Riding the Third Rail: The Story of Ontario's Health Services Restructuring Commission, 1996-2000

This is the story of the Health Services Restructuring Commission (HSRC), the change agent established and charged by the Ontario government to foster the creation of a genuine health services system in Ontario. Set up in 1996 to ?sunset? at the end of its four-year mandate, the HSRC exercised two powers, that of the government itself to restructure the province's approximately 225 public hospitals (phase I), and to advise the government, through the minister of health, on how to structure everything else (phase II).

It describes how the commission directed the establishment of a rationalized subsystem, consisting primarily of acute-care hospitals, in Ontario's cities and towns and eliminated the redundancy of the 9,000-10,000 empty beds (the equivalent of some 30 medium-sized hospitals). It is about the HSRC's vision of what a genuine health services system should do for people in the early twenty-first century, and its attempts to fill the extraordinary policy and leadership void it discovered at the outset.

The story is about fierce resistance to change in health care, especially by hospitals; it is also about how change was embraced and empowered by courageous local leaders.

It is about the development of workable strategies to build a real health care system - to create a capacity for information management; to re-engineer primary health care; to tie primary care, home care and long-term care together with hospital care and other elements into an integrated whole; to get a handle on measures of performance and productivity; and to establish accountability. It is also about the commission's frustration with a pace of change rendered glacial by powerful interests' determined grip on the status quo, by prolonged jousting in the legal lists, and by having to operate in a policy vacuum, all combined with what seemed to the 11 independent volunteer commissioners to be remarkable political timidity.

This is the story of one commission's and one province's contribution to the slow, difficult, ongoing struggle to create genuine health care systems thoughts Canada.