The focus on internal cost savings is a detriment to hospital planning ~ Hugh Holland

The integrity of hospital planning …

It is difficult to know whether the focus on internal cost is coming from the Ministry of Health, the regional LHIN, or from local MAHC planners. But the focus on internal costs at the expense of external costs raises serious questions about the integrity of Ontario’s hospital planning. In this context, the word integrity refers to the wholeness, togetherness, and consistency of the methods and values used.

It would be cheaper to make electricity from coal, but we stopped doing that out of consideration for the external costs to the environment and to health care (Respiratory diseases).

It would be cheaper to build and operate a single large OPP station in Muskoka, but we have three because response time is often critical in police work.

It would be cheaper to build and operate one big central fire station in Muskoka, but provincial municipal law requires each municipality to have a fire station because the external costs of not having one outweigh the internal costs of having one. Response time is always vital to minimizing fire damage.

It would be cheaper to build and operate one big LCBO store in Muskoka, but the province of Ontario built eight LCBO stores because from their point of view, the external costs (excessive travel time and fuel resulting in lost sales revenue) would outweigh the increased internal costs.

There are 17 schools in Muskoka. Why not have just one big central school? There are 15 banks and 12 grocery stores, two Home Depots and two Canadian Tire Stores in Muskoka. Of course each of the above examples has their own specific rationale, but there is some common rationale. The internal cost savings of a single site are outweighed by the benefits of multiple sites. It all has to do with providing effective, safe and convenient service to the customer.

Depending on the assumptions of where and how it might be built, it ‘might’ indeed be cheaper to build and operate one large central hospital in Muskoka. But like the above examples, the internal cost savings of a single hospital are outweighed by the external benefits of multiple hospital sites. The external and internal benefits of two acute-care hospital sites include:

• Less wasted travel time and fuel, and reduced risk of travel accidents for all concerned.
• Fewer avoided visits that result in more costly treatment later.
• Reduced number of costly permanent disabilities and deaths.
• Stronger doctor-patient relationships resulting in less over-diagnosis and over-treatment.
• More successful recruitment of patient-centered doctors and staff.
• More successful recruitment of volunteers that do most of the reception and guiding work.
• A stronger sense of ownership that reflects in Hospital Foundation fundraising.
• Better achievement of the Ministry goal of patient-centered (Customer-centered) care.

Most of the benefits of convenient patient-centered care are outlined in detail in the book Better Now by Dr. Danielle Martin, a renowned family physician and professor of medicine at the University of Toronto who was called before the US Congress to explain the benefits of the Canadian Health Care System. Dr. Martin’s book provides a model for integrity (wholeness and consistency) and should be required reading for anyone involved in planning for health care and hospitals.

Hugh Holland is a retired engineering and manufacturing executive now living in Huntsville, Ontario.

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