​Health Consultations: What will the Minister hear?

Consulted to death?  More talk?  Where’s the action from the last round of consultations?  The public can be forgiven for feeling skeptical because the health field has been the most “consulted” field in our society.  In this province, consultant reports were presented in the 1960’s and finally acted upon in the 1990’s-but then, only in part.
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Why the timidity on the part of governments?  Why does common sense need more consultation?  This round of consultations is taking place because government tried to implement what they thought were logical steps in healthcare reform in February 2019.  The logic was clear:  acute care beds occupied largely by frail elders in small hospitals should be re-classified as long-term care beds.  Because small, rural emergency departments only see 2-3 patient’s over-night, why would you keep a doctor and nurse on staff to cover?  Tim Hortons would not do that?  Economically it does not make sense.  I would guess that the cost per visit would be exorbitant relative to the cost per visit in a high-volume centre.

But health care service has never been about logic; it is about the provision of quality service at a time and location that is accessible on short notice by the patient requiring care.  In urban areas, no problem; everyone knows where the H-sign is and expects to be cared for there.  But rural areas are a whole different ball game and the February issue became a firestorm when urban-dwellers tried to impose an urban solution on rural people.  Adding insult to injury was the quote from the Premier that said, of all the measures they tried to introduce, the “emergency department issue was not the most important one.”
The real problem was that the plan seemed to have been created in secret with no attempt to engage either the people who live in rural New Brunswick nor those with expertise in rural health care services.  It illustrated the issue so fundamental to good public policy which is that urban solutions cannot be easily transposed to rural communities.  There is, and has been for a long time, a communication divide between those who plan and regulate service as opposed to those who deliver service.

What the minister should be hearing is some new themes that start with rural health and long-term care.  Put a regulatory framework into place that recognizes that as long as our economy requires seafood, lumber, agricultural products there will always be a rural population.  The health and long-term care system need to respect that and those in planning and regulation need to learn some new skills.  That really is what the rural mayors are saying:  communicate with us, take us into your confidence, let us be part of planning our health and long-term care services.

As an extension of that theme, the minister may hear from some informed persons that the organizations that govern health and long-term care need overhaul.  Some physician groups, I am told, believe that the centralized health authority administration does not serve the public well. 

She will hear about the family doctor issue but will probably not hear much about the desirability of adopting other models of primary care services.  The public still is of the conviction that everyone needs his or her own family doctor and that is a marker of success. The public is to be forgiven because that is the old-fashioned model of primary care that has been in place for generations but shown to be quite inefficient in a current context.  The proper message to the Minister is:  let’s try alternate models, lets insist that health care providers work in teams and that compensation models be amended to reflect team practice, not individual practice.
 
I hope that she hears about the terrible length of time that is required to make even the most basic change in health and long-term care.  How many years do we have to wait to see visible progress on the Dementia Strategy, for instance? 

What she will not hear is the issues in the regulatory processes of health care.  Government departments, populated with some terrific people with great skill, tend to operate with “role ambiguity”; is the job one of regulation or one of management or, even, micro-management?  Public Servants, armed with regulations and expectations, have the very serious job of regulating complex care systems without necessarily having had experience working in the system being regulated.  For years there has been tension between service providers and service regulators attributable to role ambiguity.

She should hear much from the small number of organizations that represent persons suffering with uncommon diseases and it is true that for those who experience the “mainstream of ailments”, for the most part there is great care available in NB.  For those whose diagnosis is obscure and they present with challenging symptoms, there often seem to be challenges.  In one major hospital in which I worked, we had a Clinical Investigation Unit in which persons with obscure symptoms would be subjected to testing and diagnostic processes by a multi-disciplinary team until a diagnosis could be confirmed. 

Health and Long-Term Care Leadership training is probably not something that will be conveyed by people yet that is absolutely critical.  Serving in management and leadership roles in health and long-term care, whether as a Nursing Supervisor, Lab Manager, Assistant CEO, Director of Human Resources or any of the thousands of other supervisory/managerial jobs is tough!  Managing people at the best of times is tough.  Managing people who are distressed and feel overworked is really tough.  The difficulty is exacerbated if the manager has not had the benefit of broad education in health care organization concepts and the leadership skills required to excel.

The gold standard for leadership in health and long-term care is certification in the Canadian College of Health Leaders.  Dr. Malcolm MacEachern is known as the Father of modern Hospital Administration and nearly one hundred years ago recognized the need for physicians, nurses, pharmacists and others playing roles in managing health care to have advanced training.  From his leadership, educational programs were established first in Chicago, then Toronto, then in most major universities across North America.  These programs, together with the professional development programs that were also developed, caused a growth in the professionalism of health and long-term care management.

Many of the issues that land on the desks of politicians often could have been resolved long before they actually became issues; but not without serious commitment to ensuring that all players in this complex system have the training that match their daunting responsibilities.

The Minister will hear from advocacy and union groups, all good people with talents but focused fairly narrowly on their program or their professional discipline.  The Minister’s task will be to sort out the anticipated messages from the strategies that, albeit obscure, will make a real measurable difference in health and long-term care.

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 [email protected].