Several months ago I blogged about the need for sprinkler systems in retirement and long-term care homes in the province.  It is hard to disagree with this position until you start looking at the cost of retro-fitting very old facilities (which many long-term care homes are).  Managing this cost has provided a ready excuse for not taking action, but really, is this defensible?

So it was wonderful to hear the Ontario Premier’s announcement last week that the government will mandate sprinkler systems in all long-term care homes regardless of the age of the building.  As usual, the devil will be in the details of this commitment, but the signal it sends is important – our seniors are valued members of our communities and the value of their lives shouldn’t be measured against the cost of a sprinkler system.

Along with the promise of more physiotherapy services to support seniors to remain active and mobile (also announced last week), and the recent Seniors’ Strategy that contains many ideas to ensure that older citizens can live safe, secure and fulfilling lives, Ontario may well become an excellent place to grow old. 

We should all be very happy about this; many of us are closer to needing these services and supports than we like to admit.  

Melodie Zarzeczny 

I wish I could claim authorship of the following compilation of modern strategies aimed at getting the most out of that dead horse.  These pearls of wisdom have been circulating for many years.

Tribal wisdom from pre-electronic ages says that when you discover you are riding a dead horse, the best strategy is to dismount.

In more modern times, a whole range of more advanced strategies are often employed, such as:

1. Buying a stronger whip.
2. Changing riders.
3. Threatening the horse with termination.
4. Appointing a committee to study the horse.
5. Visiting other sites to see how others ride dead horses.
6. Lowering the standards so that dead horses can be included. 
7. Hiring outside contractors to ride the dead horse.
8. Harnessing several dead horses together to increase the speed.
9. Attempting to mount multiple dead horses in hopes that one of them will spring to life.
10. Providing additional funding and/or training to increase the dead horse’s performance.
11. Doing a productivity study to see if lighter riders would improve the dead horse’s performance. 
12. Declaring that as the dead horse does not have to be fed, it is less costly, carries lower overhead, and therefore contributes substantially more to the bottom line than do some other horses.
13. Re-writing the expected performance requirements for all horses.
14. Promoting the dead horse to a supervisory position. 
15. Given such a huge investment in dead horse riding, consider that, in fact, the horse is too dead to fail. 

Enough said.  Sometimes the best strategy is to acknowledge when your product/business/service has run its course. 

(With thanks to wordpress.com). 

Melodie Zarzeczny

We all do it.  We procrastinate, we put off making hard decisions, we conveniently put things aside to “deal with them later”, we avoid confrontation.   No one likes making hard decisions, especially those that might have an impact on jobs, on people’s lives, on organizations and their clients. 

Recently I have worked with two community-based Boards that were faced with difficult decisions.  The first Board made a dramatic decision that will have a definite impact on the agency’s future.  It is now up to the Board to steer the organization through very challenging times; but what is significant is that the Board decided the organization could no longer limp along, providing mediocre service at higher than average cost (and note that it took outside expertise to help the Board admit that the agency’s service was mediocre).  The second Board can’t bring itself to make a decision about its leadership and direction.  For sure it will continue to limp along (or worse). 

What makes it so hard for Boards to make difficult decisions?

Sometimes it’s

• Not getting the right information from management
• Getting information too late
• Not being objective
• Not recognizing the risk of not making a decision
• Not being well-informed about the environment
• Being more concerned about protecting personal relationships than ensuring the sustainability of the organization. 

While a good Board is indeed collegial and collaborative, it should also invite discussion and debate, and difference of opinion.  Being a good Board member shouldn’t be about popularity – it should be about asking the right questions, the tough questions, examining the answers, assessing and analyzing, and then providing leadership, oversight and stewardship through change. 

While Boards do need to make thoughtful, considered decisions, they also need to be prepared to act decisively when the situation warrants it.  Being a Board member requires integrity, objectivity, knowledge, and yes, sometimes courage. 

Melodie Zarzeczny

For the past several years work has taken me regularly to the pretty town of Hawkesbury, about an hour east of Ottawa. I have met wonderful people in Hawkesbury, have made some friends, and contributed a little bit to the economy. 

Two weeks ago Hawkesbury earned the dubious distinction of being yet another Ontario town where seniors have died unnecessarily in retirement home fires.  Since 1980, 46 seniors have died in this manner, many of whom (maybe all) could have been saved had the homes they were living in been equipped with automatic sprinklers. 

Imagine being wakened at night by the sound of a smoke detector, or by the smell of smoke or the sight of flames.  Now imagine that you can’t easily get to your wheelchair, or reach your cane, or get out of bed by yourself.  Maybe a sense of confusion impairs your ability to respond to the danger. All you can do is hope that the firefighters get to you quickly. 

This is not a new issue in Ontario.  For years now there have been calls for sprinklers to be installed in all retirement homes.  Fire chiefs and firefighters have been among the most vocal advocates.  After all, what could possibly be more heartbreaking than carrying frail, confused seniors out of a burning building? Maybe knowing that you can’t get to them all. 

Would this be expensive?  No doubt it would. Is extinguishing a burning building that, by the way, is full of vulnerable seniors, expensive? I’m sure it is.  But cost concerns can surely be the only reason that instead of action, the province is undertaking a technical study.

Shame on successive governments for leaving some of our most vulnerable citizens at risk. Shame on us all for not being more vocal. Our seniors deserve better. 

The recent 2011 Census tells us there are nearly 5 million seniors in Canada and that near seniors (people aged 60 – 64) grew faster than any other group and will continue to do so.  So that means many of us will be residing in these retirement homes in the not too distant future.  I want my retirement home to have a sprinkler system.  I want all seniors in retirement homes to be better protected.  Surely we owe it to our seniors to keep them safe in their last years. 

Melodie Zarzeczny

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