Thank you for that question.
For the interpreters, if my headset is causing problems, let me know and I will switch it out to something different.
When we look at bureaucracy, I think it's sometimes an easy target when things fall apart. I'm not saying that bureaucracies need to be big, but we do need people whose job it is to measure metrics, follow costs, make sure that workflows get followed through, audit and do all those other things. This takes people time and effort. Otherwise, that responsibility falls onto whoever else is left within the system. We know that one of the major causes of burnout among physicians is actual administrative work, so I will try to temper some of that criticism of bureaucracy in my answer.
I think the challenge is workflows, actually. The federal government is not a provincial or territorial medical system. ISC has gone through an evolution. They've changed from a program that's usually based on grant funding or other things to a more sustainable program where they are trying to design and create health systems in partnership with first nations and Inuit and Métis nations across the country. Along the way, they're revisiting those workflows and asking questions. Do three people have to approve this? Can just one person sign off on this? Could the responsibility for signing off actually go to the physician?
These are the same struggles we have within our provincial and territorial medical systems. Me having to phone an administrator to get permission to do a surgery at one in the morning, say, could create adverse problems for a person who needs an open fracture fixed in the middle of the night. I think the redesign could be leaning towards understanding what the workflows are trying to get out of the system and lining that up with the needs of patients—right care, right person, right time, and in a place that's as convenient to them as possible.
In your last panel, there was a comment from one of the panellists that sometimes we can't create these systems because of the cost or limited resources. We know that health human resources are at a critical point right now. Trying to work through what's best for the patient, and trying to line up those approvals and auditing processes to make sure that we're compliant with workflows that work in their best interest, I think is our recommendation from the CMA—to explore this type of program redesign.