Ordinary people doing extraordinary things

Something special is happening in health care in Northwestern Ontario. No, it’s not the doom and gloom, roof-is-falling-in stuff in the daily media. It’s ordinary people doing extraordinary things as they respond constructively to change.

For more than a decade, the do-better-with-less revolution has hammered every workplace. Hospitals and health care agencies are no exception. In hospitals, the revolution was (and is) driven by galloping cost increases caused by more expensive technology, more reliance on professionals, new services, treatment of an aging population, and similar factors.

The political party in power didn’t matter. There was never enough money.

The underlying problem was (and is) a system problem. The organization structure developed in the first half of the century was too cumbersome and expensive.

Hospital governors and administrators in the northwest met to deal with the more-service/less-money problem. They explored how they could share services without giving up local autonomy. What has been achieved over the last few years? Here are some examples:

  • Nipigon’s hospital provides business services to Atikokan. Kenora’s hospital does the same for Red Lake.
  • A group in the east and another in the west provides lab services.
  • Dr. John A. Spencer (Fort Frances) is the driving force behind a regional surgery network. The aim is two surgeons in each of Fort Frances, Dryden, Kenora, and Sioux Lookout. In addition to providing more service, the surgeons will have some relief.
  • Local nurses trained at the Regional Cancer Center give chemotherapy treatments in local hospitals.
  • Hal Fjeldsted (Red Lake) says the low volume of babies born made it difficult for nurses to keep up to date on obstetrical care. To get extensive exposure, Red Lake nurses spent a few weeks working in Thunder Bay.
  • Don Ross (Nipigon) pointed out six ambulance services between Shabaqua, west of Thunder Bay, and Armstrong are co-ordinated from Nipigon.

None of this required another tier of expensive bureaucracy. No group had to give up its autonomy. It was achieved through collaboration.

Last fall at Quetico Centre, we introduced them to the concept of network organization. It provided the governors and administrators with a framework to do deliberately what they already were doing intuitively.

Here’s the difference. Traditional command and control bureaucracies were designed for the industrial era. Control is centralized. People obey a rules-based command system. A few people at the top do the thinking and deciding. The rest do the grunt work. Communication is in the form of orders and directives in a chain of command.

Bureaucracy is too cumbersome when change is rapid and unexpected.

The network organization is different. It’s designed for the information era. Purpose is central. Guiding principles shape action. Its focus is sharing resources through collaboration. Resources are applied to achieving mutual objectives while maintaining individual identity. Thinking and deciding are as close as possible to where the work is done.

Co-ordination is achieved through a network of communications linkages such as phone, fax, e-mail, meetings, and conferences.

In mid-June, 16 hospitals and public health agencies signed up for the Northwestern Ontario Health Network. They support its mission and nine guiding principles. They elected Andrew Skene (Dryden) as chair, Muriel Rampersad (Nipigon) as vice-chair, John Ostler (Geraldton) as secretary, and Gord Sheppard (Atikokan) as past chair.

They also selected three project leaders–Peter Sarsfield (Kenora) for health status, Dave Murray (Fort Frances) for transportation and access, and Carl White (Thunder Bay) for information.

Even if there were no fiscal constraints, network organization is the way to go. Better services are available that no cumbersome bureaucracy can possibly provide.

With a sound understanding of network organization and the will to make it work, not only will the health network people do substantially better with less, they will show the way to non-hospital and non-health agencies.