It may well be time for our local hospital board (MAHC) to contemplate whether it is properly constituted to most effectively represent, understand and respond to the wishes of their constituency. A recent overview of elected entities and community representative boards suggests a broader trend under way – that elected bodies and community representative groups increasingly need to be structured to hear and respond more directly to their constituents. Justin Trudeau spent a good deal of time talking about better proportional representation during his successful campaign, the new federal NDP leader Jagmeet Singh has electoral reform as one of his key four strategic pillars and our District of Muskoka Council has a review underway to study its size and composition.
It is puzzling that our local hospital board seemingly ignores the broad community view that acute healthcare services continue to be provided through a two-site operating model. The protests and backlash in many Muskoka communities concerning this issue over two years ago has already caused intervention and actions by the Local Health Integration Network and Ministry of Health.
The fact that healthcare needs to be delivered efficiently and effectively is well understood. However, the hospital’s four per cent annual budget deficit should be viewed for what it is – the result a relatively new Ministry funding formula that disadvantages medium-sized hospitals. The Ministry is studying this matter currently and while the issue needs resolution asap, a single-site hospital, 15 or 20 years down the road, does nothing to solve the funding issue today, or into the future.
On MAHC’s assertion that a one-site solution furthers long term healthcare sustainability, the fact is that no one can accurately project how healthcare will be delivered 20 years downstream. Some possible changes and needs are emerging – more services will be done out of the hospital inpatient venue through day clinics/outpatient services, by community and allied health provider services and illness prevention. Hospitals are likely to have less inpatient beds. Evolving cost headwinds will continue to expand healthcare service demands (and costs) due to demographic shifts, new drugs and technologies, rising obesity, drug addiction, mental health and more. Future hospital decisions must have the flexibility to adapt to continuing and evolving change.
A big-bang, single-site new hospital plan is less flexible than a plan that provides incremental upgrades at the hospital’s two existing sites.
So an important question remains – how can the hospital board both organizationally and governance-wise get to a place where their communities are able to know and trust that their decisions properly reflect and represent a consensus view of the constituency serviced?
Some relevant questions that could use clarification:
- Are served community areas appropriately represented on the board?
- Is there an appropriate balance between hospital-affiliated representatives versus unbiased and non-hospital affiliated individuals on the MAHC Capital Plan Development Task Force now underway?
- Are there good board governance practices in place for selection of board leadership positions?
- Does the board demonstrate appropriate public transparency and openness in how it conducts its business?
- Is the current board vested to the single-site decision made two years ago?
The questions clearly go beyond the MAHC Capital Plan Development Task Force, and the answers have long-term implications. If the broader public users are truly the shareholders of publicly funded healthcare, aligning accountabilities of the board is essential and should be expected. Healthcare in the community is of primary importance to all, and therefore everyone is encouraged to let their views known.
Authored by Dave Wilkin, (former) MAHC director, retired bank & IT executive, and Ross Maund, (former) MAHC director, career health services corp. executive.
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In answer to the five questions asked:
1. No the communities served are not adequately represented. Each municipality served should elect a hospital board rep. on the municipal ballot. This will improve transparency and accountability vastly.
2. Is there an appropriate balance on the board between hospital affiliated members and members from the private sector? No, there should not be any voting hospital affiliated members on the board. They are employees and should only be invited to board meetings in an advisory capacity with no vote. It is unethical and biased.
3. Board governance needs a colonoscopy. Recruitment to board is currently designed to be exclusionary and obstructive in order to fit a predetermined model. Election of reps. will eliminate that prejudice.
4. Does the board demonstrate transparency and accountability — absolutely not! Public consultations which I have attended have been nothing but a farce. They have been a presentation of predetermined decisions, rather than a consultation of stakeholders.
5. As for the one site solutution, if the board is married to it, they should all resign. It bucks the current trend of care in the community and would add tens of millions in cost to provide hard services like highway access, water and sewers, and broadband connectivity for remote consultations, and other e-health applications. It is without doubt the dumbest concept ever conceived and the committee members clearly have no concept of service to their communities.
Furthermore, the board guidelines are unethical and biased on their face, requiring members to “make decisions in the best interests of MAHC, “rather than the stakeholders. MAHC should not have any interests other than the best interests of the stakeholders, not hospital administrators or staff who have their own personal, political and career agendas.
an interesting article with even more interesting responses.
As Mr. Wright says, we are going to get one hospital regardless of how much we yell and scream, unless there is a concerted effort from all of the shareholders/taxpayers/ local population of whom are the same folks. The Hospital Board has an agenda and it does not reflect or even come close to what we need. The idea of LHIN’s or PHU’s are just knee jerk reactions from politicians, more than likely the reason we will not hear from Mr. Miller.
Trim the fat from the budgets, identify redundancies and overlaps, perhaps even have only one site for administration and let the two health centres do what they are supposed to do-supply health care to Ontarians, that is us!
WHERE IS NORM MILLER ?? Great question.
Norm is too busy selling compostable K-cups instead of helping out our hospital funding!
Can someone wake him up?
WHERE IS NORM MILLER IN ALL THIS ? COULDN’T HE BE OFFERING SOME SUPPORT TO THIS STRUGGLE?
I’D GO A STEP FURTHER AND TELL THE HEAD HONCHOES TO RESIGN QUIETLY, OR LOUDLY, BUT RESIGN ! ALL THEY ARE DOING IS MAKING SURE THEY ARE IN POSITION TO VET SOME GOOD PEOPLE WHO COULD DO THEIR JOBS MUCH BETTER.
THE CEO AND CHAIR’S AND BOARD MEMBERS’ MANDATES SHOULD BE “TO SECURE ADEQUATE YEARLY OPERATIONAL FUNDING TO THE 2 SITES THAT ARE ALREADY HERE, AND UPGRADE THEM AS NEEDED .
CUT THE CRAP WITH THIS INFANTILE EXERCISE IN PLANNING FOR THE FUTURE WITH A 1 SITE SOLUTION. P.S. – IN MY OPINION, THE HOUSEKEEPING AND MAINTENANCE DEPT’S. ARE DOING A GREAT JOB. – AND KUDOS TO THE ENTIRE STAFF.
We definitely NEED both sites! Stop cutting services. Many of us travel down to Huntsville from South River and beyond! Both sites have a large influx of Summer Visitors. There must be a way to continue. The food services are ridiculous, wait ’til a prominent person needs the service. Medical personnel are overworked. It is obvious that housekeeping/ maintenance services are not getting the job done. It is disgraceful what is happening to our Healthcare across the province so that politic groups can say “Look what I have saved in money” while patients are not getting what they need!
Great article by Wilkin and Maund…..thanks for speaking out……long overdue!!!!! The five (5) questions are dead on and need to be answered.
Well, folks…I think the Gov’t has other plans, via the LHINs…don’t think it really matters about what the locals think….There;s a new plan / strategy afoot…So, it really comes down to the Board trying to sell the new concept…that the locals don’;t like..to the unwilling….. Maybe it’s time to bite the bullet and let them do their work as best they can within the constraints imposed on them…and, hopefully it will have a better outcome than Mike Harris’s conversion of Ontario Hydro from a publicly owned company, selling power to the people at cost to a profit centred corporation making profit for funding it’s (originally) sole shareholder..the Gov’t.
We lost the Burk’s Falls Hospital – we were told it was financially necessary in order to save the Huntsville Hospital. What next?!?
Thank you, gentlemen, for taking a much more community centred view. We really do need to get back to basics. We have two sites that, while admittedly getting a bit long in the tooth, are still both newer than big chunks of Soldiers Memorial in Orillia. As well, there have been very substantial endowments to keep up with the times. Would we plow all this into the ground to satisfy some GTA oriented political agenda?
Let’s give our collective heads a shake, and get back to the real world of “making it work”. We have two hospitals that work. Let’s keep it that way!
A FEW MONTHS AGO THIS SAME GROUP OF LADIES VISITED HUNTSVILLE’S TOWN COUNCIL. THE OPENING STATEMENT WAS SOMETHING ALONG THE LINES OF “I DON’T SEE HOW WE CAN POSSIBLY AFFORD TWO HOSPITALS….”THAT SHOULD EXPLAIN WHY WE ARE GETTING THE NO-CHOICE SURVEYS. I AM SUSPICIOUS BY NATURE, AND SOMETHING TELLS ME THE SAME TWO LADIES ARE MARCHING TO A DRUMMER THAT CALLS THE SHOTS FROM SOMEWHERE CLOSER TO THE PROVINCIAL GOVERNMENT LEVEL.
PLEASE LET US CHANGE THIS ‘BOARD, – FAST! WE WON’T GET ANYWHERE WITH IT.
I AGREE WITH DAVE WILKINS STATEMENTS 100%,