Northern Light
Superstar
So, after getting put on to the above theme w/our annual discussion of public fountains here at UT, I decided this topic needs a broader lens.
I'll offer an example or two, but I'm less concerned w/fixing one issue here than I am in asking the question how do we induce institutions and individuals the desire for excellence and the ability, not only to have foresight but to see beyond the narrow confines of a given problem.
So a starter example, for obvious reasons, I hope, I have to omit some details to protect the privacy of persons involved. (healthcare)
So sometime back, a certain GTA hospital admitted a patient on a Friday. The patient was stone cold sober, but unable to walk a straight line or even stay up for any distance (balance issues).
Said hospital admitted the patient at around lunch on a Friday.
They knew, in order to ascertain the patients condition, they would need to do an MRI.
The hospital does not operate MRIs on the weekend unless its deemed an emergency.
The MRI being fully booked for the balance of that Friday, the patient stayed as admitted through the weekend and then Monday, by which the time the backlog was so bad, that the patient had to wait till Tuesday for an MRI.
***
I will pause the story there for now.
To point out that the cost of an admitted patient in acute care shows on the books as roughly $1,200 per day, assuming they are an 'average' patient. (not high need)
A patient confined to a bed, is more expensive.
A delay of 4 days in accessing an MRI creates a sunk cost of $4,800
The cost of operating the MRI on Saturday and Sunday for one 8-hour shift, much lower, labour and power inclusive.
Does anyone else see a problem?
***
So at some point later a discussion occurs w/hospital management about this choice.
The answers given include that the LHIN did not expressly funded weekend hours for the MRI. ( a decision being made about such things that far removed from the direct provider could be a whole other subject)
But it was pointed out that the hospital could accrue savings if just one patient per week got discharged 3-4 days sooner, and that far greater savings were possible.
This resulted in a stunned look as if no one had ever realized that.
***
Suffice to say, the policy hasn't changed.
***
Related note, MRIs are purchased by individual hospitals in Ontario. Typically at a rate of 3-5 per year across the province. The hospitals are required to fund raise for them, the province won't cover the cost.
At roughly $4,000,000 per machine, this eats up a lot of time and fundraising costs for local hospitals.
Of greater concern however, is that by purchasing one-offs there are no discounts.
If the MRIs were batch tendered by the province, say, 15 over a 3 year period from one provider, there would be volume discounts. The exact numbers would vary, but 20% is a safe bet.
That means, on $60,000,000 over three years, the province could save at least $12,000,000 by buying province-wide.
That doesn't count the savings from shifting away from fundraising which often requires significant costs all its own.
***
I personally support robust government services and don't object to paying a healthy tax rate to do so.
But we really do need to demand better of decision makers.
'Efficiencies' are never as easy as some make it out, nor do they make billions fall from the sky.
However, they aren't that hard to find either, and I would be incredibly pleased to see even a few hundred million more wisely spent.
I'll offer an example or two, but I'm less concerned w/fixing one issue here than I am in asking the question how do we induce institutions and individuals the desire for excellence and the ability, not only to have foresight but to see beyond the narrow confines of a given problem.
So a starter example, for obvious reasons, I hope, I have to omit some details to protect the privacy of persons involved. (healthcare)
So sometime back, a certain GTA hospital admitted a patient on a Friday. The patient was stone cold sober, but unable to walk a straight line or even stay up for any distance (balance issues).
Said hospital admitted the patient at around lunch on a Friday.
They knew, in order to ascertain the patients condition, they would need to do an MRI.
The hospital does not operate MRIs on the weekend unless its deemed an emergency.
The MRI being fully booked for the balance of that Friday, the patient stayed as admitted through the weekend and then Monday, by which the time the backlog was so bad, that the patient had to wait till Tuesday for an MRI.
***
I will pause the story there for now.
To point out that the cost of an admitted patient in acute care shows on the books as roughly $1,200 per day, assuming they are an 'average' patient. (not high need)
A patient confined to a bed, is more expensive.
A delay of 4 days in accessing an MRI creates a sunk cost of $4,800
The cost of operating the MRI on Saturday and Sunday for one 8-hour shift, much lower, labour and power inclusive.
Does anyone else see a problem?
***
So at some point later a discussion occurs w/hospital management about this choice.
The answers given include that the LHIN did not expressly funded weekend hours for the MRI. ( a decision being made about such things that far removed from the direct provider could be a whole other subject)
But it was pointed out that the hospital could accrue savings if just one patient per week got discharged 3-4 days sooner, and that far greater savings were possible.
This resulted in a stunned look as if no one had ever realized that.
***
Suffice to say, the policy hasn't changed.
***
Related note, MRIs are purchased by individual hospitals in Ontario. Typically at a rate of 3-5 per year across the province. The hospitals are required to fund raise for them, the province won't cover the cost.
At roughly $4,000,000 per machine, this eats up a lot of time and fundraising costs for local hospitals.
Of greater concern however, is that by purchasing one-offs there are no discounts.
If the MRIs were batch tendered by the province, say, 15 over a 3 year period from one provider, there would be volume discounts. The exact numbers would vary, but 20% is a safe bet.
That means, on $60,000,000 over three years, the province could save at least $12,000,000 by buying province-wide.
That doesn't count the savings from shifting away from fundraising which often requires significant costs all its own.
***
I personally support robust government services and don't object to paying a healthy tax rate to do so.
But we really do need to demand better of decision makers.
'Efficiencies' are never as easy as some make it out, nor do they make billions fall from the sky.
However, they aren't that hard to find either, and I would be incredibly pleased to see even a few hundred million more wisely spent.
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