On November 22, 2022, Bill 21 was introduced in the Provincial Legislature by Hon. Bruce Fitch, Minister of Health. Not a lot of fanfare, no parades or demonstrations; the legislation just got through the process of first, second and third readings leading to vote to approve. I don’t recall any press headlines.
Yet it was a decision with some real significance for health care reform in New Brunswick. In the history of this great province, and particularly in the past 3-4 decades, serious decisions on health care have been made amidst significant political push and pull pressures. The Regionalization of Hospitals in 1992, the creation of two health authorities in 2009, the hiring and firing of health authority boards and CEOs, the construct of the health authority boards, the follow up, or lack thereof, to the Council on Aging Report of 2017, the development of the Waterville Hospital at a final cost of well over $100 million, and the list goes on. A scan of media headlines over the years will show how important decisions that have serious impact on public service and the health of New Brunswickers get influenced, if not finalized, by virtue of the noise created in the public square.
The “noise” is a strange mix, typically, of legitimate concerns about quality health and long-term care issues along with positions taken by groups or persons with interests that may not be directly related to advancing quality of service. Think back to the headlines that have led to significant public attention over the past two decades. The general public has difficulty in discriminating between what is totally factual and sound information and that which may not be absolutely based on exhaustive factual analysis.
The New Brunswick Health Council was established in 2008, having been discussed as a great idea since the early 1990’s. The early thinking was that it would become a source of sound research in the health system that would inform best practices in health and long-term care and would be a source of evidence to be used in decision-making regarding clinical programs and long-term care throughout the province. But the legislation and direction of 2008 stopped a bit short of that role but did allow for the creation of an organization that has, under the capable leadership of Stephane Robichaud, amassed much data on anything you would care to know about the health system in New Brunswick.
Many academics and authors of newspaper columns have sought out great information from the website and publications of this organization. And we, the listening public, frequently hear Mr. Robichaud on CBC talk shows as he discusses reports released by the Council on a wide variety of important topics.
The challenge for those guiding and directing the health and long-term care system in New Brunswick and its essential reforms is the gap between data and real live practice. Julie Weir, the CEO of the New Brunswick Nursing Home Association, in an op ed in the TJ on Saturday, April 29, made the strong case for the need to develop best practice standards in long-term care. And she is absolutely correct; the need is more than serious. In that sector, there are 72 nursing homes governed by volunteer boards that are located in rural, small town, and larger urban areas. None has the resources in their funding base to be able to conduct extensive research to support key decisions although a small number have sought out relationships with professional researchers.
In addition to nursing homes, providing care to some 5000 residents, there are over 400 special care homes serving 7000 residents and a home care system that provides service to hundreds more.
In the reform of health and long-term care, as with the reform of any other organization or sector of society, it is pretty wise to make hard, reliable, timely, accurate information the starting point. Banks do that in loaning funds (and pay dearly for any errors); hockey teams do that in acquiring the mix of players required to win the Cup.
Similarly, in health and long-term care, where do you turn to get great, timely, relevant, accurate information on what are current standards of practice, or “best practices”. And what is meant by “best practices”?
Years ago, a Nursing Home with which I was affiliated, was part of a major international research consortium and one of the first target areas was the use of anti-psychotic medications. This has been a huge issue in long-term care for years and has been a real sore point in New Brunswick. Based on those interactions with the group, and research conducted by our own staff, we figured out some real alternatives to the widespread use of these meds. Now years later, there is best practice information known and documented with the remaining question of how do you routinely apply that information.
From my experience in the acute care field, many years ago, when faced with issues of the care of small babies born prematurely, teaching hospitals created the concept of the neonatal intensive care and that has become the gold standard, or best practice, for the care of babies born prematurely or with low birth-weight.
Years ago, the Canadian Council on Hospital Accreditation became a real national source of exchange of best practice information; those who follow the accreditation process are required to adhere to a discipline that certainly is a strong contributor to use of best practice information throughout the organization. It is not perfect but typically it sets organizations apart from others. The standards, for both hospitals and long-term care, provide essential guidance not only for clinical care organization but for the governance of the facility.
But policy makers in New Brunswick have had the challenge of figuring out how to take that wealth of information created by the Health Council and translate it into “actionable data”. That is the term used in the advertisement for board members of the Council. There is a world of difference between data and actionable data. To make data actionable one needs to understand what is involved in the application of the data and whether the system leaders are prepared to support the “actions” indicated by the data. In this small province, data might suggest that a system of health centers feeding into a limited number of superb regional centers is probably the most efficient and effective way to deliver great health care. But is that “actionable”? Similarly, it seems that multi-disciplinary primary care centers are common in other provinces, but that has not been actionable in New Brunswick until recently, yet certainly is the way of the future. There is much data to support that direction but is that actionable in New Brunswick?
The missing link in many health and long-term care debates in the past has been: What does the evidence tell you? Forget your biases, your anecdotal experiences; what are the facts?
Health and Long-Term care have always been and will always be highly politically-charged for many reasons. Everyone, every physician, every nurse, every EMT, every elected official has an opinion on how things can work better. But well-researched, honest, fair, comprehensive data can, and should, help to counter much of the noise that otherwise either compromises decisions or, sometimes, even prevents them altogether.
It is a tough assignment for the new board of the Health Council, but it is an assignment long-overdue and, if done well, can make a huge contribution to health and long-term care in New Brunswick.
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
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Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.