on hospitals, consultants and reckless spending

Yesterday was not a good day to be a hospital CEO, as one of that genre put it. The Ontario Auditor General released a report on his review of the consulting expenditures of a sampling of hospitals and it wasn't pretty. It wasn't hospitals' use of consultants as it was the apparent absence of appropriate controls; lack of tendering, charging for things that have no obvious connection to improving hospital management or health care etc.

In the over-heated environment of provincial politics, the government and health minister are taking most of the heat. They are accused of not managing health care expenditures effectively. I wonder what the criticism would be if the ministry of health micro-managed every dollar it transfers to those hospitals as some of the opposition seems to be suggesting. While the report creates an opening for incisive sound-bites, it's important recognize where the responsibility should rest.

Hospitals are the ones who must take responsibility for how they are spending their revenue, not the minister of health. The Ontario Hospital Association rightly apologized for some of the abuses the auditor uncovered. It should end with the hospitals cleaning-up their act rather than with onerous new legislation, which the cost of enforcing will be a further drain on health care resources.

Hospital executives need to start thinking in terms of accountability to the public, whose taxes provide their revenue, and not just to their boards. One hospital CEO I spoke with objects to the new requirement that CEO expenses be posted on-line, just as their salaries are now, saying "my board approves my expenses and that should be the good enough". Well it would be good enough if the board and the CEO thought like public servants rather than like the managers of a profit-making corporation selling a service. As public servants they would recognize taxpayers have a right to expect good stewardship of their tax dollars and to have access to the financial records.

In my experience, far too many hospital executives and board members fail to see the difference between their roles in a publicly-financed system and the role of their counterparts in for-profit systems elsewhere. That is where the problem really lies. They want to paid like the executives of profit making corporations with comparable revenues; they want the perks of corporate office. These CEOs, and their boards, apparently see nothing wrong in that their salaries are often double or triple those of the health minister or premier. They fail to recognize or think about how this looks to the patient waiting hours in some emergency room or clinic and being told the delay is because of lack of funding?

When hospital executives accept that they are accountable to millions of taxpayers who are their customers and the source of all their revenue, maybe things will start to improve. If these CEOs would take a deep, hard look at themselves, the government wouldn't need to take any further action.