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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  1. Excellent analysis, Hugh! I would also like to add that having a local hospital is vital to the economy as a whole. I know several senior couples who decided to purchase newly-built houses in Huntsville (along with purchasing furnishings here) because of the proximity of the Huntsville Hospital. They most definitely would not have settled here if there were just one central hospital in Bracebridge. I’m assuming that is also true of those who have chosen to settle in Bracebridge or Gravenhurst (although I have heard that many Gravenhurst residents choose to go into Orillia to Soldiers’ Memorial Hospital.

  2. Sonja Garlick on

    Wish you were on the MAHC board, Hugh. Everything you have stated makes so much sense! Well done!

  3. IMHO .. Change is required and we all know the cost to maintain 2 old hospitals with no room for expansion, very old facilities,very old technology etc etc. You will not attract the best in the medical profession with facilities like we have! We must look to the future and let go our very selfish idea of 2 hospitals. No matter how you slice it or dice at the end of the day we are left with 2 very old facilities… old services and old procedures .. same old .. same old. Would it not be great to get the services we need here locally instead of ALWAYS needing to go south?. We need to get over the emotional side of the decision and do what is right for the future .. now! The more bickering and fighting and arguments and negative OLD style thinking .. the more we will remain the same … now .. and the future and .. ALL funding will go somewhere else were there is more positive thinking and agreement to move FWD with new technology, improved services et etc!

    • Hugh Holland on

      Bob, We are not talking about two old hospitals as you seem to be visualizing. Of course we cannot have all the bells and whistles of a Sunnybrooke, but we can have two very modern smaller hospitals that will serve our needs better than one big hospital that is inconvenient for more than half of the permanent and seasonal population. And it is entirely possible to have two good hospitals for less cost than one big hospital. It just takes some practical thinking. Muskoka roads are not on a grid. We have to make long drives around some very large lakes. That is why we need so many police and fire stations, and two hospitals.

  4. Rob Millman on

    The precepts of patient-centred care mesh well with the two-site model, and both professionals and the general public are in agreement with the multiple benefits derived therefrom. Unfortunately, the LHIN is a sledgehammer in search of an ant to crush. It moves at a snail’s pace (in the absence of extensive studies). The empirical mensuration and reporting of outcomes, however, is significantly lagging behind the favourable theoretical reviews of the method.
    It is to be hoped that the LHIN can embrace patient-centred care on the basis of its success elsewhere, before any final ruling by the MAHC.

    • Not even sure how we permitted the LHINs to become imposed on our local hospitals as a kind of virtual dictatorship. Do we even know who these people are? Perhaps if we had more local autonomy, we would have more success.

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