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Name
Mike Fitzpatrick

Wed, 06/10/2015 - 13:22

Dear Stephen, Thank-you for this excellent and carefully written blog, which makes cogent and very positive arguments for reorganization of our health care service in the SELHIN. I have also had the privilege of participation in many meetings around the SELHIN Health Care Tomorrow project and, like you, I have been impressed by the tremendous work, thought and creativity that a great many clinicians and administrative leaders throughout our LHIN (and beyond), have selflessly contributed to this project. I believe that there is strong support for many of the advances mentioned in your blog, such as common credentialing, single entry point, and common PACS and health information systems - albeit that the financial implication of these changes means that they can't all be delivered instantaneously. The provocative theme of single governance will undoubtedly stimulate much conversation and emphasizes the need for our hospitals to work in an integrated and collaborative fashion. However, the counter argument to Stephen Leacock's "sunshine sketches" is implementation of hasty change, where we risk "throwing the baby out with the bath water", and even being perceived as disrespecting 170 years of service and caring for our community from our individual institutions, for “flavor of the day”. The recent report from the King's Fund (Nov 2014) entitled "The reconfiguration of clinical services. What is the evidence ?” (http://www.kingsfund.org.uk/publications/reconfiguration-clinical-servi…) related to reconfiguration of NHS services in the UK, is sobering in its conclusions. It makes the points, among many others, that "evidence to support the impact of large-scale reconfigurations of hospital services on finance is almost entirely lacking", and that "evidence on the impact on quality is mixed" – although there is evidence to support some reconfigurations. Hence, above all, we should be prudent in our approach. In the theme of your blog, I would like to end by submitting an equally provocative counter statement: Pursuit of a single governance model, with all of the associated hype and emotion, will simply distract and retard progress towards the true goal of seamless patient-centred health care in our region. That seamless, patient-centred care does not need to rely solely on good will but could be achieved, without a single governance model, by incenting hospitals (and community) for behaviors that deliver high-quality cost-efficient services that are in the best interest of our patients and our regional health care system. I thank you for taking the time and effort to stimulate novel, solution-oriented and disruptive thinking about our regional health care system.

Name
Mike Fitzpatrick
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