Special Report: Health Care

Saving Health Care: Increasing Transparency

If public figures knew their actions would be visible, only the most honest and competent would succeed.

By Ted Mitchell
Published February 06, 2013

This essay began on the topic of health care administration, but I suspect that the main problem it suffers from is widely distributed, and the cure is similarly universal. That problem is a lack of transparency.

Think back on scandals in the last several years: Ornge, eHealth, the gun registry, F-35's, Hydro surcharges, sub-prime mortgage securities.

Locally we find the LHIN/ABC fiasco, McMaster's part-time student president, Di Ianni's donations, Chapman's salary, police and fire department ransom budgets.

It's not only confined to leadership. Think of police behaving badly, city staffers doing nothing on the clock and making deals on the side. Most of these small-time indiscretions never see the light of day.

What do all these things have in common? Of course there's the obvious incompetence, greed, and fraud. But, public or private, they were all preventable with increased transparency.

Transparency is one of those overused words that I hate, because it is an admirable concept that has been appropriated by professional technocrats to become an ironic buzzword.

When a government says they are bringing increased transparency, they usually mean the opposite. Stephen Harper campaigned on it in 2006, and then made the problem of government secrecy worse than even the Liberals before him.

Freedom of information requests go through an Orwellian process and come out too little, too late, and too expensive. Democracy is hijacked by self-interest when voters are ignorant of the truth. Living under these conditions, voter apathy is absolutely expected.

For this essay, I will use the word transparency in its original, non-sarcastic meaning: operating in such a way that the public can see what is happening.

Secrecy Hides Incompetence

It is my contention that people in positions of power choose to cloak their work in secrecy mainly because of incompetence, not nefarious intentions. There are two main reasons, and one or both may operate.

The first arises in self-consciousness, the fear that others will think that they are incompetent if all their daily conflicts, uncertainties, decisions and bad behaviour are under constant observation.

The second is arrogance, the mistaken assumption that because you have achieved a certain position, your ideas and decisions are better than others. Therefore, others have nothing else to offer.

The nefarious stuff, dishonesty, greed, and backroom deals come later, opportunistically, when people realize an opaque system can be gamed. In a democracy, power corrupts only by thinking you can get away with it if nobody knows about it.

There is another dimension to this, the myth of meritocracy which ties these things together, but that's a topic for another day.

The Peter Principle

Incompetence only has meaning given some defined expectations. The brilliantly insightful and hilarious book The Peter Principle (1969, Peter and Hull, highly recommended) outlines how in any hierarchy, people who are competent at their job are selected for promotion until they reach a level beyond their competence. This means that they find themselves in a position for which they no longer have adequate skills.

Incompetence is the natural, mature state of hierarchies. It doesn't matter if it is a public or private institution; people who climb these ladders end up at a level one step up from what they are able to perform.

Private companies have little transparency, which does nothing to counter the Principle. However, at least there are market forces which can wipe them out if their structure becomes too mature, i.e. with a high incidence of incompetence.

Public institutions might have a little more transparency, but are metastasized with internal bureaucracy. Managers who aren't good at their jobs argue for more funding so they can hire more people who can actually do useful work.

They are highly incestuous, hiring peers from similar institutions and cross-contaminating all of them with cronyism. By the way, thank you to HHS and the LHIN for inspiring this essay, and yes I'm talking about you.

This is how the cancer grows: Voters are turned off by wastful spending, and a change of government brings in conservatives who cut funding. Institutions lay off the underlings who do the useful work. Incompetent bosses stay put.

Then, public outcries of inadequate service persuade a change of government, and liberals now in power restore funding which rehires the underlings, and a new manager or two.

The cycle continues, ever proportionally growing the middle and top management until gross incompetence rears its head and is no longer able to be internally contained. Predictably, you get scandals like Ornge and ehealth.

Unions have their purpose, but modern versions of them assume that everyone is equal and chronologic seniority supersedes ability. This just exacerbates the Peter Principle, in that people can actually be promoted several levels above their level of incompetence! And the more job security, the more developed the Principle becomes.

All of these mechanisms thrive in secretive environments.

Transparency is the Remedy for Incompetence

If public figures knew their actions would be visible, only the most honest and competent would succeed. It's not simply a matter of confidence, as empty platitudes don't last long in the court of public opinion.

In a transparent environment, leaders who believe in fairness, information, facilitation, and mining the best ideas will flourish.

For a positive example, I would choose Ward 1 councillor Brian McHattie, who makes an effort to communicate meaningfully with constituents. An opposite example would be how the Red Hill expressway was chosen.

A new type of leader will emerge, one who is respectful, down to earth and not personally ambitious. The days of top-down, inaccessible, aggressive human Dobermans will be over.

Narcissists like Chris Mazza, the would be Ornge Emperor of Helicopters, would have nowhere to hide. Instead, they would hire someone who would integrate land and air ambulance services, optimizing communication with CritiCall, base and emergency physicians, and design an efficient system that minimizes the shared bottom line of all related services. You need someone who is civic-minded to succeed at such a task.

There is evidence that beyond a certain level, excess pay doesn't buy more performance but actually the opposite, and we need to apply this theory now with publicly funded positions.

Salaries for CEOs of hospitals, universities, and public institutions will plummet, as these positions should max out at $300,000, comparable to a prime minister or premier. Then, the position will command respect from the public, not resentment as befit obnoxious corporate salaries on the public dime.

Imagine expense accounts of councillors, MP's and civil servants being payable only when submitted online publicly. How long would $1M bulletproof limos, $2000 hotel rooms and $15 lattes last?

Imagine all developers and lobbyists being prevented from speaking with any government individual or committee without the transaction being videotaped and posted online. Hamilton's building permits would look a lot different.

There is no excuse for a lack of transparency save one: are there any lives at stake if the information goes public? If not, take the doors off our institutions and let the light extinguish all of those incompetent, greedy vampires of taxpayer dollars.

The first leaders to insist on transparency will make the history books as pioneers of participatory democracy.

Ted Mitchell is a Hamilton resident, emergency physician and sometimes agitator who recently completed a BEng at McMaster University. He is fascinated by aspects of our culture that are harmful, but avoid serious public discussion.

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By AnjoMan (registered) | Posted February 06, 2013 at 08:39:52

Too bad the people who currently have the power to do this are incompetent..

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By Wanderwood (anonymous) | Posted February 09, 2013 at 13:39:10

Well written. This lack of transparency is all over the map; in all tiers of government, education system, & health system. As Dryden taxpayers grapple with a massive debt due to the deliberate lack of transparency by (past) council, my question is: How can transparency be forced upon those in public office if competent people are not elected (or hired) in the first place?

What was Maggie Thatcher's line? "It used to be about trying to do something; now it's about trying to be someone".

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