Greg Steer
@steerg.bsky.social
Enterprise Coach and Mentor. Retired from executive positions in the public and private sectors, I’ve developed and applied models (statistical, simulation, business) to provide insight into complex systems and guide transformation.
No. Good idea; bad solution (yet another data silo). Today, we can rationalise and centralise health information holdings to support team-based care, inc transfer of custodianship of primary care medical records from doctors (and others!) to a govt agency.
gregsteer.substack.com/p/stewardshi...
gregsteer.substack.com/p/stewardshi...
Stewardship of Healthcare Information
Healthcare in British Columbia
gregsteer.substack.com
October 19, 2025 at 4:56 PM
No. Good idea; bad solution (yet another data silo). Today, we can rationalise and centralise health information holdings to support team-based care, inc transfer of custodianship of primary care medical records from doctors (and others!) to a govt agency.
gregsteer.substack.com/p/stewardshi...
gregsteer.substack.com/p/stewardshi...
Let’s rethink emergency medical services. We can improve patient outcomes by using a hybrid virtual / in-person service model to make better use of 1st responders AND people on-site to provide team-based emergency medical services faster, everywhere.
gregsteer.substack.com/p/rethinking...
gregsteer.substack.com/p/rethinking...
Rethinking Emergency Medical Services
Healthcare in Canada
gregsteer.substack.com
October 13, 2025 at 6:48 PM
Let’s rethink emergency medical services. We can improve patient outcomes by using a hybrid virtual / in-person service model to make better use of 1st responders AND people on-site to provide team-based emergency medical services faster, everywhere.
gregsteer.substack.com/p/rethinking...
gregsteer.substack.com/p/rethinking...
We can’t expect 2.8M CDN users to individually protect pt health data. Transfer custodianship of health info from doctors to a govt agency to improve stewardship. Acting on behalf of doctors & pts, it would have the mandate & resources to protect pt info.
gregsteer.substack.com/p/the-traged...
gregsteer.substack.com/p/the-traged...
The Tragedy of the Health Information Commons
Healthcare in Canada
gregsteer.substack.com
September 29, 2025 at 4:12 PM
We can’t expect 2.8M CDN users to individually protect pt health data. Transfer custodianship of health info from doctors to a govt agency to improve stewardship. Acting on behalf of doctors & pts, it would have the mandate & resources to protect pt info.
gregsteer.substack.com/p/the-traged...
gregsteer.substack.com/p/the-traged...
Patients need control over THEIR health info. Proliferation of data silos held by clinicians makes this impossible. Transfer custodianship of health info from docs to a govt agency to improve stewardship of health info, security & pt care.
1 pt, 1 record.
gregsteer.substack.com/p/the-traged...
1 pt, 1 record.
gregsteer.substack.com/p/the-traged...
The Tragedy of the Health Information Commons
Healthcare in Canada
gregsteer.substack.com
September 22, 2025 at 7:15 PM
Patients need control over THEIR health info. Proliferation of data silos held by clinicians makes this impossible. Transfer custodianship of health info from docs to a govt agency to improve stewardship of health info, security & pt care.
1 pt, 1 record.
gregsteer.substack.com/p/the-traged...
1 pt, 1 record.
gregsteer.substack.com/p/the-traged...
Data interoperability among primary care EMRs won’t really help. It just digitises the fax paths. One EMR federally licensed & provincially administered:
⬇️ admin burden
⬆️ team-based care (primary, acute)
⬇️ cost
⬆️ privacy and security
Faster Better Cheaper
gregsteer.substack.com/p/stewardshi...
⬇️ admin burden
⬆️ team-based care (primary, acute)
⬇️ cost
⬆️ privacy and security
Faster Better Cheaper
gregsteer.substack.com/p/stewardshi...
Stewardship of Healthcare Information
Healthcare in British Columbia
gregsteer.substack.com
August 19, 2025 at 5:59 PM
Data interoperability among primary care EMRs won’t really help. It just digitises the fax paths. One EMR federally licensed & provincially administered:
⬇️ admin burden
⬆️ team-based care (primary, acute)
⬇️ cost
⬆️ privacy and security
Faster Better Cheaper
gregsteer.substack.com/p/stewardshi...
⬇️ admin burden
⬆️ team-based care (primary, acute)
⬇️ cost
⬆️ privacy and security
Faster Better Cheaper
gregsteer.substack.com/p/stewardshi...
No. Patients must own their medical information & authorise its use. Data scattered in an uncharted, expanding universe of silos accessed by 70 EMRs is an info mgmt & security nightmare. One pt, one record, administered by a govt agency for pts & clinicians
gregsteer.substack.com/p/the-traged...
gregsteer.substack.com/p/the-traged...
The Tragedy of the Health Information Commons
Healthcare in Canada
gregsteer.substack.com
August 19, 2025 at 4:33 PM
No. Patients must own their medical information & authorise its use. Data scattered in an uncharted, expanding universe of silos accessed by 70 EMRs is an info mgmt & security nightmare. One pt, one record, administered by a govt agency for pts & clinicians
gregsteer.substack.com/p/the-traged...
gregsteer.substack.com/p/the-traged...
One patient, one record.
August 15, 2025 at 3:28 PM
One patient, one record.
No, Canada needs to improve stewardship of health information by transferring custodianship of medical records from physicians to a govt agency so clinicians access trusted, secure, and complete patient info. Interoperability just digitises the fax paths.
gregsteer.substack.com/p/the-traged...
gregsteer.substack.com/p/the-traged...
The Tragedy of the Health Information Commons
Healthcare in Canada
gregsteer.substack.com
August 15, 2025 at 3:22 PM
No, Canada needs to improve stewardship of health information by transferring custodianship of medical records from physicians to a govt agency so clinicians access trusted, secure, and complete patient info. Interoperability just digitises the fax paths.
gregsteer.substack.com/p/the-traged...
gregsteer.substack.com/p/the-traged...
Need an open & transparent accountability fw: common objective, perf measures aligned with objectives, & rewards tied to KPIs.
Political obj is make people (voters) feel good so “measures” are inputs (#EDs, ED hrs).
Emerg Med obj is make pts better, measured by results (e.g. time to diag & treat).
Political obj is make people (voters) feel good so “measures” are inputs (#EDs, ED hrs).
Emerg Med obj is make pts better, measured by results (e.g. time to diag & treat).
August 4, 2025 at 7:23 PM
Need an open & transparent accountability fw: common objective, perf measures aligned with objectives, & rewards tied to KPIs.
Political obj is make people (voters) feel good so “measures” are inputs (#EDs, ED hrs).
Emerg Med obj is make pts better, measured by results (e.g. time to diag & treat).
Political obj is make people (voters) feel good so “measures” are inputs (#EDs, ED hrs).
Emerg Med obj is make pts better, measured by results (e.g. time to diag & treat).
💯 You manage to what is measured. Our healthcare system has budget administrators, rewarded for balancing budgets & ⬇️ political noise. We need service managers, accountable for managing resources to ⬆️ pt outcomes. Coaches work with doctors & other team members to help them achieve this common goal.
August 3, 2025 at 4:50 AM
💯 You manage to what is measured. Our healthcare system has budget administrators, rewarded for balancing budgets & ⬇️ political noise. We need service managers, accountable for managing resources to ⬆️ pt outcomes. Coaches work with doctors & other team members to help them achieve this common goal.
“The new policy comes at a time when the health authority is under financial pressure from the province.” 🤔
This policy is about reducing expenditures, not managing Human Resources. “No OT” not the same as “manage OT to maintain service and minimise burnout,” which staff are trying to do w/o OT.
This policy is about reducing expenditures, not managing Human Resources. “No OT” not the same as “manage OT to maintain service and minimise burnout,” which staff are trying to do w/o OT.
August 3, 2025 at 1:27 AM
“The new policy comes at a time when the health authority is under financial pressure from the province.” 🤔
This policy is about reducing expenditures, not managing Human Resources. “No OT” not the same as “manage OT to maintain service and minimise burnout,” which staff are trying to do w/o OT.
This policy is about reducing expenditures, not managing Human Resources. “No OT” not the same as “manage OT to maintain service and minimise burnout,” which staff are trying to do w/o OT.
So the Quarterback goes to hand off the 🏈 to the Running Back, who says “Nah, you do it.” QB is pummeled.
The QB isn’t responsible for fixing roles & responsibilities problems. The Coach is. If the RB managed to stay on the team, the O-line might even give the Linebackers some free hits on the RB.
The QB isn’t responsible for fixing roles & responsibilities problems. The Coach is. If the RB managed to stay on the team, the O-line might even give the Linebackers some free hits on the RB.
August 3, 2025 at 12:22 AM
So the Quarterback goes to hand off the 🏈 to the Running Back, who says “Nah, you do it.” QB is pummeled.
The QB isn’t responsible for fixing roles & responsibilities problems. The Coach is. If the RB managed to stay on the team, the O-line might even give the Linebackers some free hits on the RB.
The QB isn’t responsible for fixing roles & responsibilities problems. The Coach is. If the RB managed to stay on the team, the O-line might even give the Linebackers some free hits on the RB.
The problem with 🇨🇦 healthcare is an obsolete & broken business model, not technology. Need to fix the model (e.g. roles & resps) to properly apply technology, so it’s not just a patch. Improved stewardship of health info would improve healthcare, everywhere.
gregsteer.substack.com/p/stewardshi...
gregsteer.substack.com/p/stewardshi...
August 2, 2025 at 4:49 PM
The problem with 🇨🇦 healthcare is an obsolete & broken business model, not technology. Need to fix the model (e.g. roles & resps) to properly apply technology, so it’s not just a patch. Improved stewardship of health info would improve healthcare, everywhere.
gregsteer.substack.com/p/stewardshi...
gregsteer.substack.com/p/stewardshi...
I’d look to the ITSec folks to secure the user interface and the application tunnel. Sante Quebec seems to have a good strategy at the network level.
gregsteer.substack.com/p/sante-queb...
gregsteer.substack.com/p/sante-queb...
Santé Québec : Une stratégie pour protéger la confidentialité des renseignements sur la santé
Santé Québec : A Strategy to Protect Privacy of Health Information
gregsteer.substack.com
July 30, 2025 at 4:03 PM
I’d look to the ITSec folks to secure the user interface and the application tunnel. Sante Quebec seems to have a good strategy at the network level.
gregsteer.substack.com/p/sante-queb...
gregsteer.substack.com/p/sante-queb...
💯 It is almost impossible to secure 70 EMRs & primary care medical records scattered across an ever-expanding & uncharted universe of info silos managed by physicians & other professions. Info Security is yet another unnecessary admin burden on physicians.
gregsteer.substack.com/p/the-traged...
gregsteer.substack.com/p/the-traged...
The Tragedy of the Health Information Commons
Healthcare in Canada
gregsteer.substack.com
July 30, 2025 at 3:27 PM
💯 It is almost impossible to secure 70 EMRs & primary care medical records scattered across an ever-expanding & uncharted universe of info silos managed by physicians & other professions. Info Security is yet another unnecessary admin burden on physicians.
gregsteer.substack.com/p/the-traged...
gregsteer.substack.com/p/the-traged...
BC healthcare has too many managers and too little management. Probably not an isolated incident for this surgeon. A monthly summary of incidents drawn from the EHR (say into a data warehouse) would help identify high performers (to recognise and learn from) and low performers (to help improve).
July 30, 2025 at 3:42 AM
BC healthcare has too many managers and too little management. Probably not an isolated incident for this surgeon. A monthly summary of incidents drawn from the EHR (say into a data warehouse) would help identify high performers (to recognise and learn from) and low performers (to help improve).
I think the problem with health information is an obsolete business model, not technology.
gregsteer.substack.com/p/the-traged...
gregsteer.substack.com/p/the-traged...
July 23, 2025 at 4:43 PM
I think the problem with health information is an obsolete business model, not technology.
gregsteer.substack.com/p/the-traged...
gregsteer.substack.com/p/the-traged...
Thx! Key is to work back from the objective & use a conceptual service model with intrinsic performance measures to drive & evaluate changes. Together with transparency, this approach enables collaboration, buy-in, & accountability.
It’s more important to know where we want to be than where we are.
It’s more important to know where we want to be than where we are.
July 23, 2025 at 3:01 PM
Thx! Key is to work back from the objective & use a conceptual service model with intrinsic performance measures to drive & evaluate changes. Together with transparency, this approach enables collaboration, buy-in, & accountability.
It’s more important to know where we want to be than where we are.
It’s more important to know where we want to be than where we are.
Everyone is frustrated with our healthcare system so I decided to apply my expertise in enterprise design & transformation to see
- what it should look like, and
- how to get there.
Diagnose & treat. My Substack has the project work-up. Here’s one insight.
gregsteer.substack.com/p/rethinking...
- what it should look like, and
- how to get there.
Diagnose & treat. My Substack has the project work-up. Here’s one insight.
gregsteer.substack.com/p/rethinking...
Rethinking Emergency Medical Services
Healthcare in Canada
gregsteer.substack.com
July 23, 2025 at 6:51 AM
Everyone is frustrated with our healthcare system so I decided to apply my expertise in enterprise design & transformation to see
- what it should look like, and
- how to get there.
Diagnose & treat. My Substack has the project work-up. Here’s one insight.
gregsteer.substack.com/p/rethinking...
- what it should look like, and
- how to get there.
Diagnose & treat. My Substack has the project work-up. Here’s one insight.
gregsteer.substack.com/p/rethinking...
Hang in there. Turns out, there are many people like you who “do good”despite the system, & we can fix the system, one step at a time. A conceptual service model provides a framework to objectively evaluate service delivery options (inc status quo), & guide transformation. Need leaders. Like you.
July 23, 2025 at 5:14 AM
Hang in there. Turns out, there are many people like you who “do good”despite the system, & we can fix the system, one step at a time. A conceptual service model provides a framework to objectively evaluate service delivery options (inc status quo), & guide transformation. Need leaders. Like you.
Hard to work as a team if there’s no communication, no accountability, and no coach. Disputed consults should be performed, and reviewed later.
Running backs don’t refuse 🏈 handoffs during a game because they don’t like the play called by the QB. Plays are reviewed after the game.
Running backs don’t refuse 🏈 handoffs during a game because they don’t like the play called by the QB. Plays are reviewed after the game.
July 23, 2025 at 3:55 AM
Hard to work as a team if there’s no communication, no accountability, and no coach. Disputed consults should be performed, and reviewed later.
Running backs don’t refuse 🏈 handoffs during a game because they don’t like the play called by the QB. Plays are reviewed after the game.
Running backs don’t refuse 🏈 handoffs during a game because they don’t like the play called by the QB. Plays are reviewed after the game.
Are there service managers & if so, what’s the escalation process? I managed teams of professionals delivering projects & services in a matrix organisation. Their job was to do the work. Mine was to ensure they had what they needed & worked as a team. Roles, responsibilities, & process were clear.
July 23, 2025 at 12:30 AM
Are there service managers & if so, what’s the escalation process? I managed teams of professionals delivering projects & services in a matrix organisation. Their job was to do the work. Mine was to ensure they had what they needed & worked as a team. Roles, responsibilities, & process were clear.