Health and Long-Term Care Reform: drain the swamp

Municipal reform in New Brunswick, having been discussed and debated for 40 years, has finally gotten off the ground!  The Finn Report, published in 2008 and prepared by Jean Guy Finn, one of the outstanding minds in New Brunswick in public policy, finally got some traction with government.  Is everyone happy?  Not entirely.  Will the initiatives underway yield serious improvements in local government?  Undoubtedly so.  Are there major hurdles to be worked out?  Of Course.  That is the challenging process of changing structures that touch on the lives of New Brunswickers.

Are everyday New Brunswickers attentive to the issues that remain outstanding?  Not really because life goes on, the sun has been shining and moose season is upon us.  But the people most impacted, the mayors, councilors and officials of local government remain concerned about the details of funding, cash flow.  Their concerns, as I hear them expressed, are a repeat of the major, sometimes explosive, concerns of implementing health care reform in 1992. 

But this change now would not be happening if the key ingredients had not been in place, namely the plan, secondly a government strongly committed to implementing a form of reform, and a cheering section to push to help in the process, namely some seriously knowledgeable people around the table of the Coalition of Concerned Citizens.

Change, however essential in the structures of public service, seldom goes as planned and intended; the political repercussions are always the unplanned and unintended consequences with casualties often resulting in sad human stories.  But it is necessary.

Similarly with Health and Long-Term Care.  Jean Guy Finn was the Deputy Minister and offered terrific leadership in the public service when the first wave was instituted in 1992 which had been based on several consultants’ reports followed by the McKelvey Levesque Commission Report.  The first phase, collapse of over 50 hospital boards into 8 regional boards, took place with much fanfare and controversy.  It was the first bold step in reform of the health and long-term care systems.

So now, for reasons described in these and many other columns in recent months, New Brunswick is faced with the demonstrated need for visible and decided action on the “plan” announced in the fall of 2021.  While two Task Force Co-Chairs have been appointed and are working on the issues through the system, and while the ax fell on the health authority boards, some observers query what is next and what is the plan.   Aside from publishing the 5 pillars in the fall 2021 announcement, the “plan” has not been revealed.
But then in 1992, the “plan” was not revealed either but the newly-created regional hospital boards were expected to simply proceed with their respective mergers of hospitals in their regions.  Beyond that, the public was not aware of further plans relative to services.

What is different now is that rather than the political concern for fiscal health of hospitals, government and the public are in a state of urgency if not emergency with Primary Care, Emergency Departments, Hospital beds filled with seniors waiting for long term care, health human resources shortages.  This was not the set of circumstances being dealt with in the reforms of 1992.

So now what form of plan is essential?  “When you are up to your neck in alligators, it is difficult to remember your initial objective was to drain the swamp!”  So goes the much-used idiom from those who teach time management and planning.  To the observers in New Brunswick, it has appeared that the alligators took over the swamp a few years ago.  There has been much talk, many seniors and-long term care plans, at least two health plans in recent years, many promises, and most recently the Task Force Co-Chairs with the plan announced in 2021.  

In the health and long-term care field there have been some CEOs that were trained and experienced and became what was dubbed “turnaround CEO’s”.  These have been people who, through their training and education, came to understand the clear difference between organizational stagnation and mediocrity and excellence.  I have had the pleasure of knowing some of these “turnaround-CEOs” at various stages of my career and learned what they do differently from CEOs who choose the safer path of organizational maintenance.  I had the pleasure to use what I learned in a few situations in which I was engaged.

Health and Long-Term Care is one such situation at this time.  When my “turnaround CEO” friends took over a hospital, large or small, that seemed to be in trouble, his or her first mission was always to get an accurate read of the situation, take a short time to figure it out and a short time to work out a strategy then to start the process of repairing and draining the swamp.

The same principles apply whether you are cleaning up a hospital that has gone awry, a long- term care facility, or a system of health organizations.  In getting a clear read of the situation, the leader seldom has the luxury of lots of time for the alligators are snapping and need to be either fed or relocated!  In health care and long-term care, we have a public, many frail elders, who desperately need great primary or long-term care.  Then we have doctors, nurses, and so many other providers of service who need clear definition of where they fit in draining the swamp and where they fit afterwards.

Yet to do all that is required to “drain the swamp” while awaiting a carefully constructed long term service plan is just not feasible; if draining the swamp is delayed pending final plan completion, the population will wait a long time before seeing improvements in the very basics of health and long-term care.  So, the key is to accelerate the draining process while aggressively getting a solid plan for future system development completed.

The health and long-term care sectors in all provinces were strained prior to the pandemic.  The pandemic has accelerated much deterioration, has accelerated many to choose retirement and redirection, thus contributing to the human resources crisis.  All the characteristics we complain about now were present in 2019; Covid just put a real floodlight on them and made us all just a bit more edgy.   Covid seems to now be in the endemic phase and we have to learn, as we did with influenza, how to live with it and adapt our practices and lifestyles accordingly.

Draining the swamp involves getting the governance of health care fixed and that will take some time in itself; but it is essential to moving forward.  Getting services properly distributed in the province, discussed in NB for the last 30 years, needs a plan to move forward and that planning can go in parallel with swamp-draining.

Fixing Emergency Care and Urgent Care needs executive leadership, not more studies.  Speaking with some of my trusted clinical colleagues across the province, they know and understand emergency care and have thought through some great initiatives to fix the issues.  But I remain unconvinced that their wisdom has been seriously engaged.  Yet they are there on the front lines.

A prominent medical director of a large emergency department in Ontario had the huge overcrowding/long wait time in his emergency department so he became trained in Lean Six Sigma, learned and applied the knowledge, engaged his colleagues in real overhaul and soon…. empty wait rooms and time to care reduced from hours to minutes.

Let’s plan for an exciting new and energized health and long-term care system, but let’s get real problems faced by real people solved at the same time and in real time.  Leadership and execution.
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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 [email protected] or www.kenmcgeorge.com