Bureaucracy and the bureaucratic mind — Ontario Healthcare Edition

Today’s Globe and Mail had a fascinating article about the latest plan to deal with the troubled Niagara region health system:


In essence, the proposal is to close more hospitals and further consolidate services into two new facilities — making service delays for emergency health care even longer. The Niagara region was the largest consolidation in Ontario, 35 local hospitals were closed, and still the most troubled. There have been a number of well-publicized deaths due to long service access times and the system is not well-thought of by either residents or staff. Given this situation, a proposal has been made to continue the process even further.

One of the fascinating things about the bureaucratic mind is its persistence in mis-applying an idea after the evidence has come in that the idea is failing. For years we have been hearing ‘economies of scale’ and ‘critical mass’ but the evidence shows that for most human systems the consolidation process makes things worse — lumping more people together exacerbates communications issues, among other things. And the more things are consolidated the longer the access times become due to transportation delays and the larger the receiving department must become to accommodate arrival surges. (I suspect that emergency room services suffer from the same type of queuing that occurs in phone systems, bank tellers and checkout lines — well studied over the years. The choice is to build excess capacity or accept extended wait times — bet I can guess which way this would go…)

And yet this service cutback through consolidation strategy seems to be the only idea wedged in their tiny heads. Maybe it is just blindness caused by being surrounded by too many sycophants and consultants — who tailor the view of the world that the executive is allowed to have. Don’t know about anyone else but somehow it looks like more money being spent to make the problems of health care service delivery worse.

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