Ep. 75: The Future of Healthcare with Dr. Victoria Lee & Dr. Danielle Martin

This episode includes a shout-out to the Ivy Foundation for distributing their $100 million endowment over the next five years to organizations supporting Canada’s transition to a low-carbon economy.

Edward Greenspon [00:00:01] You’re listening to Policy Speaking. I’m your host, Edward Greenspon, president and CEO of the Public Policy Forum, and thank you for tuning in. Canadians suddenly seem to have lost confidence in the pride and joy of our health care system. The pandemic exposed a lot of cracks as well, showing heroic activities. Getting a doctor is tougher and tougher on people, waiting lists for procedures like hip and knee replacements are long, ICUs seem in short supply. Everyone has a story of waiting for attention at emergency and a bad flu season and simply adding to the strains. The Public Policy Forum has brought together a group of reform minded health care experts, many of them insiders, to look into what’s going wrong and more importantly, how to make it right. Two members of this advisory group, both practitioners are our guests today on policy speaking. Joining us, Dr. Victoria Lee and Dr. Danielle Martin. Dr. Lee is the president and CEO of Fraser Health in British Columbia. Fraser Health is the largest health authority in the province. Before becoming CEO, she was chief medical officer and vice president for population health. Dr. Lee brings a national and international perspective to the issues at play. She’s collaborated with national and international organizations, including the Nations Development Program and the World Bank and has done a lot of work there in comparative health systems. Dr. Martin is Chair of the Department of Family and Community Medicine at the University of Toronto, which is the largest academic department of family medicine in the world. She’s an active family physician herself whose clinical work has ranged from comprehensive family medicine in rural and remote communities to maternity care. She was vice president of medical affairs and Health System Solutions at Women’s College Hospital in Toronto, and she’s the author of a book: Better Now Six Big Ideas to Improve Health Care for All Canadians. Welcome, Victoria. Welcome, Danielle.  

Both [00:02:12] Lovely to be here.  

Edward Greenspon [00:02:13] Okay, so let’s start with you, Danielle, alphabetically here. It sort of feels that Canadians suddenly have begun questioning a system that, as I said in the intro, has long been their pride and joy. So, what’s gone wrong here? And, you know, if perhaps something’s gone right, I don’t want to presume it’s wrong, but Canadians seem to think something’s gone wrong.  

Danielle Martin [00:02:36] I think you’re right that people are questioning and it’s not just in Canada. One of the things that is important for us to do is to take a step back and ask, are we having a Canadian problem, or do we have a global phenomenon occurring here? And we saw Macron talking about a complete overhaul of the French health care system. We see the nurses in the NHS going on strike in the first time in its history. There are massive issues. I believe, speaking with my colleagues in the US in American health systems. So, we are in a global situation and of course we are experiencing a particularly Canadian version of it, which is that we have come through these last few years of the pandemic where we threw all of our resources in the health system into trying to cope with COVID-19, with its diagnosis, its treatment, its prevention. We now have to pick up the pieces in a moment where we have an unprecedented crisis in human resources. So if it feels like it’s hard, it’s because it is. Canadians are right to be questioning the state of the system. Also, it’s not just happening here. It’s happening everywhere. So I don’t know whether misery loves company or not, but misery sure has got it in this moment.  

Edward Greenspon [00:03:48] Victoria, I want you to address the same point, but maybe also tell us if you think this is a changed expectation by people, if it’s a recognition of something that they just hadn’t tuned into previously or if things have substantively changed.  

Victoria Lee [00:04:03] Yeah, I agree with what Danielle mentioned. This is a health system, but really, from all of the impacts of the pandemic and the responses where people have come together, and in the West Coast where I’m from, we’ve also had a lot of weather events. So extreme weather events, disasters on top of the pandemic that it’s been in that emergency mode for so long. So, I don’t think there’s any health system in the world that’s gone through what we have together and haven’t seen some of the impacts that we’re seeing. I do think there’s also that component of expectations. I think there’s a couple components. On one side, the health system was able to rally together collectively very quickly and in a agile way, bring together services, whether it was for testing vaccines. That was much more patient, family oriented. So having scheduling that’s available online and being able to see what your records are. I do think there’s also those expectations from what the public has seen through the pandemic, what the health system is capable of. There are expectations that from the provider side and the system side of what we can do in change, but more difficult to manage when we’ve got more diversified priorities versus a single priority. I also think expectations in terms of people have been waiting for services during the pandemic and are very keen to get on top with those services, whether they were waiting for primary care, surgical diagnostic services. They want to get on top of that now. So, there is that mismatch between that expectation from the public and what the health system can deliver given the challenges that we have with the current health system, health human resource crisis as well.  

Edward Greenspon [00:05:50] If you would elaborate for a second on what you mean, that it’s more difficult to manage because we have a diversified system. You know, I would think all systems are different. So what are you focusing on when you say that?  

Victoria Lee [00:06:00] So normally our health system has a number of priorities that we’re trying to deliver. During the pandemic, it was singularly focused on delivering to responding, preventing, treating the pandemic in every focus of what we do every single day, every hour was around that. Normally, we would have diversified priorities, whether it’s senior’s care, primary community care, whether it’s acute operational efficiency, whether it’s human resources. They’re all tied together at the end of the day to improve our population health, improve our health system, quality and safety. But it’s not as focused and targeted as the whole health system, all the policymakers, practitioners working to one specific area.  

Edward Greenspon [00:06:46] Danielle, what would you describe as the main top line headline challenges that the system needs to confront right now?  

Danielle Martin [00:06:54] People. Full stop. The most important challenge that we face is we do not have the people in the system to respond to the need. So whether you are calling your family doctor’s office and the phone is just ringing and ringing and ringing because there aren’t enough medical secretaries to answer the phones, and some have left, and others are off sick, or their kids are off sick, or their home taking care of their parents because we’re in the middle of the triple threat of viral illness on top of everything else, or whether you are in the emergency department where they are regularly down eight, ten, 12, 20 nurses on any given shift or whether you are being admitted to the hospital and you’re in a gurney in a hallway because there aren’t enough beds, because we haven’t been able to move people out to home because we don’t have enough, we use in-home care.  

Edward Greenspon [00:07:45] What is a PSW? 

Danielle Martin [00:07:46] A personal support worker. You know, whatever the staffing, wherever you are in the system, the experience that you are having of waiting or feeling under pressure or feeling that the system is overwhelmed. It is by and large not a demand side issue. It is the supply side issue. We do not have the team members. We’ve seen huge numbers of people retiring. Just in family medicine alone, for example, in Ontario, in the first six months of the pandemic, we saw a doubling of retirements among family physicians. And so huge numbers of people have exited the provision of health care. The result of that is that there are fewer people left behind to do the same amount of work, or perhaps even more work, because we are all doing what we were doing before, plus COVID care for the foreseeable future and so it is a people issue.  

Edward Greenspon [00:08:41] Let me stick with you on people for a second then I’ll come to Victoria and ask her what her main priority that she sees at the moment is, which may impact people as well. But Daniel, when you say how so many people are leaving the system, was this something that could have been predicted? To what extent is that pandemic related or to what extent was it, you know, moving in that direction any case? And were we prepared?  

Danielle Martin [00:09:04] Well, I think it’s a multi-stream complex problem. Right? So first of all, we’re seeing people exiting and moving all around in every sector of the economy. My understanding is it’s not so easy to hire people to work anywhere. I went to get a coffee last week and the coffee shop was closed because they couldn’t find staff to staff the coffee shop. So, we are we are seeing a huge turnover and churn in human resources all across every sector of the economy. We are of course seeing an increased number of people leaving health care and retiring from health care in the wake of the pandemic. Whether we want to call that burnout or whether we want to call it a reprioritization of people’s concerns, of course, we’re also facing massive inflation at a time when public sector wages have by and large been held steady and constant for quite some time. That’s why we see the nurses, for example, in the UK going on strike around wage controls for the work that they do. So, it’s complicated. Was it predictable? I mean, I think it’s probably predictable that when people’s workload increases massively and the stress increases massively in essential work in a global public health crisis, that more of them might choose to move on to some other thing. I don’t know whether predictable helps us, though. I think the question is, was it preventable?  I don’t know, other than through the retrospective scope, you know how confident I feel making proclamations about that. I do know that I think there are some things that we could be doing now to help get ourselves out of this hole. Hopefully we’ll have time to talk about some of that.  

Edward Greenspon [00:10:38] Victoria, do you want to pick a priority if you think we really need to pay attention to now?  

Victoria Lee [00:10:43] Yeah, I think the immediate priority, what’s in front of our faces and every day in, you know, here and elsewhere in other industries is all around that people piece. I do think in health what is in front of us longer term is that transformation agenda. I think the pandemic gave us an opportunity to learn about what are some of the strengths as well as some of the areas that were challenged in our health system. It really, really highlighted those strengths and assets as well as deficits. Where we end up is we have an opportunity now to transform the trajectory of our health system. That transformational agenda, I think, is the headline that we really need to delve into. As Canadians, as residents of Canada, what is it that we need from our health system? Because often what happens is if we just add more people to our existing system, if we just add more beds to the existing system, if we just build more into our system, we’re not going to hire or build our way out of the challenges we’re currently faced with. That’s why I go to it’s the transformation and transformational change agenda that we really need to take on nationally and globally to a certain extent. In Canada, I think we have actions that we can take that leverage our existing infrastructure, and what we’ve learned throughout COVID time, that transformation agenda, I think how exhausted people are, how fatigued people are from the pandemic, it’s a difficult time to move forward with that agenda. I think that is the current context that we’re in. But I think that’s where it’s also exciting and the opportunities lie ahead. From what we’ve seen, we can do this. We can actually get to a point where leapfrog into some of transformation, whether it’s digital, whether it’s people, whether it’s system change or policy changes. I’m confident that we can do it if we put our minds, efforts and leadership into it.  

Edward Greenspon [00:12:51] Well, you both have put your minds to this with several other people on a panel. The Public Policy Forum, as organized in the first part of your insights are hitting the public as we speak, and more in waves of our specific areas will be explored later. So, let’s talk about transformation then. You also talk about, you know, things that could be implemented quickly. So, you know, I guess there’s a little bit of a balance there. But let’s go down that road and let’s start with the idea, which is very central to the support of a patient centric system. Danielle, let me go back and start with you. What does that mean? What is a patient centric system and is ours patient centric today? 

Danielle Martin [00:13:33] I think that if you ask most Canadians who have had recent contact with the health system, they often will say, the people I dealt with were great. Canadians are very fond of saying that the nurses really were trying very hard and working very hard, or I really love my family doctor, or my oncology team was lovely or whatever, but they will then follow it with a story of the disjointedness of their experience. So, a people-centred system is one in which you don’t have to work so hard to navigate and get what you need. So that begins, in fact, it begins and ends with access to care close to home in the community, with a family doctor or a primary care team who knows you, who cares about you, walked with you on your journey through the system and can connect you with everything else that you need along the way. It means being able to access your data and know and carry it with, you know, what you’re due for what you’re up to date on, what your lab results are. Be able to have some faith that your data is also crossing boundaries appropriately between your various team members in your care. So that your family doctor knows when you get admitted to the hospital or your hospital team can see that you had a medication change that might have caused you to land in the emergency department, etc. It ultimately means a decent experience of the care. By decent experience I don’t mean, cucumber water and foot massages, I mean decent treatment and a feeling that you are seen as a person and that your experience matters. So that is something that we have a right to expect, that our patients have a right to expect, and that we have not done a good job of doing in the Canadian health systems thus far. That’s the opportunity.  

Edward Greenspon [00:15:20] Victoria, why don’t you take us a little further, you know, from your perspective of what we need to do to be a patient people-centred health system?  

Victoria Lee [00:15:29] Yeah, I think that distinction is important to it in terms of patient people centric, because from my perspective it needs to be people centric because when we go to patients it’s often the traditional, very paternalistic model of you’re sick and therefore we need to take care of your mindset that sometimes comes out. People also go beyond the health care system to what could we do from a preventive perspective? What could we do to keep people healthy, living longer, managing their chronic conditions in the community? Sometimes when we define people as patients, the other aspects go with it. So, I really like that people-centred, first of all. I also think that in terms of that connected integrated care, what we currently experience in our health system is that it’s getting more and more complex and complicated. Every specialty area, whether it’s in family medicine, whether it’s in surgery, whether it’s in subspecialties of medicine, there’s so much evidence that’s coming out and new ways of doing things and technology, but it’s difficult to keep up. How the health system manages is to create all these subsets of services that’s supposed to help with that. But even with a PhD, sometimes difficult to navigate our health system the way it is. I think for me the way to visualize it is we don’t know what’s behind the wall when we plug our electronics into our power outlets, but it’s complicated behind that wall with all of the ways that we actually get electricity. But right now, we’re asking the patients and people to navigate. What I’d love to see, is that we navigate that whether it’s through family medicine and primary care teams or whether it’s through a health system, because we also need to look after people that don’t currently have attachment to patients. So, I think there’s opportunities to do that through technology, virtual triage. There’s opportunities to connect the system to electronic medical records that are much more tight, interoperable than what we currently see huge opportunities to empower patients and people, because right now we don’t have the information data that you require to actually keep yourself healthy and manage your care in the community. So, there’s I think that opportunity to be people-centred should be really driven by that. What do people need to be healthy, the community living as long as possible independently as possible. 

Edward Greenspon [00:18:05] In some ways it feels to me like there’s a bit of a contradiction in what you’re both saying, in that you want it to be an easier system to get through, but you want me to have access to my records and I should be, you know, figuring out how to get through. So, you know, I think we’ve all had the experience of, if not for ourselves, being an advocate for someone else in the system. The whole idea that you need an advocate seems to me wrongheaded to start with. I mean, that’s an illustration of a failure, it seems to me. But are you in being more people centric, putting more responsibility on me when I encounter the system? Danielle, you seem ready to jump in.  

Danielle Martin [00:18:46] You know, there’s a great thinker on this question at the Mayo Clinic. His name is Victor Montori, and he has written a book about this question and what he calls the work of care and the ways in which, as health care becomes more complex, we download the work of care onto the person who is sick and actually probably in the least good position to be doing the work. So, he talks about re-uploading that care into the system. The way that I think about it is I suppose you’re right. At some level it could be seen as a contradiction. We want people to feel like they are a member of their team, but they understand what is going on with them. I would ideally like for my patients to be able to tell whoever they encounter, if they so choose what their diagnoses are and what medications they take and when their next appointment is like. People should be able to be given the information to navigate themselves in that way and be as engaged as they want to be in their care. But that doesn’t mean that they should be running around doing the problem solving for themselves. So we used to say in some parts of the health and social services sector, there should be no wrong door. Any door you knock on should get you access to the service you need. Well, actually, no, in my view that just leads to a proliferation of doors, which is super confusing for people. There should be one door. It should be really clearly marked, where you go when you are feeling unwell, when you have a question about your health and then through that door should be a person who cares about you, who can be your advocate, because everybody needs an advocate actually in a complex system, but you shouldn’t be relying on your family members or on yourself to do that. That advocate should be your primary care provider or team, and that is where the navigation then happens and occurs. If you’re the kind of person who really gets a charge out of keeping track of your blood pressure on an app and messaging your endocrinologist twice a week, go for it. If you’re not that kind of person and that just feels like work to you, you shouldn’t have to in order to be able to get the care that you need for your hypertension or diabetes.  

Edward Greenspon [00:20:47] Victoria, your first part of your career in population health, you said in the deliberations of this group that, you know, more health has to be upstream. Why don’t you describe that as well? Because I think you’re trying to get us to a situation where fewer people have to cross that rubicon into the system in some ways, right? 

Victoria Lee [00:21:06] I think what I’m really talking about is converting what’s really the focus of our current system, which is sickness based to a wellness-based system, and how do we value that as well as invest in that, as well as empower people to join that. I like the way Danielle had framed with being a member of the care team as individuals that we can be member of the care team, whether it’s an upstream journey of prevention to downstream journey of chronic disease management, to rehab, from surgery to palliative care choices. But I also think that we can get more people to be part of that care team, whether it’s municipalities, whether it’s schools, whether it’s businesses. So when we actually partner given how much impact that we have, we can really move some of the work upstream. It also deals with some of the people problems that we’ve talked about. So I was talking to one of the mayors the other day, talking about how having more services for seniors in the community, whether it’s Aquafit, whether it’s seniors connections, social connections, whether it’s Meals on Wheels, all of those actually help to keep people healthy in the community. So that’s just one of the examples of the upstream measures that we can take so that we don’t have as much downstream impacts to making our health system more sustainable. So, if you go really upstream, it goes into social determinants of health, whether it’s healthy policies or climate environment. We’ve seen some of the impacts of that as well as housing, all those things. I think that as we look at our health system in a way that’s sustainable, not just from a financial perspective but also from a population perspective, climate perspective, it really makes sense for us to look at not only the bigger partners and players in that care team, but how much can we push to upstream investments that’s going to have much bigger downstream impacts. There are small examples of individual actions from vaccination to bigger examples such as housing and climate policies that actually impact our individual and population health more. I know again, similar to health system navigation, I find that sometimes it’s siloed instead of connected when it’s really what’s going to keep somebody healthier and what’s going to cost less in our health system, that is actually also better for the environment. For instance, the heavier climate impact questions are on the acute health system, and that’s the most expensive system and it’s also least desirable in terms of having people looked after in the hospital setting because that means they just require that aquity of care. We’d rather have them healthy in the community as long as possible. So all of those things are connected and I think that’s another huge opportunity that we have in our health system in Canada, given the infrastructure that we have.  

Danielle Martin [00:24:12] If I can just jump in on that, Victoria, because I agree with you that I think you know, there’s a reason why the World Health Organization has moved from talking about patient-centred to person-centred to people-centred care, and that is because we recognize that health is not something that happens to atomic individuals. It is a good that is produced in communities. So when we talk about person centered, that’s all very well and fine for the one individual marching their way through the health care system with a particular illness. But real serious health interventions and health care system reform happens in communities, it happens in neighbourhoods, it happens in towns and cities where where people are engaging in the production of health together. So thinking about this at the level of populations which is where data can be super useful, is is a critically important part of the conversation and actually the pandemic has given us a gift in that respect. I think that Canadians do understand now that health is not something that just happens to individuals or illness, that the behaviours that I do have an impact on your health, the decisions that we make collectively having an impact on all of our health, that we kind of only worry about our own health without thinking about the health of our neighbours, etc., like those are conversations that I would not have anticipated we would have had at as high a level as we have seen over the course of the pandemic. Now, what are we going to do with them now that we’re in this new pandemic phase and trying to pick up the pieces of the rest of the health care system that I think is the is the interesting part of the conversation.  

Edward Greenspon [00:25:48] I thought part of the gift was going to be and perhaps another gift is maybe people are also seeing the value of data.  

Victoria Lee [00:25:54] Yeah. You know, I think that data is the new currency of our society, actually, data and attention. Given our public health system, we’re very rich in data. Before the pandemic we really underutilized our data and saved just putting it into a savings account and not doing much with it, but data should be for action. We’ve seen some of those data driven actions during the pandemic. Here the opportunity from my perspective and from the panel conversations is really empowering individuals with data, empowering systems with data, but ensuring that the data is connected. So there’s traditional health data that can be collected, but there’s also data that we can connect beyond the health system. So what would it look like if we connect your data that you have on your Apple Watch, for instance, with the health system data that we have on your individual information, and then use AI and machine learning to predict your journey and be able to make sure that instead of you having to another disaster with your diabetes management, we can actually predict that’s happening about two or three weeks before and get additional support that you need. So there’s impacts of the individual care level, but there’s also a huge impact in system levels. Like, for instance, we can look at digital twinning of the health system to look at population level connected data and beyond the health system to weather patterns with insurance data, with other information that actually connects to not only look at potential solutions in the health system, but policy changes and the impacts that we can have before making those changes. I also think it makes changes much more rational by being able to be data driven instead of currently, it’s predicted often and we make changes, but it’s very difficult to go back once to make we make some of the changes or additions to the health system. So I believe that there’s another huge opportunity from Canada and then how we currently carry out health services and ensuring that we’re really empowering it by data.  

Edward Greenspon [00:28:08] When someone invokes rational decision making, it brings me immediately to the role of government in all of this, and there is a discussion going on. Might sound like a bunfight to a lot of people, but nothing between particularly the provincial level governments. The premiers and the federal government have a lot of discussion about money. So what extent are we talking about a money problem, Danielle?  

Danielle Martin [00:28:34] I used to think that and I used to say pretty often that I didn’t think we needed much more money in the system. I agree with Victoria’s earlier characterization that I think if we take more money and put it into the existing system, we will get more of the same result. But I am also of the view that we are in a different situation now in Canada’s health systems than we were in a decade ago. The pandemic really has taken a toll, a very serious toll on our health systems, in our on our health workforce. And we’ve got a bunch of things that we need to get done that are going to be hard to do in the absence of any investment at all. So I am of the view, to quote our country’s good friend Roy Romanow, that we need to use any new money to buy change. It was true when he said it, it’s still true now. The fact that it’s taken us a couple of decades to learn that lesson doesn’t make it any less of an important one. So, I do think that there is an investment needed, a quite considerable one. I think that the federal government has to bring serious money to the table in the conversation with the provinces and territories. I think that that money needs to be used to advance some of the key reforms that we know are required because otherwise, the risk is that in spite of the best efforts of provincial and territorial leaders, which I believe they do put in, those dollars get sucked into a whole bunch of things that you and I won’t feel at the front line as users of the system and as clinicians in the system, we won’t feel any difference at all. So it’s got to be, yes, we need money and it’s got to be used to buy change.  

Edward Greenspon [00:30:17] Okay, and maybe people go back and Romanow report from the late 1990s. Victoria, when we talk about money, I sort of think of a lot of reports that show that Canada is a fairly high spender relative to high income countries, not as much as the United States, of course, but relative many countries. But we don’t seem to get the outcomes for it. So what’s the problem? Is money the answer?  

Victoria Lee [00:30:41] Yeah, I think the US is definitely an outlier. When you look at the Commonwealth report, W.H.O. reports or OECD reports, whatever reports that you look at the US is definitely an outlier when you look at per capita spending and how much they spend. But the spending in Canada, when you combine all of the individual pieces of it, because I think sometimes people confuse our public health system as completely publicly administered. But when you look at medications, for instance, dental, physio, all of those combined, Canada actually spends quite a bit in comparison to our neighbouring high-income countries. So, are we not getting value? Because if you look at the recent, the most recent Commonwealth report where at the lower end of rankings of ten out of 11 countries that were compared in terms of quality and safety and equity measures and where I go to is similar to what Danielle said because I don’t think that we need to put more money into our current system. It’s not really going to help. But we do need infusion of money for innovation and transformation agenda because as we get into that change mode, we do need some investments to actually make that happen and execute and execution dollars and reframing how we actually buy services would be worthwhile to consider as well. I’m not talking about the traditional clinical services and those areas. What I’m talking about is currently we often approach the problem with the solution in mind and procure for widgets in mind. But I think where we have more broader opportunity is buying outcomes. So instead of partnering to buy a widget, we would partner with industry, partner with internal programs, actually buy it by outcome. So, if it’s, you know, ensuring 95 percent occupancy within our health system, what are digital transformation opportunities that we can leverage to get to that outcome instead of just buying a widget for that outcome? So the approach could be different. But I do think overall, I don’t think we need more money in the system over time. I think that it’s infusion of money currently for transformation innovation. I think we need to use it differently in our approach as well as how we work through the infrastructure procurement to get those outcomes.  

Edward Greenspon [00:33:10] Let me just try a final question. Maybe we’ll all try to be brief on this, although it’s a big question in your report with your colleagues and with the Public Policy Forum, you basically try it seems to shift power in many ways to the patient person to go back to that theme with a kind of service guarantee. Victoria and then Danielle, just talk about that for one moment and how important that is to have a transformation.  

Victoria Lee [00:33:40] I think that’s pivotal. That’s central to our transformation agenda. How to transform our system really is around people and what kind of services they need. So, is it actually defined as for current interpretation of the Canada Health Act or is it different than what’s currently being interpreted? So from even from legislature level to how services are organized, whether we’re looking at primary care teams, whether we’re looking at health system navigation empowered by digital technologies, whether we’re looking at what kind of data patients, families and people really require, everything really should start from what do people require, what do the residents of Canada require and what makes sense in terms of our transformation journey from where we’re at to where the future can be? I think in the past, a lot of the change has been centred around policies and providers and not necessarily people at the very centre of it. I think there’s an opportunity to really change how our system services function with people at the centre.  

Edward Greenspon [00:34:50] Almost a right, Danielle, is that right?  

Danielle Martin [00:34:52] I mean I would settle for some clarity on what to expect because I think quickly When we get to rights, I mean, if really we want to get into rights, then we should be talking not about a right to health care, but a right to health and then it’s a new start. If you start talking about a right to health, you’re not talking about health care anymore. You’re talking about income and you’re talking about education and social services and all kinds of other things. I do think that the notion that people should have clarity on what they can expect the system to deliver to them, they should know where to go to get what they need and they should have clear answers to their questions about how to how to get through an episode of care in the health system seems to me to be pretty basic and fundamental. Yes, I do think it puts the power back in the hands of the users of the system, which is where it belongs. I think that if we talk about it in terms of a service guarantee or whatnot, the risk is that we sometimes can spiral into sort of facile conversations about, well, if you don’t get your knee replaced in 82 days instead of 89 days, then what’s your recourse? And do you get to sue the government or what? I don’t think that that’s the point. I think the point is people should be able to know what to expect when they interact with the system. They should have good experiences of it and there should be clear journeys that they undertake when they when they come into contact with the system. That is whether we call that a service guarantee or whether we call it an expectation that the cause is less important.  

Edward Greenspon [00:36:27] Last word to you, Victoria. 

Victoria Lee [00:36:28] I wanted to give an example from Alaska, they called their patients customer owners. In Canada as taxpayers, people are the owners of the system. Exactly as it’s been said, people need to define what the expectations are, what the deliverables are, and what we need to be accountable for. And they need to be at the very centre of the health system that’s going to be sustainable.  

Edward Greenspon [00:36:51] And that changes the balance of power within the system, of course. Listen, I want to thank you both. Danielle Martin, Victoria Lee, I want to thank you for your participation in the panel and the continued participation as it digs a bit deeper into some of the issues that you raised. But mostly, you know, your people in the system. You’ve worked very hard yourselves over the last number of years. I think Canadians do appreciate, despite the difficulties that there have been, the extraordinary hard work that’s gone into it. But somehow or another you’ve managed not to be swallowed up by the status quo. You’re both reform minded, and you will be the air carriers of change. I think Canadians are effecting change, and I think they want to know what that looks like. thank you for helping paint that picture.  

Danielle Martin [00:37:38] Thank you, and thanks to the Public Policy Forum.  

Victoria Lee [00:37:40] Yes, thank you for having us.  

Edward Greenspon [00:37:43] At this point in the podcast, we like to do, our members shut out. This week we want to say how #PPFProud we are of the Ivey Foundation for distributing its $100 million endowment over the next five years to organizations supporting Canada’s transition to a low carbon economy. So the Ivey foundation is going to spend out. It announced that decision to mark its 75th anniversary a month or so ago. We’re proud of our member Ivey foundation for supporting initiatives, tackling climate change such as PPF’s own Energy Future Forum and for recognizing the important role philanthropy can play when it comes to Canada’s climate and energy transition. The Ivey foundation, I would say, has been an institution builder. It’s a leader in setting up a number of organizations that will be at work and doing good work long after that money is spent out.  

Edward Greenspon [00:38:37] So I’m ready to finish this podcast and I want to ask you to share the episode with your network. Feel free to leave us a review on the podcast platform of choice. Have a look at the report on health care that Daniel and Victoria have been working on and figure out a way to engage in that conversation for such an important part of our life and the life of the country. I want to thank my colleagues at the Public Policy Forum who make this podcast happen, I’m Edward Greenspon, and this has been Policy Speaking.  

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