If Canada had a System-Wide Healthcare Strategy, What Form Could it Take? - Paper Working Draft

Report — May 28, 2014

Discussions about Canadian healthcare are heavily influenced by political considerations – commonly cited as a reason for chances involving multiple political jurisdictions being hard to implement. That said, strategy and governance are concepts at home in management theory and practice. Could a management perspective contribute usefully to the debate about a system-wide Canadian healthcare strategy in a way that could address the political obstacles?

For our purposes, we will take system-wide strategy to be interchangeable with “Canadian strategy,” “national strategy,” and “pan-Canadian strategy,” but not “federal strategy.”3 Based on this, we will address the above questions as follows. First, we will explore how well our system is performing. If it is as strong as it should be, we will have less of a reason for wanting to look beyond the existing Canadian structure than if it is poorly performing. Second, are there are credible calls for a system-wide strategy? If not, and it is only a hypothetical possibility, there will be little urgency for strategic change. Third, what does having a strategy mean, and what form could such a strategy, or strategies, take? It is easy to misconstrue having a system-wide strategy as being equivalent to, or necessarily connected with, a specific form of governance, such as a federal government imposed top-down arrangement. This is not intended here. Fourth, I argue that a good prima facie case exists for a Canadian system-wide strategy. Building on this, I propose that the balanced scorecard approach is well suited not only to frame a Canadian strategy, but also to be used as a strategic management tool. Fifth, the scorecard of the newly restructured National Health Service, England, can be fashioned as an illustration of what a Canadian balanced scorecard might look like. This is not to say we should emulate the NHS model, only that it contains certain important features that we might consider adapting for our own purposes. Sixth, I set out two governance models, collaborative governance and corporate governance, and show why the latter has advantages over the former in providing a basis for governance oversight of a Canadian system-wide strategy. Finally, some concluding remarks will draw the discussion points together. 

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