The Brunswick News Legislative Bureau published a front-page article on December 29 giving an assessment of the “rocky road to health reform” in New Brunswick. In it they cited the major goals set by government and showed how Covid has been a set back to reform but how in the pandemic the province eventually was able to break down some silos to get things moving a bit faster.
It was noted, however, that some influential advocacy groups still express skepticism, particularly on the nursing situation.
A subsequent article by Sarah Seeley on January 3 observed the angst being felt by people waiting for access to primary care services including new residents in New Brunswick who have waited three years. The technological measures introduced by government that largely revolve around “virtual care” are stop-gap measures at best and are no substitute for having a relationship with a Primary Care Service provider, be that a physician, nurse practitioner, or an integrated primary health clinic.
Then over the Christmas break, many people in the United States were aghast as Southwest Airlines, challenged, as were other airlines, with the heavy weather issues, cancelled thousands of flights each day for several days leaving tens of thousands of travelers with totally compromised family plans at this important time of year. This happened while Delta and American had minor issues but largely got their passengers to their destinations.
Tom Demerly was a pilot for Southwest for 35 years and wrote an amazing analysis of the organizational history of the Airline. The gist of it is: this crisis, impacting tens of thousands of people and causing such corporate embarrassment, did not just happen. While the organization had a brilliant beginning and was strong for many years, the organization lost its focus with change of leadership and essential corporate investments in infrastructure were not made. This is, in his judgement, in stark contrast to the other major airlines that fly successfully because of major investments in modern scheduling systems for passengers and staff.
As I read his account, it struck me that health and long term care in New Brunswick has had a somewhat similar story: strong beginnings, commencement of major overhaul, then loss of focus. The issues in Emergency Departments, Primary Care, Information processing, Surgical backlogs, Nursing and other health human resources did not just suddenly happen. Looking carefully at the history, major changes have been called for in each of those areas as well as the governance models for decades. A shortage of family physicians is nothing new and the roots of the issue go back 20 years, for instance, and similarly with nursing issues.
R. Buckminster Fuller, that great architect, systems theorist, philosopher and futurist, said: “you never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
So it is with Health and Long-Term Care, very complex systems that desperately need direction. Trying to respond to public service requirements without acknowledging that existing models need to be radically changed if not replaced is just a painful process to watch. Simply recruiting family doctors without announcing a new model of service, recruiting nurses from wherever they come in advance of developing a new model of care is not healthy. And on it goes.
People still express fear that they are going to have to tolerate second rate primary care because they have no idea of what the plan is to move forward. Government gives assurances and sets goals that often are not met, and, frankly, the public is often skeptical of political promises anyway. They are skeptical in health care because many have heard political assurances of better days for two decades.
What is the new model that should be developed? Clearly solo family practice is a thing of the past and government knows that. Perhaps the entire approach to educating nurses at all levels should be re-invented.
Get the right people with the right mindset and knowledge in the same room for a while and new models could be documented in days and it would not require a multi-million dollar consultant bill. The province has some brilliance that has yet to be tapped. But as with the story given by the pilot of Southwest airlines, the people at the table need to have serious experience in and commitment to operating great health systems that work. It is not all about the money.
Government is often accused of too much focus on the budget and the bottom line, yet fiscal responsibility is absolutely important. But experience has shown, as it did in the early days with Southwest, that if you get the service right and are committed to making it efficient and customer focused, the bottom line will prosper. In health care it is dead wrong to start with the financial objective and work backward; on the contrary, the starting point is simply: what service, in what volume, at what level of quality and quantity do we want for the various public groups we serve?
In responding to that question, the policy makers must give all due consideration to the different requirements of various population groups: infants, pregnant mothers, children, teens, young adults, mid-life men and women, seniors.
In the old model of service delivery, the focus has been on maintaining services in each viable community, as difficult, and sometimes nearly impossible, as it has been. Health and Long Term Care requires an entirely different approach to planning, one that I have never heard expressed in our fair province but one that is necessary in order to move forward.
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.