Opinion by D. Wayne Taylor, Executive Director of The Cameron Institute and response from the Editor-in-Chief
Dear Editor-in-Chief, There is little doubt that Canadian healthcare needs innovation. This journal, to its credit, recently devoted an entire issue to that. But we missed the mark. I am not being critical of the authors or their articles as they passed the test to be published. They just were not examples of innovation per se. Yes, they may have documented improvements in processes or the adoption of new products to improve efficiencies and/or service but there was very little innovation involved.
Innovation is the development, commercialization and adoption of research whether it is in drugs, devices, IT, management systems or any other part of healthcare. Canada is not a leading innovative nation generally speaking, according to international comparative surveys and rankings, and definitely not innovative in the realm of healthcare. We have also declined and are continuing to decline in these rankings in terms of research as well.
It is a generally accepted fact that the bulk of research comes from academe supported by government and industry funding. It is also a generally accepted fact that the bulk of innovation comes from the private sector. Canadian healthcare – at least in the provision of physician and hospital services – is a collective of governmental monopolies in its funding, delivery, regulation, administration and governance. By definition governments are not innovative.
I am all for continuous improvement, the use of modern technology and products, streamlining and creating better service for all but I did not read about any true innovation in Forum nor have I. It is not the journal’s fault because there is very little, if any, true innovation taking place in Canadian healthcare to write about.
There is tremendous inertia in Canadian healthcare: both cognitive inertia and action inertia. When will we get beyond pilot projects, white papers, and quasi-academic thought pieces and look outside of our borders and see what the rest of the world is doing? Insulin is our tired but true claim to an innovative past. Using new products to keep food warm, improving procurement efficiencies, and enhancing activation of the frail elderly are good things to do but are hardly innovative as compared to what is really happening in the world today. Talk about pan-Canadian visions is interesting but does nothing to address our innovation deficit.
I wrote an article recently for Forum in which I compared Canada with Austria. Both countries spend 11% of their respective GDPs on healthcare. But there are virtually no waits for care in Austria whereas Canada has one of the worst wait records in the industrialized world. Those who got the point wrote me some very nice e-mails. And then there were those who missed the point. “But Austria is different! They do this. They have that.” Precisely! I was not saying copy Austria but what I was challenging Canadians to do was change. We can never expect to have any more healthcare or any better healthcare if we do not change how we do healthcare. Period.
The fundamental problem is we cannot, will not and choose not to see beyond the extreme limits placed upon us by the black box of single-payer physician and hospital services – and choose to basically ignore the other 30% of the equation which is private. As long as we ignore the private sector generally and lessons learned in other jurisdictions around the world we will continue to regress to the median of healthcare in the world. This myopia is anti-innovation. Innovation in how healthcare is financed in the United States has been driven from the top down and requires execution by the private sector. Do not expect innovation to come from the bottom of a government monopoly – it never has and it never will.
Hopefully future issues of Forum will be filled with examples of innovation to prove me wrong.
Regardless, I say, wake up Canada! Wake up First Ministers! Innovation knocks at the door. We just need to unlock that door and let it in.
D. Wayne Taylor, F.CIM
Executive Director, The Cameron Institute
FORUM’S EDITOR-IN-CHIEF RESPONDS:
Dr. Taylor’s assessment of Forum’s recent edition on innovation is less a comment on the journal and more of a comment on change and the Canadian healthcare system. He essentially acknowledges that the type of “innovation” that one would expect should be occurring in the Canadian health system given the economic circumstances) is non-existent. Dr. Taylor refers to “cognitive” and “action” inertia in the system and the need to get beyond pilot projects. His frustration is unmistakeable.
So, there are elements of Dr. Taylor’s assertions that are difficult to dispute, particularly in terms of his own comparative work on the Canadian and Austrian health systems. However, there are other aspects of the analysis that I would like to better understand his perspective especially as it relates to the benefits of how innovation is driven in the U.S. healthcare system. On the one hand, I hear Dr. Taylor saying that we as Canadian healthcare leaders need to move off of an incremental, micro approach to innovation and change. And on the other hand, he presents the efficacy of a private sector approach to riving big change in healthcare in the U.S.? What macro, population health indicators lead to this conclusion.
For me, the key point that resonates in Dr. Taylor’s letter is captured in his comment that: “We can never expect to have more healthcare or any better healthcare if we do not change how we do healthcare.” Despite the fact that Dr. Taylor talks about “lack of innovation,” innovation or lack thereof is really his point of departure for the real issue which is the inability of leadership to drive the type of change that is required in the system.
From Dr. Taylor’s perspective he wants to know why healthcare leaders are not leveraging the data, evidence and research to create an improved and sustainable health system. Research such as his study of the Canadian and Austrian health system that clearly demonstrated improved health service models are possible to attain. Dr. Taylor reminds us that the current healthcare system is not sustainable and nor should it be given the many inefficiencies and quality concerns. He reminds us that incrementalism is not going to solve the problem—and he is challenging us on the notion of what “innovation” really looks like. Dr. Taylor, I believe would argue that what we are putting forward as innovation and change is not substantive in terms of the problem at hand and at best we are “nibbling at the margins.”
I would have difficulty disagreeing with Taylor on this “magnitude of change” point and in adding my own perspective to the debate would argue that the type of change required in the health system requires a total reframing of the priorities and realignment of funding. The type and magnitude of change required starts with a revisiting of the Lalonde Report from the late sixties. Leadership needs to drive the type of change that will move us from a system that is predominantly focused on treatment to one that emphasizes prevention and wellness.
I suspect that Dr. Taylor’s frustration with the inertia in the health system is a reflection of many leaders and academics frustrations as well.