals “into the 21st century”. Some described it as a “financial ray of sunshine”. Health System Funding Reform (HSFR) promised a new era in healthcare.
But rather than a revolutionary funding mechanism, Ontario hospitals got Quality Based Procedures (QBPs): “standardized clinical pathways based on best clinical evidence”.
The trouble with QBPs is that by focusing on standardizing clinical pathways, they ignore other important dimensions of quality, namely customer experience. QBPs do not incent improved customer experience.
Focusing only on clinical pathways is like Starbucks’ coffee scientists obsessing over the quality of coffee beans, the temperature of espresso steam, and the precise way to make latte foam, but then ignoring all the other components of good customer service: friendly staff, clean stores, pleasant music, etc. The quality of Starbucks coffee is only one part of its success. Customers walk past other coffee shops to Starbucks for more than just high quality coffee. People return to Starbucks for great customer service and an enjoyable experience. Customers leave knowing Starbucks wanted them there.
No one argues for low-quality care. Improving quality beats staring at budgets. But QBPs miss a key dimension of quality: patient experience.
Unfortunately, QBPs do not reward hospitals for good patient experience, such as being respectful of patients’ time and providing friendly service. QBPs reward hospitals only for providing clinical quality as defined by QBPs.
QBPs focus on product, not patients; coffee, not customers.
Standardizing care pathways is probably a good thing. But once hospitals standardize, will patients get great customer service? Will QBPs motivate hospitals to serve patients like Starbucks works to earn customer devotion and trust? Or will hospitals continue as they are today, trying to do things as cheaply as possible and within budget? I suspect hospitals know they won’t get more and more money for providing more services. They will find a tipping point of maximal efficiency and stop. Just like they did with global funding.
We must debate motivation, not structure. If healthcare is a rowboat, standardized care pathways address leaks. They keep the boat afloat, but they don’t get us anywhere. They don’t help us view patients as valued customers, they won’t shorten wait times, and they don’t encourage innovation. Quality will plateau, limited by budgets.
We need our system to reward hospitals for putting patients first. We need true patient-based funding. So far, finance reform has only motivated hospitals to see certain patients as more risky, and costly, than before. It remains to be seen if finance reform in Ontario will live up to its promises in the future.