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Canada's Healthcare Challenges Demand Interdisciplinary Training for the Development of Creative Solutions

Magdalini and Daniel Penello
Magdalini and Daniel Penello
Students in the Rotman MBA Program are strongly encouraged to seek and participate in summer placement opportunities after completing the first year of the program. Thanks to the support and encouragement of Dr. Bob Bell, Orthopaedic Surgeon - CEO of the University Health Network, who is my supervisor in the Scholarship in Surgery Program, I was given the privilege of completing an administrative internship in UHN's Corporate Planning Department this summer. To say that this experience gave me the opportunity to apply my newly-acquired business knowledge to the healthcare setting is an understatement. Although I worked with financial spreadsheets, the Balanced Scorecard, strategic planning frameworks and business plans, the real value of this experience was being exposed to a completely different but equally important side of healthcare that had been invisible to me in my role as a surgical resident. From a business point of view, Ontario hospitals are in a very difficult and unfavourable position. They are in a market where there is only one "buyer" of their services (a monopsony): the Ontario Ministry of Health and Long-Term Care through its new Local Health Integration Networks (LHINs). The LHINs ultimately determine the funds each hospital will be given in order to provide the services they plan to deliver in the coming year. However, since hospitals have little control over the types of patients that walk in their door or the types of medications, tests or operations that their physicians will deem necessary, managing the budget while continuing to provide high-quality care to increasingly informed patients is a very challenging task.

Along with provincial initiatives aimed at improving accessibility to certain priority tests and procedures, there has been a widespread push towards increasing hospital accountability for the services they provide. More than ever, operational efficiency, quality measurement, knowledge transfer and performance management have become critical success factors for Ontario hospitals. Making strategic decisions that will not only streamline patient care but also allow the hospital, as an organization, to pursue its broader objectives of excellence in education, research and patient safety requires new and innovative approaches.

My involvement in the development of a strategic plan for the Peter Munk Cardiac Centre this summer exposed me to the challenge of attempting to efficiently and ethically distribute limited resources (money, support staff, space and time) among many equally-deserving departments. During this process, managers must address difficult questions such as, "Is it better to invest in an area that will result in a moderate benefit for the majority of our patients (like a better cardiac MRI scanner), or should we invest in a new technology that will result in a significant benefit for a small subset of patients?"

Creative solutions to these challenges, as I have learned, arise from lateral thinking and the ability to integrate concepts and models of practice from diverse and seemingly unrelated fields. Some consider the fields of business and medicine to have irreconcilable differences in their priorities, methods and goals. This narrow view is a barrier to creative solutions and one that is generally held by those who know only one domain and have a limited understanding of the other. During my summer experience at UHN I also spent a considerable amount of time helping Rehab Solutions identify and evaluate expansion opportunities. In addition to a strong clinical understanding of the specific needs of the patient population being served, evaluating options required knowledge of real-estate development, human resource management, finance and space planning. Important decisions cannot be made in a vacuum. My experience at UHN has reaffirmed my belief that a business perspective does not seek to reduce important clinical decisions to dollars and cents, but rather injects a rich mix of relevant information into the context in which the decision must be made. An appreciation of the broader context enables effective leaders and decision-makers to understand and align the interests of key stakeholders so that creative and sustainable solutions to our many healthcare challenges can be realized.

Daniel Penello, MD
Resident, Division of Orthopaedic Surgery
MBA-Candidate, Rotman School of Management, UofT

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