Premier Higgs has announced a health summit in June 2020 at the conclusion of a 3-month period of consultation with people in the province on health care issues. John McGarry, Chair of the Horizon Health Authority Board of Directors, has appropriately said that the summit must concentrate on more than rural health care issues and he is absolutely correct. Since the province started down the road of a planned approach to health care in 1992, there has been a long drought! Instead of rain in response to the drought we have seen for decades now a series of unrelated initiatives leaving the health system resembling a patchwork quilt.
There have been many health summits in recent years. During the term of David Alward, the Canadian College of Health Leaders and the Institute on Public Administration, both New Brunswick Chapters, held a summit in Moncton with Minister Flemming and Jeffrey Simpson. Not much has happened. Then the NB Medical Society sponsored really well-organized event involving some national leaders early in early 2015. What is aggravating to those of us close to the scene is that hopes get built up when these events are held and supported by our leaders. At both of these events, and there have been more, many of us walked away with a new spring in our step expressing hope and optimism.
You see, everyone involved in health and long term care in New Brunswick has been looking for change for many years. But we all define change differently and there never has been a way to get a compelling vision for change articulated.
As Ichak Adizes, the world authority on such matters, often says: a vision must be compelling, motivational, unifying and simple to repeat. Health care in New Brunswick has not had that since 1992, if we even had it then. Each government in the past two decades had felt obligated to produce a Health Plan which seems to create some expectations for a session of the legislature but not much more.
Good people, consumers and health providers, will respond to a vision that ignites and inspires. Cutting and closing does not inspire. Achieving Excellence does! No one with whom I work wants to work in an environment of mediocrity or poor service. Yet every day we place practitioners in those environments and expect them to perform.
By establishing a vision that excites and ignites, we then have to follow that with actions that support the vision. If we say that we want Excellence in Emergency Care then subject clientele to waits of 10-12 hours, “the truth is not in us.” The truth is that it is possible to get to a 30-minute standard for time-to-care. And it is possible to establish hospital-sponsored Urgent Care Centres that provide efficient service for those huge numbers of non-life-threatening conditions that present each day.
But executing on that vision is where it comes apart. In this environment, you cannot effect change with influential and powerful groups such as nurses, doctors, the larger array of health professionals and unions entirely by edict. They need to know and embrace the vision then they need to see what are the steps that get to that vision. This is the job of seasoned and effective leaders.
It would be all too easy to assume that the resistance to the plan as announced by the health authorities simply reflect a stubborn resistance to change, but that is highly doubtful. General Patton is quoted as saying, of his officers, “they won’t battle the plan if they have helped plan the battle!” It would appear that somewhere, somehow those who feel most impacted by the proposed changes did not feel part of the battle.
So one key outcome of a Summit on Health must be a sense of engagement by key people in the province. With each “summit”, the good people looking for focus and direction emerge with a heightened sense of frustration. Traditional government-led consultations are very predictable and, for the most part, participants leave knowing that decisions have already been made and the consultation was for public relations benefit. I have attended many of those run by governments of all stripes.
Now it is certain that the entire population cannot be personally involved in shaping change; but it is possible to create broad consensus when the vision is clear, people are led and not driven, and key ambassadors are helping to advocate.
The Summit will be yet another gathering with good coffee, a predictable round of speeches and good fellowship unless people feel that it is going to get beneath the surface to deal with issues that have been masked over for decades. One such issue is the Nursing Issue, incredibly critical to great health care but dealt with only on the surface by media, politicians and interest groups. There is a whole world of issues there that need to be identified and committed to strategy starting with Advanced Training and Certification, Professional Recognition, working to full scope, education, the role of non-RN professionals, and much more.
Primary Care has many critical sub-headings. It starts with defining what we mean by Primary Care, determining what the federal legislation says about the rights of citizens to primary care services, figuring out the gaps in services, the various levels of inefficiency, what role each health professional should play in providing quality, efficient primary care. This is not just a GP and NP issue and simply adding NPs to the mix does not, in itself, create system effectiveness.
Some of the great primary care takes place when doctors, nurses, family practice nurses, nurse practitioners, social workers and others work together in integrated teams. New Brunswick is not ready for a widespread move to this model, but the province needs to adopt some models and ensure their success by careful, deliberate, intentional management. Success does breed success and eventually primary care can morph to a model that better serves the public including quality, integrated Urgent Care.
Creating Centres of Excellence is another; Cardiac Surgery at Saint John works ever so well with high standards and great outcomes, largely because we do not have 2-3 struggling programs competing for resources and skills but because talent, technology, and infrastructure have been concentrated where people collaborate for excellence.
The province must take the same approach with each of the clinical subspecialties that ensures that professionals collaborate, that we recruit the very best to each specialty and that in recruiting the system can attract and retain a system of sub-specialties. In so doing, as in primary care, each specialty must develop advanced trained nurse practitioners, physician assistants, and technology support in order that the program can offer the high standard of care that the population requires.
Getting to Excellence in all health care programs will require strong leadership to execute a strong and inspiring vision. While that vision inspires great people in health care, taking the steps necessary to get to excellence and remain at excellence requires great leadership skills. Engaging highly intelligent and often self-willed professionals is just a part of it; then inevitably there are the issues of dealing with those who are not inspired by the new direction and vision.
The Summit will be a great place to start; we need to manage expectations by asserting that the proof will be seeing the plan to move forward and who will drive it.
Ken McGeorge, BS,DHA,CHE is a retired health service executive, a part time consultant and columnist with Brunswick News. He can be reached at firstname.lastname@example.org
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.