“If you don’t know where you are going, any old road will do”, so says the oft-quoted quip from Lewis Carroll. I have attended many planning and strategy sessions in which that was used to get audience focus on clarity of vision and plans.
David Duplisea, the CEO of the Saint John Region Chamber of Commerce said it well in his Brunswick News article on Saturday, October 28, 2023. Commenting on the lack of a visible plan for critical issues in the province, of which he named health as one important one, he said: “it’s time to put the cards on the table.” His article went on to observe the great successes of fiscal prudence with surpluses and paying debt while issues of health care and others continue to dog our society and economy with no apparent plan.
In the same edition, commentator Dr. Linda LeBlanc, a prominent medical specialist in the field of Cancer treatment with Dumont Hospital showed clearly, with her interprovincial comparisons, how New Brunswick’s Health system issues have more to do with leadership, vision and direction than with resources. Analyzing her observations and applying them to the issues in New Brunswick, it is safe to conclude that fixing those awful issues that drag the system down and cause the public so much grief is not so much about adding more money to the pot but making intelligent and skillful use of what already exists. I have had sufficient conversations with this prominent physician to understand that hers is a voice worth listening to.
There are many professionals in the health system, medical, administrative, diagnostic, nursing who can express problems and symptoms of issues. But few who take the time or have the ability to get beneath the surface to determine the difference between symptoms and underlying causes. At the root of good medicine is the process of taking symptoms through a process of testing and analysis to differential diagnosis that eventually leads to a full-on diagnosis. Once the accurate diagnosis is made, these gifted people can then bring the treatment regime to the diagnosed situation to help the patient.
The same process applies to the organization of health care and Dr. Leblanc has the right instincts and analytical skill to be able to see a problem and work through to an accurate diagnosis of the situation.
Then along come not one but 12 respected medical specialists at the DECRH who decry, in the October 31 edition of Brunswick News the lack of an apparent plan for reform. It takes a lot of time and resources to recruit and retain quality specialists and their frustration seems well founded in that there seems to be no known or apparent plan for the orderly reform of Health Care in New Brunswick. If the DECRH is not in line for the hybrid surgical suite why not? Was that a decision taken in the context of planning the array of surgical services in the province? In a normal planning process that would have been part of the decision-making at the time of planning the major expansion at the DECRH.
Based on what was reported in their letter, I would wholeheartedly agree with the angst of the doctors. Key players must be involved in such decisions, not surprised by them.
What is concerning to outstanding physicians such as these, and others, is living with the unknown. The need for reforms and upgrades has been evident for a long time. The announcement of Health Reform being a priority set expectations, 4 years ago, of a planning process that would engage the outstanding people who are left to perform services long after the ribbon cutting and the photo-ops.
That we have long waits in Emergency, that we have up to 40% of all acute care beds occupied by people who should not be there, that we have thousands of people without access to appropriate, professional, integrated primary care (they often refer to it as “have no doctor”), that there are inordinately long wait times for essential surgery are all known and have been documented, written about, complained about. And the only thing the public has heard, or those few who heard it on the news for a fleeting moment, is that the health authorities have new board members. No talk of vision, goals, strategy, timeline. In short, no hope for those who need hope.
Accountants and many who seek to make improvements in essential public services always start with the assumption that there will be huge dollar cost additions associated with what is being proposed. That is the public service mentality and has been for generations. Have a new idea? Give us 50 more staff and we will fix it!
But it doesn’t have to be that way, nor should it be that way. The public service is good at what it does which is to regulate and to manage the legislative process. As Dr. LeBlanc points out, haphazard fixes to create a photo op or deflect a headline usually are quite ineffective and rob New Brunswickers of quality care.
What is aggravating to great professionals like her, and to informed people with experience in transformation, is to see the waste of time, money and energy in tilting at windmills when a serious focus on intelligently managing resources that are already available could yield results in fairly short order.
Dr. LeBlanc suggests an Ombudsman as an independent person with some authority to expose and influence some important issues. I would go a step further to propose that, as stated in my last commentary, neither Health Authorities nor government can do what needs to be done by themselves to “right the ship”. Some new thinking that comes from experience and knowledge, as well as experience in reform and re-structuring, must be brought to the table for the purpose of instituting strategies that will have results in real time. our population has been waiting with baited breath for four years.
Dr. Michael Gardham, Associate Professor of Medicine at the University of Toronto published a thorough analysis in the November 2023 Health Management Forum. As he traced the evolution of the health care system in Canada, he outlined how the costs of pharmaceuticals and all that goes into health care have skyrocketed despite the fact that conventional local volunteer boards have been largely replaced by governance creations of government put in their place ostensibly to provide “better governance” over a system thought to be spiraling out of control. But the issues have not been improving with more government intervention but have been getting worse.
General Dwight D. Eisenhower said: “No battle was ever won according to a plan but no battle was ever won without one.” Health and Long-Term Care reform is a battle; New Brunswickers are, in fact, suffering, the worst being the seniors. It seems that so many who deliver care are asking: “What’s the plan, General?”
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.