Recent headlines by other professional writers in Brunswick News have said: Build Back with Private Health Care, and Fourth Wave Highlights Health System’s Fragility. Both articles were superb in content and challenging thoughts. It is nearly the end of October 2021 and those observing the scene are waiting anxiously for the reforms promised by Premier Higgs to be announced. The public knows the system is broken, nurses and many physicians know it is broken. Most with whom I speak have limited confidence that government can, in fact, rescue the system.
The pandemic has taken a toll on everyone who works in the health and long-term care system and has forced a level of change and disruption totally unheard of in modern times. It has, in fact, robbed many great people of what once was the joy of going to work every day. The distress felt within the system, particularly the hospital and long-term care sectors, is made so much worse by virtue of the place from which it all started in early 2020. The pandemic has tested every health and long-term care organization; those with great workplace cultures at the beginning tend to fare well as they work through any crisis. If the workplace culture has elements of toxicity, undue work stress, internal communication issues then working through any crisis, let alone one that is prolonged for two years, is a formula for disaster.
Over-crowded waiting rooms, long wait times up to 10-12 hours. The headlines have been in the news for years. Staff do the best with the knowledge and training they have along with systems available to them. But the issues of overcrowding and perceived slow response times continue. Why is that? And what do the health authorities need to do to fix it?
The issues will not go away by simply trying to change a few policies or hire more staff. In my July 22 commentary, I developed the need for strong leadership to deal with some challenging issues. Not until those at the top understand that the “fix” requires more than just talk and more than mere motions and political positioning. It requires a “deep dive” to get to the real core issues, as challenging as that will be.
In 1962, Dr. Malcolm McEachern, the father of modern hospital administration, described emergency departments in his classic text, Hospital Organization and Management. In it he listed 8 critical elements that are required to make an emergency department function and, in the narrative, there was not even a hint that the Emergency Department would be used as a replacement for the doctor’s office! Originally the department was developed for the care of patients presenting with fractures, trauma and other life/limb-threatening conditions. Consequently, he emphasized the basics such as the visible presence of an involvement by specialists, proximity to the operating room and much more. It was a place where those conditions that could not be dealt with in the family doctors’ office could be managed effectively.
So what has happened in the meantime? It is said that at least 80% of the visits to emergency are not life-threatening; serious, important, but not fitting the traditional definition of emergency. They arrive, as has been stated on numerous occasions, because they cannot get access to a provider of primary care services who can deal with the problem. In the old days, they call their doctor. Not so in 2021 for many reasons described in earlier commentaries.
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.