With the old system of block funding, you would get a finite amount of money and were told to get on with it. The only real stick [for the government] to use is, ‘Don’t get into a deficit,’ like Vancouver Coastal did. If you get into a deficit, there are real problems, but otherwise it’s a case of manage as best you can. That means the bottom line is more important than the patient.
What do you bring to the management game?
You try to focus on what the real priorities are, and persuade others that those are the correct priorities. Then, you try to end up with an implementation plan that you think is going to work – that is not too big or too small but just right to do the job. It’s a matter of, ‘This is our objective and this is how we get there.’
Is it the same for private and public sector?
It is the same in both, but it is particularly vital for the public sector, because in the private sector you already know what your objective is. You are trying to make money for shareholders and everyone is talking the same language. The board knows the objectives and that this is what they have to do. [At Teck] we knew we had to get stronger in coal to survive in that market and when we saw a rival trying to take the key mine in the area, we had to fight back. So you know where you are. But in the public sector, that is not so clear at all.
It is a big adjustment for business people coming in to the health sector. All of us know that in terms of unit costs, if your competitors are way below you, you’ve got a real problem. Here they abandoned unit costs, and they don’t use it for decision making.
Did you approach the challenges at VCH like a private-sector manager?
I tried to, but the first thing you learn is health is extremely complicated and there are a lot of unforeseen circumstances. … Don’t go in all gung ho, but instead, listen and learn. Go out in the field often; go to clinics and hospitals, and listen. And it is too big an area to try to do everything – it goes all the way from public health and swimming pools to palliative care and hospices. … The problem was bigger than just VCH; it was how to make the system more responsive to what it is supposed to be doing in the first place.
Think of it this way: When you are in the private sector and you ask what the customers want, you think quality, availability and price. And in health care, what does the patient want? The patient also wants quality, access to the system and value for money. They are practically identical [in goals]. So how come these two systems operate on a totally different funding basis? … There is something fundamentally wrong with a funding system that is not permitting managers, who have the ability, to actually do the job.
What do you hope is your legacy?
It would be a sustainable funding system, when dollars follow the patient in order to provide a high quality of patient service, where you improve patient access through shorter wait times, and you produce value for money for the taxpayer.
After six years in the health system, what is the big thing you have learned?
If you bring in pay for performance – what we call patient-focused funding – you are really saying that the money is following the patient. Whoever treats the patient gets paid, and those who don’t treat him or her don’t get paid. And you can see that reflected in our annual report. And now, it is about how you get the other elements of management system to align properly with that principle.
Chairman, B.C. Health Services Purchasing Organization, Vancouver
Born in London, England; 74 years old
Bachelor of science in economics, London School of Economics
After school, joined Ford Motor Co. in Britain. Later took a job with Air Products and Chemicals Inc.
Moved to South Africa for a job in the mining industry.
In 1980, was recruited by the Keevil family to join Teck Resources Ltd. Served as chief executive officer from 2001 to 2005, when he retired.
Chairman of Vancouver Coastal Health from 2007 to 2010.
Appointed chair of BCHSPO in 2010