Improving the health care pulse

Angela Downey, CMA, FCMA, works to improve Canada’s health care culture while encouraging students to understand the value they can offer as accountants

By Robert Colman

Health care providers and all levels of government in Canada are struggling to sustain and improve the country’s publicly-funded health system, while also keeping the costs of care in check. Despite the importance of cost control, one rarely hears mention publicly of the important role accountants can play in creating differences in this arena. One accountant who is making a difference is Angela Downey, CMA, FCMA. Downey is an associate professor of accounting at the University of Lethbridge, adjunct professor at the University of Ottawa medical school, and co-director of the Centre for Health Management Research (CHMR) at the University of Lethbridge. The CHMR is a joint initiative between the Faculty of Management and the School of Health Sciences, and it’s here where she is creating change, step by step.

The Centre for Health Management Research has a mandate to encourage health-related research and to create a dialogue among a variety of stakeholders focused on changing Canada’s health care system from a curative to a preventative one. These stakeholders include government policy makers, primary and tertiary health care providers and researchers, and work site health promotion experts and researchers.

“The focus is really on prevention — how to help organizations undergo a transition to a wellness culture,” says Downey. “Many organizations attempt to develop such a culture, but they just don’t get there. What we are asking is, what models work? By establishing best practices, we hope to be able to encourage their adoption elsewhere.” Downey puts her management accounting expertise to work by using strategic financial tools and frameworks in the process of reviewing current practices and suggesting alternatives.

Evidence-based change

For instance, Downey has developed an economic model to cost out new treatments and processes in hospitals, using activity-based costing and the Balanced Scorecard to do so. She used this while working on an Ontario Ministry of Health and Long-Term Care funded study that examined the cost effectiveness of planning, implementing and sustaining nursing best practice guidelines.  

The study looked at current best practice guidelines around the treatment of pressure ulcers (bedsores) in patients (how and/or if best practices were used). Registered Nurses Association of Ontario (RNAO) reports, and other relevant inputs were also examined to determine whether the way in which they were managed was the best option available.

“What came out of the study was that it was better to prevent pressure ulcers in the first place, rather than treat them afterwards,” says Downey. “They can recur very rapidly in people with compromised health and can take several years to treat. However, if these patients are put on dynamic bed surfaces, which constantly move, it’s possible to save as much as $4 million a year just in in-hospital treatment.

“The dynamic bed surfaces are expensive to rent — about $800 a week — so originally it was assumed that it would simply be cheaper to treat patients for any complications afterwards. That turned out to be incorrect, because a lot of surgical interventions can be necessary.”

Thus, by understanding the economic model through the consideration of all factors, it was possible to change certain processes for the better. Through this, new best practices were developed and could be shared throughout the nursing community. Downey is currently part of a 21-person multi-disciplinary team that was recently awarded a $1 million research grant that will further this research. The grant is to conduct a five-year study to better understand how to improve the implementation and dissemination of evidence-informed best practices in health care.

Wellness-based prevention

Downey is also looking at the effect of better patient education on wellness. “The onset of Type 2 diabetes is dropping to people in the 40-50 year-old range in southern Alberta,” she notes. “Even kids are getting it now. Because these patients are younger, it’s harder to educated them on good self-health care. We are developing a variety of Internet information forms, then will attempt to determine what   economic effect this has.” 

Last year, Downey and her colleagues also completed some preliminary research on a work site wellness change model. She and several colleagues from the University of Lethbridge and universities in Ontario are assessing the effectiveness of health promotion programs and activities in organizations of various sizes. Health promotion, generally, is about organizations creating an environment that encourages employees to make better lifestyle choices. The project participants include for-profit and not-for-profit organizations.

Thus far, what the researchers have observed is that, among organizations that have launched wellness programs and have encouraged better lifestyles, there are many hurdles still to master. Launching such programs is handled well, but maintaining them is a distinct challenge.

Although it’s a challenge, Downey believes that her involvement in such programs is very important.

“We have to develop metrics to show the benefits of healthy living, to connect better health to increased profitability,” she says.

Outreach: inspiring students

Downey has been studying and researching in the health promotion area for more than 10 years now; her doctoral dissertation focused on the status of health promotion in Canada and the motivation of Canadian managers to implement workplace wellness programs. She attended Richard Ivey School of Business for her Ph.D. in Management Accounting and Control, completing her thesis with the assistance of a CMA Canada scholarship in 2000.

“If it hadn’t been for the CMA, I wouldn’t have had the experience or support to do what I’m doing right now,” insists Downey. It was more than simply the scholarship that she speaks of. “I went back to school to get courses for the CMA designation,” she explains. “In the last year of class, I was asked to teach an introduction to accounting course at a local college. I realized it was a lot of fun, and it encouraged me to take my Master’s in accounting at the University of Saskatchewan.”

Her choice of study topic wasn’t a struggle for her. “There’s a lot of pure accounting research out there, and while it’s important, I find it unrewarding,” she explains. “Accountants have a huge role to play in saving our health care system.”

Downey acts as a mentor and adviser to University of Lethbridge students interested in pursuing the accounting profession. For instance, she regularly coaches students for accounting case competitions, in which students present analyses and recommendations for a challenging accounting case. She is the organizer of the University of Lethbridge’s annual Inter-Campus Accounting Case Competition.

She is also currently serving as president of the Canadian Academic Accounting Association (CAAA), hoping to improve scholarship and teaching in the classroom.

“I think we have challenges in the classroom, and students could really help us understand what works and how we can improve that environment to make it more effective,” she notes. For her part, Downey likes to use case studies in the classroom to bring the material alive. “I like to inspire my students,” she enthuses. Her focus is on management control systems in the undergraduate program and statistics in the graduate program.

 Through CAAA and her experience elsewhere, Downey believes there are serious challenges in accounting academia. “We’re desperate for academics in Canada,” she says. “We don’t have enough one-year Master’s programs to get people into our universities. And I don’t think we talk enough about academia as a career option. We need to show students that there’s this other option for them.”

Downey inspires and encourages through her own example. She spent two years on the Lethbridge CMA Chapter Executive, one year as secretary and the other as director. She regularly lectures on the valuable role CMAs can play within their organizations with regard to the well being of their fellow employees, and has facilitated the management accounting sessions in the CMA preparation program sponsored by CMA Alberta and organized by the University of Lethbridge Faculty of Management.  

Downey was made a Fellow of the Society of Management Accountants in 2003, and received the University of Lethbridge Faculty’s Advisory Board’s award for Distinguished Community Service in 2004. In 2004, she was promoted to associate professor and awarded tenure.

Robert Colman is editor-in-chief of CMA Management.

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