Why is it that what is developed in health policy to transform delivering care doesn't seem to succeed?
I suppose this question depends on how you define "success".
Is "success" finding greater efficiency?
Is it providing more value or more quality?
Is it simply reducing cost to government?
Is it providing more services with less funding?
Is it simply getting along with less?
Is it creating some kind of tangible legacy?
Is it creating a continuum of care?
Is success generating Big Data and creating more Health Information Technology?
Is it creating teams where everyone works together?
Is it allowing patients to die at home if this is their wish?
There has been much "policy development hand wringing" from many groups on efforts in these areas. Politicians, policy makers, and providers have all attempted to provide input over many, many years.
Why then, with so many people working together (and well paid to work on these efforts) for decades on these issues, has the "success" been so insignificant in constraining health care costs that government routinely reverts back to constraining delivery of care including the slash and cut approach?
We saw it in the 1980s with the introduction of the Canada Health Act.
We saw it again in the 1990s with Ontario NDP "Rae Days", caps and clawbacks, and hospital cuts.
We see it in Ontario now with Premier Wynne's heavy handedness with physician negotiations where cuts have become the solution once again.
Why isn't success defined as meeting the needs and goals of the patient in their own care?
Why isn't success defined as allowing patients the freedom to access the care they need in a way that meets their needs?
Lots of questions exist surrounding these issues but one of the most significant reasons that health transformation cannot be achieved in reality and why any "success" is muted is that every 10-15 years the policy cycle renews. Every 10-15 years lessons previously learned are forgotten. There is no health care policy succession planning and with every cycle that ends, the next group of politicians, policy makers, and providers start fresh with the belief that the current system can be made more efficient and meet growing demand. All this despite decades of attempts that demonstrate otherwise.
Wisdom in health care planning does not exist.
There is a vast chasm that exists between health care Theory, borrowed or created, and health care Reality. No amount of policy development can change that until there is a transfer of experience and wisdom from those who have come before to those that are coming after. We do this in medicine. Why not in health policy?
How can this be accomplished?
First, let us all acknowledge that many health transformation efforts fail.
Then, create a living document that includes all of the policy changes and their results.
Perhaps then we can bridge the chasm between Theory and Reality and avoid the cyclical lapses that seem to confound finding true sustainability.
As always, I am grateful for your comments and contributions particularly in my absences.