Lessons Learned #6:
HOW ONTARIO’s HEALTHCARE SYSTEM IS DESIGNED TO FAIL PATIENTS, TAXPAYERS, AND HEALTHCARE STAFF
by Ted Ball, Quantum
If you read my last five Lessons Learned essays, you know the core assumptions behind them. For example,
That the “low rules” non-design ( as opposed to “minimum specifications”) that the Ministry of Health & Long-Term Care (MOHLTC) public servants proposed to the new government would not be very successful. Using that approach, in my judgement, Ontario would experience the norm for most large-scale change projects in healthcare—that is, that only 30 percent would succeed. For that reason, I initially projected a 70 percent failure rate for Ontario Health Teams (OHTs).
I also assumed that, shortly after the June 2022 election, a re-elected Ford minority government would be faced with a very serious post-pandemic financial crisis, with interest payments on the money we already owe reaching more than $2 billion monthly.
Given these financial realities, my assumption was that smart communities, in “stewardship,” would utilize the OHT development opportunity to collaborate on a solid integration/transformation plan for the local healthcare service provider partners within their OHT before being hit by the budget constraints that I believe ought to be expected in the provincial budget of 2023–2024, although the “reckoning” could stretch to 2024–2025.
While these were my key assumptions for the Lessons Learned series, as a student of system design and an experienced practitioner in facilitating health system integration and redesign for 30 years, I have been writing these essays with the faint hope/intention of adding value to the handful of OHT system designers who are actually engaged in designing an integrated, transformed, patient-centred, seamless system of services across their OHT region.
In most communities, however, the power dynamics between the OHT community partners has reached the point where the community’s best interests are threatened. In too many cases, we are heading for yet another “provider-centric” system driven by the historical power relationships between the providers and the government decision makers, rather than by community need or based on evidence on achieving value for money.
Some governing board members might be surprised to learn that in many communities, the low-rules world of healthcare planning introduced by the MOHLTC in 2019 has now evolved into a type of permissive “cowboy mentality” in which some acute-care CEOs (a complex, extremely challenging management undertaking in normal times) are, in the midst of the pandemic being egged on by public servants to expand into other healthcare-service businesses along the continuum of care.
Yes, our public servants are behind this strategy—despite the fact that (a) very few hospital CEOs have already solved the critical issues of quality, safety, and patient satisfaction at their own hospitals; and, (b) they know nothing of the even greater complexities of businesses elsewhere in the system—whether they involve sub-acute care, long-term care, nursing home care, chronic care, etc.
These are dangerous, ill-advised measures that truly demonstrate the extent to which our public servants don’t understand the nitty-gritty real-world health-system issues in all their glorious complexity. Rather than asking our overburdened acute-care hospitals to take over community agencies, designing systems, structures, and processes for system integration and transformation processes could still save a few our healthcare systems at the local level—if only the stewards on community governing boards and among CEOs would finally step forward as leaders.
After the election in June 2022, it will also be critically important that the next Minister and Deputy Minister of Health actually want OHTs to have the devolved authority to allocate the system’s bundled resources so they can fund each OHTs unique strategy. Will there be a leadership team at the top that believe in community empowerment?
If OHTs are empowered, I think I have some helpful pragmatic insights from the school of hard knocks to share with system designers who are open to learning. Having served as a transformation coach with 23 different communities, systems, and health service providers (HSPs) across the United States and Canada, I believe I can still pass on some valuable pragmatic information about what worked and what didn’t work in other similar integration/ transformation cases.
There is huge value in understanding how people figured out how to customize their system and organizational designs to fit the unique circumstances of their community’s healthcare delivery system. But now, quite frankly, such efforts are simply pointless.
From the system integration agenda perspective, the Ontario Health organizational designs are not aligned with creating a better, more integrated, equitable, seamless, and more patient-centred healthcare services delivery system at the local community level, but rather, they are designed and aligned for public servants to focus on individual HSPs—measuring and evaluating their performance in order to hold people accountable and then allocating resources to organizations based on their silo performance metrics—not service integration, not improved health outcomes, not patient satisfaction metrics.
The vision is about high-quality services for patients; the organizational design is about creating high-quality jobs for public servants.
I think this is how you spell M-I-S-A-L-I-G-N-M-E-N-T. 🤷♂️
That was the realization I came to—in an instant—when I saw the new structural design and functional design of Ontario Health. Remember, this is a $73 billion-a-year cost centre, employing hundreds of thousands of professionals, and, providing Ontarians a source of pride. No question, healthcare is a key political issue in this province.
Who would have believed then, that, in Ontario, the interests of the “owners” of the system, the citizens/patients would be positioned in a distinct second place to the narrow self-interests of the most powerful of the system stakeholders—not the doctors and hospitals—but the public servants, the people who control the design of the macro system and have a long tradition and history of seeking bureaucratic security, growth, and prosperity.
What I know from the perspectives of organizational and complex system design is that the plans released by Matt Anderson, Ontario Health’s CEO, will generate deadly countervailing forces that will most certainly result in yet another round of failed system redesigns—just like the previous attempts with the 36 District Health Councils; 14 Local Health Integration Networks (LHIN)s; 83 Health Links—and now, 82 OHTs. Yes, they learned nothing.
Indeed, they gleefully plough forward, oblivious to the lessons lost. The new Ontario Health functional and structural designs are actually aligned to achieve, not the compelling patient-centric visionary rhetoric of the politicians, but rather the following outcomes:
A system of bureaucratic command-and-control over 2,000+ health service providers in 82 Ontario Health Teams, located across the five Ontario Health geographic delivery systems; and,
The establishment, in each of the five Ontario Health regions, of a traditional system of top-down authority structures, functions, and processes to facilitate the micromanagement of strategy development, system design, and strategy implementation at the regional and OHT levels.
So, the VISION of integrated, patient-centred, and seamless healthcare services is very different than the OUTCOMES that will be delivered by the recent functional and structural designs of Ontario Health. This ought not be a surprise. The outcomes are embedded in the design. “Every system is perfectly designed to produce the results/outcomes they achieve,” as W. Edwards Deming said.
When I reflect on the many lessons learned on my personal system-integration and organizational-transformation learning journey, perhaps one of the most significant system design concepts that I painfully came to understand is that of ALIGNMENT—organizational and system alignment.
Alignment is not a concept that is very well understood in the public sector, which tends to compartmentalize functions in silos that are designed to be isolated from one another and yet, in reality, have huge impacts on one another’s functioning.
In a car, for example, the engine’s component parts must be in alignment for maximum fuel efficiency and for basic functioning. If the component parts of the cooling system of the engine are not designed and aligned together to achieve their intended purpose, or outcome, (i.e., the cooling of the car), the car breaks down and ceases to function. Without alignment, systems and sub-systems simply fail to achieve their stated outcomes and intended purpose.
But the MOHLTC has never understood system design, nor complex adaptive systems, nor why, without an aligned system, the stated outcomes will never be realized. All the public servants ever saw in this exercise was power arrangements. They were never engaged in a best-practice system design exercise called designing for outcomes—a process involving aligning all the key leverage points on Quantum’s tetrahedron framework that, when aligned in combination, will produce the intended results.
Rhetoric about being patient-centred was just that—rhetoric. The public servants evidently thought that politicians seem to like marketing/branding phrases like that, so it has never occurred to them that, with the art and science of system alignment, they could actually achieve that goal and more, if only they understood the concepts of system design and system alignment. But they don’t get it.
As a noun, alignment refers to the degree of integration of an organization’s core systems, structures, processes, and skills, and the connectedness of the people to the organization’s strategy and vision. As a verb, aligning is a force—like magnetism; it’s what happens when you pass a magnet over a scattered iron filings.
I first encountered this concept of “alignment”—painfully—when I went down to visit Herbert Wong, the founder of Quantum Solutions in Austin, Texas. I had been part of a team that had just completed “The Essex County Win/Win Model for Total Health System Reconfiguration,” which some people thought might become the leading-edge example of applied systems thinking and complex system design for an integrated health and social services delivery system focused on evidence-based population-health implementation strategies, structures, and processes.
An Ontario hospital CEO at a conference in the US heard Herbert Wong speak on the subject of designing complex, adaptive, human systems and told him about the innovative biosphere of human services that we were creating in Windsor. I was invited to meet with Dr. Wong and his team to explore what we were learning in Canada about complex system design.
Quantum Solutions was seen at that time as a leading innovator in healthcare modernization and population-health system redesign, focused on patient experience, and driven by the knowledge and insights of frontline care providers, managers, and governance—all utilizing systems-thinking tools to tap into their collective intelligence based on evidence from organizational science and minimum specifications for Integrated Delivery Systems (IDS).
When I arrived in Austin in the Spring of 1994, Herbert Wong and his team of leading experts in complex adaptive system design had just completed their research and design work on what later became the leading Organizational Alignment Framework for complex adaptive systems like healthcare.
THE STRATEGIC ALIGNMENT MODEL FOR COMPLEX SYSTEM DESIGN
The component parts of Quantum’s systems-thinking-based tool—the Strategic Alignment Model— are STRATEGY, STRUCTURE, CULTURE and SKILLS. These four components of system design are arranged on the key leverage points of the tetrahedron shape (see diagram at the end of the essay).
System-thinking guru Peter Senge once said that while several alignment models are based on the same science and the same art and reality, he thought that Quantum’s Strategic Alignment Model is the most informative model because it visually demonstrates that it is STRATEGY that drives structure, culture and skills.
He pointed out that other alignment models simply leave one confused about what organizations actually eat for breakfast.
The public servants are only interested in what they understand to be the only really important organizational component—the structure. But an organization’s structure is much more than an organizational chart that outlines who has the power and authority to blame others in the human hierarchy.
STRUCTURE is actually made up of several components, including functional, structural, and work process design; decision-making and accountability design; information systems and digital strategy, rewards, and incentives; and, strategic budgeting. Unless each of these components is aligned to the outcomes of the system—including alignment with the components of skills, culture and strategy—nothing productive or meaningful happens.
But in all of their system redesign efforts, the public servants, always just focus on power and authority because that has been their obsession. They never have been much interested in culture or the skills required to succeed. Big mistake.
CULTURE describes the organization’s typical way of thinking and behaving and includes the norms, values, interpersonal behaviours, behavioural expectations and leadership styles. This basic set of assumptions influences what the group or organization pays attention to, what things mean, how to react emotionally to what is going on, and what kinds of actions to take in certain situations.
Organizational culture is also highly influenced by the interplay of the other component parts of the Strategic Alignment Model. For example, what assumptions is an organization holding when it puts in place rigid command-and-control systems, structures and processes rather than best-practice accountability processes? Is there an assumption that people can’t be trusted and need to be carefully watched and monitored? And, do these comprehensive bureaucratic systems actually improve accountability or do they produce cultures of fear, anxiety, blame, and blame-avoidance dynamics?
An organization’s SKILLS also strongly influence how it thinks and behaves. The skills of dialogue and reflection, for example, produce organizations in which people are more open to learning and where trust, teamwork, and innovation flourish.
What I began to understand as Herbert Wong and his team took me through their new knowledge product for designing complex human systems was that while the Essex Reconfiguration Plan was a model in systems-thinking and complex system design, it did not in fact achieve health and social services system alignment.
As the Quantum Design team in Austin explained the science and art of this system design framework, I was saying to myself, Oh my God, the Essex County Win/Win Model for total health and social service system reconfiguration will never get off the ground. It’s misaligned.
What I know now, for a fact, is that if a system isn’t fully aligned, it will collapse.
Given that I invested most of my professional life as a healthcare-system policy wonk, capacity-builder, and complex system designer, I was dismayed—and flabbergasted—to discover that the latest health system reorganization will, in my judgement, actually destroy any hope for Ontario to develop a seamless, high-quality, patient-centric, healthcare services delivery system.
Fuhgeddaboudit. 🤷♂️
Without system alignment, those grinding sounds you hear are not just inefficiencies but desperately unhappy frontline care providers and support workers who feel disrespected. Not to mention lots of preventable harm and preventable deaths of the patients being served by a dyslexic, unmanageable, and unsafe system made increasingly chaotic by bureaucratic top-down structural, functional, and process designs that serve the narrow self-interests of the public service rather than supporting healthcare service providers to successfully serve patients.
All these things were bobbling around in my head as I listened to the Quantum Solutions team’s background research and science on organizational and system alignment. As I gained further insight from their art-and-science approach to organizational design and began to understand the key leverage points in a complex adaptive system, I became increasingly alarmed, experiencing what Daniel Goleman termed an “amygdala hijack” in his book Emotional Intelligence. I began to fully realize how the misalignment of the Essex County Win/Win Model would almost certainly cause it to fail—a true disaster for the people of Windsor and for the Essex County healthcare workforce.
I was broken-hearted. All that extraordinary effort…for nothing.
Fortunately for those of us who were responsible for the system design, the Essex County System Reconfiguration Model ultimately failed not because of misalignment but because of health system politics. In the end, the Ontario Hospital Association (OHA) CEO mobilized the three Windsor hospital CEOs and their governing boards to oppose the reconfiguration of healthcare services (read acute care) and health-related social services.
But that’s how I came to fully grasp the concept of alignment and realize that our grand vision of a health-and-social-service population-health biosphere was not aligned on the component parts of structure, culture, and skills. It was devastating back then, 35 years ago.
Well I just had the crap scared out of me again a few weeks ago as I read Ontario Health’s recent announcement about its new organizational and functional mandates on funding allocation, strategy development, system design, clinical program evaluation, performance measurement, and strategy implementation, as someone who has studied and taught complex system design, I understood, with the same palpable surge of fear that I experienced with the Windsor Model, that Ontario’s brand-new health system has been designed to fail!
Oh, my, I was not expecting that.
Trust me, after investing most of my professional life in numerous activities and projects designed to improve the quality, safety, and effectiveness of services provided by our healthcare delivery system, this is not a conclusion I am happy to reach. Transformation coaches, by definition, must always remain hopeful and optimistic. But I can’t. I know for a fact that with the latest healthcare system reorganization we are absolutely doomed to repeat the same mistakes over and over again.
Given my long-held positive estimation of Ontario Health CEO Matt Anderson as a competent and capable systems thinker and given my public view, as a governance coach, that the Ontario Health board of governance was a very solid board, I never expected this talented group to produce such a display of old-style, factory-model, command-and-control, self-serving, centralized bloated bureaucracy that will micromanage the changes they decide to implement.
The board of Ontario Health needs to take a long, hard look at the organizational design plans it has now approved and reflect on the type of organization it actually wants OH to become—rather than become the organization that has now been designed for them.
Remember: “Every system is perfectly designed to produce the outcomes it generates.” My gut tells me that this particular organizational design and its outcomes are not the future that the leadership of Ontario Health envisioned for themselves.
So, I ask the board and senior management of Ontario Health: Who and what should OH become? Is Ontario Health an organization that provides the pragmatic supports people in HSPs and in OHTs need to be successful, or is it an organization that provides command-and-control micromanagement of the delivery system in order to hold people accountable for the results?
DOES ONTARIO HEALTH SUPPORT OR CONTROL HEALTHCARE PROVIDERS?
I don’t think that Matt and his board have the intention of creating a self-serving organization. However, from a design perspective, what would you expect the outcomes to be if you insert four to five vice presidents, i.e., 20–25 new VP positions, in addition to the 10 VPs on the senior team at head office. Each of the regional offices would get VP-level senior managers with the following suggested functions and titles:
Vice President of System Strategy, Planning, Design, and Implementation;
Vice President of Clinical Performance, Accountability, and Funding Allocation;
Vice President of System Access and Flow;
Vice President of Clinical Programs and Innovation;
and, Director of Communications.
When you look at the design of the Ontario Health regional structures and divisional VP functions, plus the devolution of authority over resource allocation from the MOHLTC to five Ontario Health regional vice presidents, the functional design and mandates suggested raise many important questions.
For example, would the regional VP of “system strategy” be doing a strategy for their region? If so, what about the community-based strategies that will emerge from the 82 Ontario Health Teams? What if the strategies for the region and the strategies for the OHT are not aligned? Are CEOs still the chief strategy officers of their organizations or is the VP of strategy in their region the last word on strategy? Is it still the community governance board?
How extensive will the powers and authority of these VPs of regional strategy be? Will health service providers be implementing their own organizational strategies as well as their part of their OHT strategy in addition to the OH regional strategy that each of these vice presidents develop?
Another question: will the separate and independent top-down regional health strategies be in competition with the region’s 15–20 independent OHTs who are also preparing strategies? Or will the regional VP of strategy tell the OHTs what their team’s strategy should be or how it should be more in sync with the regional strategy?
Or, will the VPs of regional strategy have professional organizational development (OD) teams available to help facilitate strategy development within each of the 15–20 OHTs in their region as a way of supporting (not controlling) the OHTs to be successful?
The group in charge of implementing plans at the local level are normally the bosses. They drive change. So, while CEOs are held accountable by their bosses (their boards) for achieving certain results, in the new OH design, there are people whose job it is to “implement” plans and designs. Think about that.
Will the VP of “planning, design, and implementation” have the full authority to simply insert their plans on independently governed health service providers and OHTs? Or does the division under this vice president simply provide helpful, value-adding support services—like, for example, providing funding for an office of strategy management for each OHT to help the partners co-ordinate their efforts on strategy execution and implementation?
The whole reorganizational design smacks of a raw bureaucratic power-grab—and nothing else.
What about the position of Regional VP of Accountability? What’s that about? Oh, those poor tortured public servants. They are obsessed with accountability even though they don’t really understand the concept and certainly don’t practice it themselves. The MOHLTC has always confused the concept of accountability with the authority to allocate blame.
Accountability is very different from blaming, which means to “find fault with, to censure, revile, reproach.” Blaming has been a long-standing bureaucratic process that generates fear and results in “compliance behaviour.” As author Marilyn Paul says, “blaming is more than just a process of allocating fault. It is often a process of shaming others and searching for something wrong with them.”
“A blaming culture,” according to Paul, “causes dysfunction in organizations and systems because where there is blame, open minds close, inquiry tends to cease, and the desire to understand the whole system diminishes. When people work in an atmosphere of blame, they naturally engage in defensive routines, covering up their errors and hiding their real concerns.”
Today, the raw emotions of fear and anxiety are the key driving forces in our profoundly human healthcare delivery systems. As a result, compliance has become the most common trait of leaders across our healthcare system. There are very few leaders prepared to “speak truth to power.” Inserting five new VPs of accountability will certainly grab the attention of all 2,000 healthcare service provider CEOs and executive directors. They’ll know what’s coming.
Bureaucrats have long been jealous of community governance boards, whose actual mandate is to hold their CEOs accountable for outcomes in the interests of the “owners” of the organization. With five VPs of accountability, do you think they will be able to generate tens of thousands of hours of work in processes that will never add any value?
Imagine the fewer numbers of preventable patient deaths there would be if the resources invested in bureaucratic accountability processes were to be reinvested in patient safety and quality improvement. While governance boards might concern themselves with that, public servants don’t have strong views on quality—unless, as in Health Quality Ontario, there are lots of nice, high-end jobs attached.
What the public servants usually like is ambiguity. Ambiguity is the friend of the bureaucracy because when things are not really clear on issues like accountability, they can interpret the meanings to their advantage.
Another favourite strategy is to favour dual accountability, in which the public servants and the governing board share supervision authority over the operating CEO. Dual accountability is a crime against organizational science and is referred to as a “worst-practice design.”
If you have a sense from this that our public service is not shy about advancing their their own narrow self-interest, watch the mandate and processes that evolve around the regional VP of funding allocation and accountability.
Remember that the MOHLTC’s first draft of their OHT plan suggested that, after fighting the “devolution of authority over allocation of resources” to the LHINs for years, the Ministry itself suggested in their report to the new government that each of the 30 OHTs—headed by a hospital CEO they recommended—should have the devolved authority to allocate the resources within the delivery system from a bundled payment covering each of the HSPs in their OHT.
That was an amazing development for a group that had opposed devolution for decades. But giving the authority to allocate resources to the delivery system to the selected and trusted hospital CEOs was a radical change for the Ontario public service in 2018.
As in the US Accountable Care Model, these 30 hospital-centred OHTs were to be granted a bundled payment, thereby empowering the CEO to fund all the services available in their hospital’s Ontario Health Team. While that idea didn’t make the final cut, it is always important to be aware of what the public service really wants. They certainly want the function of allocating resources to be under their control. That’s where the jobs are.
Former Health Minister George Smitherman says that the public servants moved very quickly after he left the Ministry to convince their new Health Minister, David Caplan, to not implement the LHIN Act on the devolution of authority over the allocation of resources from the MOHLTC to LHIN boards. Caplan agreed and, as a result, not a single LHIN was able to successfully implement their Integrated Health Service Plan.
Now, with this most recent misaligned organizational design from Ontario Health, rather than devolving authority over allocation of resources to the OHTs, the self-serving decision has been to retain this authority at the Ontario Health regional level—hence, five regional VPs of resource allocation and their division’s additional public service staff to oversee this function.
Really? How many times do we need to learn this lesson?
Maybe you have seen this movie before….and didn’t do, or say anything. 🤷♂️
You might remember from an earlier essay in this series that I quoted former Health Minister George Smitherman saying that “devolution of authority over the allocation of resources” from the Ministry to LHIN boards so they could fund their approved Integrated Health Service Plans was expected to cut the size of the Ministry of Health by about half, since 50 percent of the centralized OPS jobs were devoted to micromanaging local processes and determining centrally within the various silos (acute care, primary care, LTC, mental health, etc.) what the Ministry had decided on budget allocation.
So, reflect on the functions implied by these new position titles that would be involved in each of the new departments of the five OH regional offices.
Think about it. How many public servants would it take to staff up in order to fulfill the mandates of each of these new regional VPs? If we are modest and estimate that each of the four VPs should be limited to 30 to 40 people across each of the five regional offices (plus communications and propaganda functions), that would equal about 1,000 new positions for the re-bloated bureaucracy where responsibility for allocating resources stays with the regional offices rather than devolving to the Ontario Health Teams.
This whole reorganization feels like an incoherent jumble of secret compromises that sends the Ontario Healthcare delivery system back to 2003, when the MOHLTC first declared that their purpose was to “manage the healthcare system.”
Yes, it is silly, but it took 20 years to finally prove that public servants can’t or shouldn’t manage the healthcare system. Do they now think it is the mandate of Ontario Health to manage the healthcare system?
While Ontario Health may hold off until after the election before hiring all the regional office divisional staff required by each of the 20–25 new regional VPs—in addition to the 25 ADMs left back at the “Ministry of Doctors and Hospitals,” they are nevertheless going ahead now to hire the first 20–25 top bosses.
When you reflect on the emerging design of Ontario Health, when you project out three to five years from now and see the unfolding delivery system that will emerge from this particular set of structural and functional designs, you will find that the outcomes being achieved do not reflect the rhetoric of “integrated, patient-centred health systems”; rather, they reflect the outcomes of lots of unnecessary command-and-control jobs and functions for public servants.
So, where was systems thinker Matt Anderson and his competent-seeming board of governance when they bought this 1960s old-style traditional factory-model organizational design that amounts to a fundamental attack on the role of community governing boards and their accountability relationship with their senior managers?
Given the political sensitivities, do they really intend to have a massive re-bloat of the bureaucracy before the election—just as we lose frontline care providers who, at the end of the pandemic, will be leaving in droves?
What will people be saying when our emerging shortage of frontline care professionals is happening just as the next generation of new, expensive bosses arrive?
Think of the optics of the Ford government expanding the Queen’s Park hierarchy with 30 new vice presidents at Ontario Health while watching our depleting frontline in healthcare—and, at the same time, facing exploding new cost and wage pressures on the current $73 billion healthcare budget.
Tough times ahead. How can Ontario Health add value in this environment?
Does the board of Ontario Health intend their organization to be in the bureaucratic control business rather than in the empowering and supporting business?
If you ask MOHLTC senior executives, they will tell you that first option is hard, exhausting, impossible, thankless work in which you get to have the illusion of control while often being blamed for everything anyway. The second option—the empowering and supporting business—is fun and energizing. With board members and senior managers who have real-world transformational experiences, I really believed—until now—that they would/should add value.
This is sad. We really should not be heading back to the good-old golden days of centralized, bureaucratic control by smart people in Toronto who know better than everyone else.
But, unless there is some sort of leadership revolt (community governing boards and CEOs? a new Minister & Deputy? Matt & the OH board?), it won’t happen. This top-heavy, very expensive, bureaucratic, process-oriented vs. results-oriented system has achieved the stage of development known as learned helplessness.
We provide large pay cheques and get very little value back.
Oh yeah, the public servants bought a lot of compliance from most senior executives. That way, we will never learn. We just keep making the same mistakes in each successive iteration of the Ministry’s response to the system and political demands for decentralization and devolution of authority over resource allocation.
My first essay in this Lessons Learned series was entitled: “Will Ontario Health Teams Be Able to Save their Local Health Systems”? Please click on the title and reread this initial essay to understand the recurring journey and loop our health system will be going on.
So, after only six essays in this Lessons Learned series, with the recent structural and functional misalignments that will now be implemented at Ontario Health, we now know the answer to the question of OHTs ability to save healthcare.
The answer is NO!
Ontario’s macro healthcare delivery system has been designed to fail patients, taxpayers, and healthcare staff. Been there. Done that. Got the t-shirt. 🤡
You? Want to go another round? 🌈🤷♂️🙋♂️🤪