By Stephen Bornstein
with Adalsteinn Brown
University of Toronto
Canada has a mismatch between the world-class health research we produce and how that research is implemented into our health-care system.
Our doctoral graduates are among the most productive and respected researchers in health services, health policy and health economics – and Canadian universities are often in the global top 10 for these areas of study. Yet our health system continues to underperform.
Where’s the disconnect?
The Commonwealth Fund ranks comparable health system around the world on a number of performance indicators. It continually places Canada as one of the worst performers across a number of categories, such as timeliness, safety and efficiency of care. Only the United States routinely performs worse, sitting at last place overall.
It would be easy to point to health-care funding as the culprit but that’s largely not the case.
Canada spends roughly 10.4 per cent of its gross domestic product on health, more than the United Kingdom, New Zealand and Australia.
The truth is, we often don’t manage our health system well.
But much can be done to lift Canadian health care out of its poor standing.
Over the last several decades, a number of studies from experts inside and outside of Canada have pointed out the gap between the performance of our system and the level we should expect.
Landmark reports from Manitoba and Ontario show that a patient’s likelihood of getting needed surgery depends heavily on where they live. Studies also show a huge gap between what we know to be effective and appropriate care and what people actually receive. And a study from over a decade ago shows that nearly one in 13 hospital visits resulted in adverse health events with nearly nine per cent of these ending in preventable death; a follow-up study last year shows that little has changed.
We can do better, but how?
Health system changes require greater input by people trained to create and use evidence to design, implement and evaluate them. That’s not happening in Canada.
Every year, more than $3.5 million is invested in the training of health-care-related PhDs in Canada. But for the majority of them, the likelihood of academic employment is low and declining. In fact, the vast majority will work in health services and management fields, not academia. Yet our doctoral programs in health sciences don’t prepare them for such work.
An extensive interview-based study found that our recent health PhDs are not having the impact they could have on Canada’s health system – the sort of impact that many of our most advanced graduates with PhDs see as the goal of their careers and the reason for their training. While well prepared in academic terms, they lack preparation in the managerial and leadership skills necessary to make tough decisions based on evidence with a relentless commitment to evaluation and improvement across the system.
We can change this – and we’ve started to.
Over the past two years, the Canadian Health Services and Policy Research Alliance has worked with experts to improve the impact of Canadian PhDs on the quality and sustainability of our health system – by changing the training and preparation they receive.
It’s time to move health research out of the academy and into the community.
We now provide experiential learning opportunities during and after PhD training, where individuals get the opportunity to work with hospitals, government agencies and other health-care providers in the community – to apply their skills and findings directly in the service of health system improvement.
We’re building an open source curriculum to teach health PhDs essential managerial and leadership skills they need to make sure their expertise gets translated into better decisions across our health system.
Discussions about health funding will always be important, but we need to make sure we have the personnel to make the system better, regardless of the dollars transferred between levels of government.
We have a great resource in Canada’s university-based training programs in health services and PhD graduates who want to make a difference. Now we need to make sure they have the opportunity.
Adalsteinn Brown is the director of the Institute of Health Policy, Management and Evaluation and the Dalla Lana Chair in Public Health Policy at the University of Toronto. Prior roles include senior positions in the Ontario government. Stephen Bornstein is director of the Centre for Applied Health Research and a professor at Memorial University. Prior roles include senior positions in the Ontario government.