We know Ontario’s family doctors are highly intelligent, caring practitioners.  They study for years to gain the knowledge and expertise that allow us to put our lives trustfully into their hands when we get sick.

By the same token, the CEOs of our largest corporations are knowledgeable, skilled business people, entrusted with public and private funds to run complex organizations that keep our economy and our lives running smoothly and (in most cases) profitably.

Would you ask your Bank President to diagnose your health issues?  Of course not. 

But with recent initiatives in primary health care, what we are asking doctors in Ontario (and other provinces) to do is to govern and manage large organizations to deliver programs and services in a new model of primary health care delivery. 

Doctors don’t get business training when they go to medical school.  They don’t get training in governance, human resource management, or finance.  Yet they are being expected to preside over Family Health Teams, to establish collaborative health care practices, to hire, supervise and fire employees, to meet legislative and regulatory requirements for corporations, and to undertake and manage performance monitoring and measurement. 

If these new initiatives in inter-professional, collaborative primary health care are going to succeed, the Ministry needs to assess and invest in the infrastructure, systems, training and support that physicians need. 

Melodie Zarzeczny

In the current debate about rising health care costs there is a commonly heard suggestion that we need to “bend the cost curve” of health care.  My fear is that this bend is going to happen on the backs of the already lowest-paid workers in the sector (think PSWs and home care staff, for example). 

Many of the strategies underway and coming are long overdue:

• Optimize the scope of practice of all of the health care professionals in the system;
• Instill more rigour in the measurement of institutional performance;
• Apply lean techniques and strategies in the health care sector;
• Review compensation and incentive plans for our health care providers; 
• Encourage the use of lower cost alternatives to hospital care; 
• Encourage patients to share responsibility for their health and their care. 

All of these strategies make sense.    

But a caution …  Community-based agencies and providers, who have for decades been quietly providing solid, high quality care, can’t be squeezed any further.  We can’t and shouldn’t be asking them to do more with budgets and pay scales that are already far less than their hospital-based counterparts.  Sure, they don’t have the overhead.  But we are asking them to provide more complex care, to more patients.  We are asking them to meet new and demanding contractual arrangements with no recognition of the cost.  We are pressing them to use their volunteers to provide services that we might otherwise have to pay for. 

We’ll bend the cost curve, possibly.  And we’ll bend it so far that we will be able to brag that we are looking after patients using the most demoralized, poorly paid, burnt-out health care workers anywhere. 

Melodie Zarzeczny

You’ve got a business to run.  You’re busy.  Everything is running smoothly.  As the Chair of the Board (or the CEO, Executive Director, or Board member), you’re feeling pretty confident that everything is under control.  No need to complicate life with Board meetings, Committees, policies and endless reporting. 

Or is there?  By ignoring the importance of good governance, have you left yourself open to risks that could pose a threat to your business?  Or to you and your directors personally?  Do you know the extent of your personal liability?

Does your Board meet regularly?  If not, you are probably not in compliance with your  ByLaw.  Are you in compliance with Bill 168?  If not, you are placing your organization and your Directors at risk of lawsuits and fines.  (Do you know what Bill 168 is?)  Are your policies sufficiently rigorous to withstand a lawsuit?  Are your Directors sufficiently well informed so as not to be held personally liable in the event of legal action?

But it’s not just about avoiding costly lawsuits.  Good governance also contributes to the bottom line – it builds social, human and financial capital in your organization.. 

Good corporate governance is not just for big business.  In fact, one could argue that it’s more important for smaller organizations, who can gain tremendous advantages from the effective use of their Boards and Directors.

Melodie Zarzeczny