10 years since the Romanow Report – how to move forward

Gustavo completed his PhD from the Institute of Health Policy, Management and Evaluation at the University of Toronto in October 2012 and has provided part-time research and analytic expertise to the Health Council of Canada since September 2012.

Recently, I attended the CAHSPR forum, Ten years since the Romanow Report, a unique opportunity to discuss the advances in transforming health care in Canada, and a privilege due to the critical transcendence of this discussion at the current time. Not only has it been a decade since the Romanow Report, but we are also two years away from the conclusion of the 10-year period set in the 2004 First Ministers’ 10-Year Plan to Strengthen Health Care.

Overall, the forum featured thoughtful presentations with diverse visions on the challenges that our health care system is facing, and some ideas on areas where future action should focus. It particularly called my attention to the fact that the future directions look very similar to the ones identified 10 years ago by the Romanow Report. The advances that were highlighted as promising examples were mostly components of the reform that were supposed to be fully implemented and operative throughout Canada at this point, as committed to in the Accords. The lack of innovation and low levels of F/P/T collaboration were described as a constant throughout these years. We are about to reach the deadline, yet we are far from achieving the goals. An integrated, patient-centred, community embedded and adequately supported health care delivery system needs to be a priority in the near future. Missing in the presentations and discussion were the questions “why are some reforms failing?” and “what are we going to do to avoid having exactly the same discussion ten years hence?”

Fortunately, as a recent graduate from the PhD program at the Institute HPME at the University of Toronto, I was invited to attend the CAHSPR students’ discussion with the Honorable Roy Romanow after the general forum. I was impressed by the level of criticism that students - sometimes called “the new generation” - have about the accomplishments that “the old generation” has achieved in advancing towards an effective, efficient, integrated, and patient-centred Canadian health care system. Somehow, this part of the forum, far from the microphones and podiums, felt more authentic and constructive.

If we want to protect the principles of our health care system, we need to achieve permanent transformation, and be dynamic and adapt to changes in our society and the challenges it faces. We need more courage to go against the way things are when we know they are unproductive or wrong. We need dramatically more innovation to challenge the way we translate evidence into patient and community care, and in the way we translate those principles into a healthy population.

I encourage CAHSPR to continue to host these forums, and include new voices, and the Health Council of Canada to continue supporting them.

Gustavo Mery, MD, MBA, PhD