Canada's Healthcare Challenges Demand Interdisciplinary Training for the Development
of Creative Solutions
Magdalini and Daniel Penello
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Students in the Rotman MBA Program are strongly encouraged to seek and participate
in summer placement opportunities after completing the first year of the program.
Thanks to the support and encouragement of Dr. Bob Bell, Orthopaedic Surgeon - CEO
of the University Health Network, who is my supervisor in the Scholarship in Surgery
Program, I was given the privilege of completing an administrative internship in
UHN's Corporate Planning Department this summer. To say that this experience gave
me the opportunity to apply my newly-acquired business knowledge to the healthcare
setting is an understatement. Although I worked with financial spreadsheets, the
Balanced Scorecard, strategic planning frameworks and business plans, the real value
of this experience was being exposed to a completely different but equally important
side of healthcare that had been invisible to me in my role as a surgical resident.
From a business point of view, Ontario hospitals are in a very difficult and unfavourable
position. They are in a market where there is only one "buyer" of their services
(a monopsony): the Ontario Ministry of Health and Long-Term Care through its new
Local Health Integration Networks (LHINs). The LHINs ultimately determine the funds
each hospital will be given in order to provide the services they plan to deliver
in the coming year. However, since hospitals have little control over the types
of patients that walk in their door or the types of medications, tests or operations
that their physicians will deem necessary, managing the budget while continuing
to provide high-quality care to increasingly informed patients is a very challenging
task.
Along with provincial initiatives aimed at improving accessibility to certain priority
tests and procedures, there has been a widespread push towards increasing hospital
accountability for the services they provide. More than ever, operational efficiency,
quality measurement, knowledge transfer and performance management have become critical
success factors for Ontario hospitals. Making strategic decisions that will not
only streamline patient care but also allow the hospital, as an organization, to
pursue its broader objectives of excellence in education, research and patient safety
requires new and innovative approaches.
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My involvement in the development of a strategic
plan for the Peter Munk Cardiac Centre this summer exposed me to the challenge of
attempting to efficiently and ethically distribute limited resources (money, support
staff, space and time) among many equally-deserving departments. During this process,
managers must address difficult questions such as, "Is it better to invest in an
area that will result in a moderate benefit for the majority of our patients (like
a better cardiac MRI scanner), or should we invest in a new technology that will
result in a significant benefit for a small subset of patients?"
Creative solutions to these challenges, as I have learned, arise from lateral thinking
and the ability to integrate concepts and models of practice from diverse and seemingly
unrelated fields. Some consider the fields of business and medicine to have irreconcilable
differences in their priorities, methods and goals. This narrow view is a barrier
to creative solutions and one that is generally held by those who know only one
domain and have a limited understanding of the other. During my summer experience
at UHN I also spent a considerable amount of time helping Rehab Solutions identify
and evaluate expansion opportunities. In addition to a strong clinical understanding
of the specific needs of the patient population being served, evaluating options
required knowledge of real-estate development, human resource management, finance
and space planning. Important decisions cannot be made in a vacuum. My experience
at UHN has reaffirmed my belief that a business perspective does not seek to reduce
important clinical decisions to dollars and cents, but rather injects a rich mix
of relevant information into the context in which the decision must be made. An
appreciation of the broader context enables effective leaders and decision-makers
to understand and align the interests of key stakeholders so that creative and sustainable
solutions to our many healthcare challenges can be realized.
Daniel Penello, MD
Resident, Division of Orthopaedic Surgery
MBA-Candidate, Rotman School of Management, UofT
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