In all the noise made in public about health care issues, the pleas from interest groups, unions, associations, societies, almost without exception, are for “Government to do more; we need more…..”
Seldom does one hear any discussion about issues of efficiency and effectiveness of the current services and systems. Why is that? It goes against the grain of interest groups to acknowledge that there may be other ways of achieving better service. And because health care is a highly-charged political system, majority governments have only 2-3 years at most in order to make a dent in improving one of the most complex and convoluted sectors of our society. We, the people, have a love affair with our health care system and heaven forbid that any politician should do anything to offend my doctor or my daughter, the nurse, or all those other people who the public believe to be working very hard to keep services going.
When we, the people, are investing $4.6 billion each year in services targeted at making us better or helping us in our last days of life, we have every reason to be asking the simple question: are those funds being deployed efficiently and effectively? And if someone wants me to believe they are, where is the evidence to support that assertion? The Auditor General has had occasion, in recent years, to raise issues that get little response in public policy.
For instance, in the field of primary care, it has long been established that much of the first-contact care required by people could be given by nurses, LPNs, NPs, Physician Assistants, EMTs and more. Some physicians, in moments of candor, have acknowledged that much of what “occupies my time in the office” could be done by a good Nurse and there is much evidence to support that. Progress on developing a properly integrated system of primary care, a system that will cause “orphan patients” and “over-crowded emergency department waiting rooms” to shrink, has been constrained by lack of vision, leadership and the compensation models.
To the topic of insufficient nursing staff, one needs to ask basic and pertinent Lean Six Sigma questions: what is the nature of the work? Can the work be performed by someone else with a different level of training? Are methods and systems efficient or is there redundancy in the system? And what about the methods by which clinical staff are supervised? Who drives the culture? Who zeros in or absenteeism? Why has the Magnet Hospital initiative failed to take off in New Brunswick?
Long-term care is yet another story. For over 40 years the planners have wrung their hands about the aging population and the dilemma it would present. For two decades, informed people have sounded warning bells and have tried to get more coherent development in long term care. For at least two decades, governments have conducted either a Seniors Study or a Long-Term Care study and to what end?
The evidence continues to point to the structures that finance, manage and regulate health and long-term care. Using what already has been proven in other jurisdictions can, and will, rescue our system but only with focus, strong leadership, and the will to confront that which is not functioning.
Ken McGeorge,BS,DHA,CHE 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 and author of Health Care Reform in New Brunswick. His email address is firstname.lastname@example.org.
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Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.