My book by this title commences with this question on the inside front cover because I wanted readers to understand that making our health system work for New Brunswickers is not about simple improvement but about transformational change.
Being a writer was never in my career path at any time until the opportunity afforded me nearly two years ago by Brunswick News. They asked for a series of commentaries on Health Care Reform and I was only too happy to oblige. It was, in fact, a labor of love for me because I, like thousands of others in the health and long-term care system, have seen so many events happening, policies announced, projects approved for which there seemed often to be a gap in logic! Many days I, and many others, would end the day with many questions about the wisdom of decisions and strategies.
But we could never express reservations because of the system. Good people with wise insight who are “in the system” must be very careful in what they say and to whom they say it. In the time that I have been writing columns I have heard from many who are reserved and just say “keep doing what you are doing.” For many of us, speaking truth as we knew it often could put our careers in jeopardy; for some of us it did.
During Covid-19 we are all urged to “follow the science” on issues of medication, treatment, prevention, mitigation, masks, social distancing. Yet in the broader health system decisions all too often get made for the wrong reasons. Sometimes these are small decisions, sometimes they are huge mega-million-dollar decisions.
In writing columns, once the first two or three were published, I began to hear from superb people; some retired, some within a few months of retirement, some very eager to retire. I have heard from patients and families from across the province who often tell tales that lead me to wonder: can this really be the case? And usually, on checking out some facts, it is the case. I have heard from people who desperately seek quality mental health support for a loved one with stories that are defensible and true. I have heard from all too many, particularly in the senior age bracket, who have no family doctor.
This is particularly tragic since it is 19.9% of people in the senior age group who have 3 or more co-morbid conditions which makes them prime targets for the annual influenza season and Covid-19. Just in recent weeks, anecdotally some large practices seem to have closed leaving people to fend for themselves.
Prior to and during the failed attempt at reform in February, there was not a week that went by without some serious public discussion about unacceptable wait times in the Emergency Departments of major hospitals. All this, of course, fed into the resistance from rural communities that contributing to the stepping back from the closure of these services.
There are some clinical services in the province that work really well and about them we need to be proud. But there are others that illustrate the need for upgrade, modernizing the organization, consolidation. And who can forget the years of discussion with only incremental progress in getting this fairly small health system properly digitized. The world, in this area, has passed us by leaving much catch-up to be done.
So, with much encouragement from persons of influence in the province, I set about to consolidate all of the columns into a book. In the book you find the various columns gathered together in topics such as Primary Care, Seniors and Long-Term Care, Nursing Issues, Pandemic and Covid-19, and a major collection on Health Care Reform. For the reader, there is a preface and Introduction that sets the stage for all that comes after. Then there is a summary that tries to tie health care reform together. Warning to reader: this section is controversial because it lays out the big elephant in the room that never gets discussed in terms of health care in New Brunswick.
So why the title: Health Care Reform in New Brunswick? It could be called something more politically correct like “We Are All in This Together”, or “Improving Health for New Brunswick”. The choices are endless. This book is not about making readers feel good. It is not, by the same token, about creating widespread discouragement. But my mentors over the years, trying to help me in leadership roles, taught me that “if you cannot name it, you cannot change it.” Glossing over the real issues will simply get us more of the dissatisfaction that exists at many levels.
Ichak Adizes, one of the foremost corporate analysts and consultants in the world, uses a corporate life cycle chart that shows what happens to organizations that do not renew themselves. The last two phases of the cycle are Bureaucracy followed by Death. He says: “Often an organization’s biggest problem is an inefficiency in solving its own problems. Solve this problem and everything else falls into place.”
It was his teaching that helped us understand the need to create a compelling vision at York Care Centre. Once that was done, so much of what led to the Centre of Excellence level was much easier to accomplish.
Back to the title: what is the difference between Reform and Organizational Change? True reform happens when those in authority acknowledge that the issues are huge, the issues may not be what they think they are, the central core issues may not be readily visible and identifiable, some of the central issues may not be universally popular, and that the customer is worthy of respect and engagement.
True reform can begin with some real pain and usually does. All those “elephants in the room”, the things that people never discuss for fear of recrimination, sometimes the things that leadership has not even considered…………all need to be identified and on the table for analysis and prioritization.
Organizations that have the courage and stamina to sustain such a process endure some initial pain but always come out at the end stronger and better. It does take real courage to admit that what you thought was the issue really is not the central issue at all.
It will take wisdom, courage, talent, persistence, and a lot of humility, not to mention tact and diplomacy, to work through the process that will make the NB Health System the model that it can be. But it will not happen using conventional approaches to planning in health care in the province. The 1992 regionalization of hospitals was a plan done behind closed doors because it could so easily have been torpedoed. It was an activity that had been recommended by experts for 30 years. It was tough but it got the job done.
That started a process in place that has been all over the map since the late 1990’s. The one thing that leadership has going for it now is a general awareness amongst the public of the need for major change. This book is not a prescription but simply a tool to stimulate the discussion that is needed amongst intelligent people to move to reasonable changes.
Ken McGeorge is a retired CEO in major teaching hospitals and long-term-care facilities. He was co-chair of the New Brunswick Council on Aging and is a columnist with Brunswick News. His email address is firstname.lastname@example.org.
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.