Wherever I go, and with whomever I converse, eventually the conversation goes to the unsatisfactory condition of the health and long-term care system in New Brunswick! Readers of these columns keep asking: is anyone listening? Aren’t you getting discouraged? Do you think anything will really change?
Those questions are framed against decades of growing deterioration of health care at the very basic level as described in the last commentary. The other element framing the discussion is that the Higgs government had a large plank in its platform promising reform of health and long-term care. Expectations have been running high as the first attempt was scrapped, a promised series of public consultations seemed to proceed during the midst of lock-down, followed by the announcement of “a plan for health and long-term care reform”, however tentative, was announced in the fall of 2021.
What puzzles those who are raise the questions is: if the issues are so serious and there seems to have been public mood supporting significant improvement, why does nothing appear to be happening? Why do such “basic things” show no signs of improvement?
On social media you would think it is all the fault of government or a cabinet minister. During the run-up to elections and when the legislature is open, the public discussion always revolves around casting blame, trying to make government look bad and, in the process, make the critic look strong.
But the health and long-term care systems are so convoluted and complex that informed people listen to or read the accounts of those discussions and roll their eyes because they know the truth is buried deeper than can be intelligently exposed.
Politicians get elected based on either a solid party platform or because the public is fed up with the incumbent government. But in the campaign discussions, the real issues seldom, if ever, get serious air time. Politicians must be cautious because one slip of the tongue can haunt them for the rest of the campaign.
Take, for instance, the electoral fascination with “two tier system”. That comes up over and over and simply serves as a distraction from any real issue. The Canadian health and long-term care system has, forever, been based on multiple tiers of financial support. Government is not, nor has it ever been, the sole financier of health and long-term care services. When the system, as we now know it, was first introduced in 1958, there was no thought that all that you could imagine in health and long-term care would be funded by government. Much of what drives cost today was hardly dreamed of at that time.
Yet focus on real issues of primary care, rural health care, governance of the system, training and certification of key health care providers, and regulatory systems never ever get attention during campaigns as they should.
When government is formed, someone gets the nod to be Minister of Health and unless the appointment carries with it the specific instruction from the Premier and Cabinet to Reform the System, key strategic things do not happen. Instead, we get years of promises of training more nurses, recruiting more doctors, adding a nursing home or two, or going to the wall with a collective agreement. All of those things, and more, are part of “keeping the machinery of government going.” But they solve no issues.
Health and Long-Term Care is far more complex than municipal reform for there are tens of thousands of people within the system along with the thousands of people involved in the regulation of the systems that will have opinions and, in many cases, much resistance to some of the most minor attempts at reform.
The regulatory authorities, not typically led by those with experience in health care administration, tend to default to following regulations, balancing the budget, and “feeding the machine of government.” That is what they do and they do that very well; that is what they are paid to do and held accountable by government to do.
But those with education, training and experience in health and long-term care service administration know where the minefields are and can point to the many holes that are in the dike! Those who have successfully led excellent health care organizations, know intuitively that the health system is not meeting any acceptable system goals and is in bad shape. Persons trained in this manner would and should be very outspoken and taking serious steps to correct the failures of the system. The very lives and well being of New Brunswickers is at stake, for Heaven’s sake.
To be in senior management and to fail to put your job on the line to force change in the system is a failure of our system. Strong leaders are typically driven by passion for excellence and system success.
But in a system that is as highly politically charged, as is the case in New Brunswick, there is a low tolerance for outspoken persons in the system; rather, tolerance of the status quo with its mediocrity has been, for years, the order of the day.
It is not possible to get the brokenness fixed while playing it safe politically at the same time; the required changes are a matter of principle, not of popularity. The instability in leadership in the health authorities and in the departments that regulate health and long-term care speaks volumes.
The changes needed to redeem the system are not simple fixes; on the contrary, they require intimate understanding of exactly how the system works, who influences its operation and at what levels. It requires an intimate knowledge of the principles of Lean Six Sigma applied to the most sensitive elements of the system.
A strategy that succeeds in rescuing the system will make the majority very happy; nurses, physicians, the public, the paying agencies. But all successful change comes with a price and there will be some that are not so happy. For the most part, those who will resist the essential reforms are those who do not fully understand how the system works, whose careers and compensation models are sufficiently attractive that any change seems a threat, and those who are so near retirement age and have managed to survive until pensionable age, for whom any major change can be a real threat.
None of these reactions should be severely criticized for they are natural human responses to change; response to change at any level is normally born from lack of knowledge or a perceived threat to one’s well-being. Resisting change is not, in itself, evil. It is a failure of leadership, however, when those in leadership roles fail to understand the sources of resistance and work with them toward the essential goal of fixing broken systems. How could anyone disagree with reducing surgical wait times or improving access to primary care or clearing out the 12 hour waits in Emergency Rooms. Gathering people around a shared vision is job number one for leaders.
Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at firstname.lastname@example.org or www.kenmcgeorge.com
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.