Healthcare innovation requires courage and slack

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In Canada, one in five people doesn’t have a family doctor they see regularly. Emergency wait times can be as high as 22 hours. An ageing population threatens to strain an already burdened healthcare system. And while these numbers cover the situation in Canada, countries around the world face similar challenges.

How did we get here? And what can be done about it?

Samer Faraj is a professor at the Desautels Faculty of Management at McGill University and a leading scholar in healthcare reform. For him, improving healthcare requires more than hiring ambitious managers or injecting more money into the system. It requires opening our minds to new tools, technologies, and institutional structures.

“There has to be courage in terms of trying out reforms, even if there’s a possibility they won’t be obvious successes,” he said on the McGill Delve podcast.

Cutting some slack

The problem is that there’s no slack in the system for trying new things, said Faraj. And to a degree, there’s a good reason for that. The axiom “do no harm” applies as much to systemic interventions as it does to medical treatments. Any changes to the medical system must be done carefully and deliberately, lest they negatively impact the delivery of care to patients.

But safety isn’t the only barrier to rapid innovation. Some of the system’s rigidity also comes from bureaucratic limitations, said Faraj. Health workers operate within the bounds of what they are and aren’t allowed to do. A hospital director may want to try new things, only to discover she can only use a small percentage of her budget on innovation. Or a doctor may want to send blood test results via email, but he’s required to book an appointment to advise the patient face-to-face, even if the results are fine.

These kinds of bureaucratic limitations will vary from country to country or, as is the case in Canada, from province to province. But addressing them can free up the experts to try health reforms without requiring more funds, said Faraj.

“It’s not a question of money,” he said. “It’s just a question of how the money is used.”

Pain points

The current state of healthcare demands new approaches, explained Faraj. Years of changing public health trends and a reluctance to adapt have contributed, in part, to crowded emergency departments and a dearth of family physicians and other healthcare workers.

There are more doctors than ever before who work in the Canadian healthcare system, but it’s still not enough to keep up with demand. From 2021 to 2022, hospital workers (excluding physicians) worked 26 million overtime hours, which adds up to 13,000 full-time positions.

Wider public health trends, like the ageing population, have also threatened to strain the healthcare system for some time. Most people consume more healthcare in their final 10 years of life than they do during the rest of their lives, said Faraj. We can expect increased pressure on the system as boomers and millennials, two of the largest age demographics, require more care with age.

We shouldn’t underestimate the impact of the COVID-19 pandemic, either, said Faraj. During the peaks of the crisis, non-essential surgeries were deferred to protect patients and free up resources to support COVID-19 victims. This created a backlog of appointments that continues to impact wait times today.

“The institutional setup needs reforming,” said Faraj. “Not in a major way, but the management and organisational system can be played with.”

Listen to Professor Samer Faraj’s full interview on the McGill Delve podcast. Listen to it here or search “McGill Delve” wherever you download podcasts.