Sue Rickards, in her commentary on Friday, September 18, 2020, advocated the attack on chronic social and economic problems at their roots. It was a good piece that illustrated the shallowness of much conventional public policy decision-making.
Such has been the case with health care for generations until 1992 when true reform was initiated by the NB government. Taking the first steps to consolidate control and direction of acute care by merging hospitals into regional structures was an important first step. While that was a very difficult, highly-politically-charged step, it was only the beginning. What was to come later would and should make a serious difference for citizens of New Brunswick.
So, why do we still have tens of thousands of people without a family doctor or access to efficient primary health care? Why do we still have huge waiting times in hospital emergency departments? Why do we still have such issues with Long Term Care that cause frequent “backing up” in the emergency department and with acute care beds? And why do we have such long waits for essential surgical interventions? And why does it take 3 months to get a routine abdominal ultrasound? And why, still, do patients presenting with obscure clinical symptoms not get to centres of expertise early, thus preventing months or years of suffering?
Why do we still go from crisis to crisis with health professional staffing? Those, and more, are questions posed frequently by readers of these columns. And they are good and profound questions that deserve an answer. But not the typical reading of a briefing note by an elected official. Not a letter from a Minister drafted by the fine staff who draft letters and reports.
It is time to go deeper. These issues are not new; they have haunted New Brunswick for decades while those of us who pay our taxes diligently, under the Canada Health Act, are entitled to much better. We elect officials on the promise of delivering as promised. And elected officials oversee a public service that is supposed to be sufficiently experienced, knowledgeable and skilled to support government in finding solutions to the public policy issues of the day. And they do recruit some good people and they are compensated accordingly.
So why do these issues linger? Why do so many sit on a waiting list for years “for a family doctor”, or for life-changing surgery? Why is a trip to the Emergency, when recommended as the only viable option on Friday evening, such a dreaded activity? And the elusive crises in the prestigious nursing profession continue to make the media.
At election time, and we have seen this pattern for years, interest groups start advancing their issues well in advance then when the election campaign begins, the platform is loaded up with promises that are symptomatic but not anything that will drive public policy to a resolution. In each election that I have witnessed in New Brunswick since 2006, the promises for health care become so predictable as to be really boring! To the Nursing “shortage” it is said that “yes, we will increase the number of seats in the training programs.” New seats promised many years ago never did materialize and the promise was not even close to a resolution to what is a complex and challenging problem.
But this builds favor with the many thousands of people concerned with this most important issue; therefore, puts some votes in the box.
To the chronic issue of “no family doctor”, the promise in several cycles has been to recruit new doctors. Not even close to a resolution to the problem! But it gets votes from people who don’t know the difference when, in fact, new systems of primary care service, as seen elsewhere, need to be urgently developed.
To those concerned about the wait time for admission to nursing home, the promise of more nursing home beds or a renewed nursing home plan might be sufficiently appealing as to draw some votes. But the promise has nothing to do with solving the problems because the answer to waits for nursing home beds is much more complicated than piling on more expensive real estate.
So how do we get to real solutions to these lingering and frustrating issues? We start by acknowledging that despite the caliber of our public service and the caliber of our elected officials, the past 20 years (or more) has not served us well. Something is missing and where there is a vacuum, something needs to fill it. Professional groups, advocacy groups, civil service, and elected officials surely can agree, when they look at the same evidence, that the public is not now being served effectively. Those in that collection who cannot agree to that basic assumption need some consciousness-raising.
Secondly, those same groups, in a structured way, need to get from symptom to root cause. In discussions with professionals one on one, they know what the real issues are; professional groups, however, have a tough role because they have to represent a broad base of practitioners from old school and traditional to new school, IT based, innovative and daring! And everything in between. So professional groups have a tough time of getting the broad base of their membership to come along with changes that are essential to creating solutions.
By the same token, elected officials desiring to fix important issues, have to rely on public servants who may or may not have had exposure to other systems, different ways of delivering service, state-of-the-art Information Technology and more.
So, the next step, recognizing those practical challenges of helping people to understand the need for change while keeping them feeling engaged, is to find some leaders from other systems where these issues have already been resolved. In previous commentaries I have championed the engagement of External Reviewers. These are not consultants per se. We need to find out who has successfully led major change in Emergency and Urgent Care; who stands out as having really taken these issues on and led to solution. Who are the champions and leaders in Primary Care, for instance?
Who are the leaders who have already dealt effectively with the complex nursing issues that we face? And then we apply the external review to each of the key problem areas, the intent of which is to make sure that we bring to the table the best, most highly-respected counsel possible.
Outstanding university health centres such as Queens and Dalhousie have used this approach for decades which is how excellence is not only achieved but maintained.
The resulting conversations are hard conversations and they are not conversations given to rapid exposure in public; people have to be free to be open, candid, entirely honest, free from the conventional posturing that public positioning requires. The results of these difficult conversations eventually need to get in the public forum but not until all reasonable steps of engagement have been executed resulting in resolution of these chronic issues. The public deserves no less; the public is, after all, the customer; all others are providers of service and must never forget that.
Ken McGeorge 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 book author of Health Care Reform in New Brunswick. His email address is firstname.lastname@example.org
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.