The Goldilocks philosophy of healthcare administration – What size is “just right”?

Posted Jul 31, 2018

Andrew Neuner, Chief Executive Officer, HQCA

Recently, there has been quite a heated discussion in Ontario (more on this herehereand here) about whether healthcare bureaucracy costs (i.e., costs related to administration; not costs related to delivering front line care) are unreasonable or “bloated”. This conversation is not Ontario-specific and made me think about this in the Alberta context, given we are often criticized for our comparatively high healthcare costs, which includes administration, and see this topic pop up regularly in the news. It is also important to note this is not a 2018 issue. This has been simmering for some time now (see here and here).

Maximizing how we spend public funds on healthcare is critically important. Healthcare is often the largest segment of a provincial/territorial budget, Alberta being no exception to this rule.

As a voter and tax payer myself, I am also personally invested in and care about how our money is being spent.

As a leader of a government agency in healthcare who is both responsible for managing some of that spending within my own organization and recommending ways to improve the quality of healthcare in Alberta (improving quality very often leads to decreased costs), I am truly aware of the weight of this issue and feel a responsibility to champion opportunities to address this every day.

So, before we listen to more pledges about how healthcare spending can and should be reconsidered, especially related to administration, I think there are two important questions to answer:

What do we want our health system to achieve?

What does it take (realistically) to achieve that vision?

As a system, we need to answer these questions and make sure our system is designed to support the desired outcomes.

As health reporter André Picard stated, “Complex systems such as health care don’t run themselves. Oversight and management is required.” Thoughtfully structured bureaucracy supports an efficient and effective healthcare system or, as the famous saying goes, form follows function.

So, before wildly targeting administrative costs, or any other costs within our health system, let’s first consider what we want our health system to achieve (a clearly articulated strategy), followed by important resource mapping to support the realization of that strategy. Or, more simply: Set a goal, then plan and position every part of the system, including administration, in a deliberate and cost-conscious way to support the achievement of that goal. This may require new partnerships and/or innovative approaches and understanding how other health systems outside of Alberta and Canada are achieving the same goals. This could also require asking people to try new roles or challenges. However, answering these questions and then taking actions that focus on outcomes and working to get the vision and structure of our healthcare system “just right” sounds to me like the best way forward.

Follow Andrew on Twitter @HighNeun

HQCA Matters is published monthly and presents HQCA representative perspectives on topics or issues relevant to healthcare in Alberta.