Is There Accountability in Health Care? A Governance Perspective on Systemic Reform

1. Institute of Public Administration of Canada Toronto Region Is There Accountability in Health Care? A Governance Perspective on Systemic Reform Notes for a presentation by Denis Desautels, OC, FCA Centre on governance University of Ottawa April 4, 2003

2. Outline of Presentation • Recent trends in governance and accountability • Health Care: an enormous governance challenge • The current delivery system • Why Canadians want accountability • Gaps and obstacles • Avenues for improvement • Conclusions

3. Defining Governance Governance is the framework of practices and structures which govern decision making and implementation in organizations and structures where power and information are shared. This applies to a country, a society or an organization be it private, public or civic.

4. Defining Governance (cont’d) • From the more simple to the very complex • A private corporation • A public company • A state-owned corporation • A hospital • A ministry • A health care system

5. Evolution of Governance in the Public Sector • Factors which encouraged innovation • Globalization • Technology • Horizontal management • Factors which imposed innovation • Crisis in public finances • Political ideology

6. Evolution of Governance in the Public Sector (cont’d) • General direction (attributes of new systems or models of governance) • Less hierarchial • More inclusive • More distributed • More horizontal • Decentralization and empowerment

7. Accountability and Governance • Good governance is not an end in itself • Good governance contributes to effective accountability • Effective accountability leads to superior performance, but: • Governance and accountability are becoming more complex

8. Impact of this Evolution on Accountability • Modularity and need for coherence between accountability and management systems • Less hierarchical accountability (more between equals) • Emphasis on results • Shared accountability • Can lead to better accountability • Need for experimentation and learning • “Soft” accountability

9. Governance & Accountability in Health Care • The public interest challenge is accountability to Canadians: • A conceptual challenge • High public expectation for information on the state of the health care system

11. Governance & Accountability In Health Care, being accountable to Canadians raises questions: • Canadians as stakeholders in society? >>access/coverage/equity • Canadians as users of health care system? >>performance • Canadians as taxpayers? >>spending

12. Do we have Accountability?Gaps and Obstacles • Data Gathering • Coordination • Incentives • Legislation • Funding and increasing costs • Acceptance of open evaluation

13. Avenues for improvement • Committing to accountability and transparency • Building the foundation for accountability • Technology • Service integration • Joint oversight

14. Conclusions • Resolving F/P/T tensions • Providing accountability to the public • Meeting the true challenge of creating a continuum of services locally