Premier Higgs is a professional engineer and engineers and accountants have one thing in common: numbers and formulae. And it is good that they do or the world would be in a bigger mess than it is.
What was eye-catching, however, was the headline on Wednesday, November 8, 2023 that said: No Politics in Hospital Decision. According to the article, he was referring to his meeting with doctors in Fredericton who had expressed frustration that the new, multi-million-dollar Surgical Suite project at DECRH would not include state of the art imaging equipment. Apparently, the equipment that makes it a hybrid Operating Room will be going to Saint John Regional instead even though the Chalmers Foundation is interested in raising the funds to purchase the equipment required to create the hybrid status.
Does that sound familiar?
In the 1970’s, the Moncton Hospital was the first to acquire a CT scanner with their hospital foundation raising the funds to make it happen. Soon after that, CT scanning was in place at Saint John Regional Hospital. By the mid-1980’s, Fredericton was feeling the need and by then, in other jurisdictions, the CT scanner was becoming “a basic tool of medicine”.
The Chalmers Foundation, at that time in its infancy, raised the money and soon a CT scanner was installed at DECRH. Apparently, government had a plan to place a CT scanner in the DECH and eventually they did pay a significant amount of the cost. But at that time, the three hospitals were defined as “regional hospitals” and the DECH was doing some significant vascular and chest surgery, along with some serious orthopedic work so by this time, in other centers, the CT scanner was a normal tool of the medical profession.
Then along came the Magnetic Resonance Imaging technology in the 1990’s which was, by then, commonplace in major medical teaching centers. Major hospitals in New Brunswick were lobbying for access to MRI technology and a mobile unit was purchased to serve Saint John and Moncton. Then later in the 1990’s a mobile unit was secured to serve Fredericton and Edmunston, then a third mobile service was introduced in Bathurst serving Miramichi and Campbellton. Meanwhile, stationary units were secured for Saint John and Moncton. Within a few years stationary units were installed at all the major regional hospitals.
What often is not understood either by policy-makers and the public is that the purchase of the equipment is only where it starts. Supporting the new technologies requires not only medical staff to become trained in that technology but it also requires teams of highly talented technology staff and support staff to not only become trained and certified but to undergo annual up-dates in knowledge and to work shifts that will enable the equipment to be used efficiently and effectively. The operating costs, over time, make the cost of purchase pale in comparison.
In advocating for health care reform, I have often decried the fact that in this small province, the mechanism has never been in place to deal with the complex topic of Technology Diffusion. This is a mouthful that simply refers to the public policy issue of getting innovations from the research or factory then to the point of use in our society and economy.
South of the border, those decisions are not too difficult with hospital chains doing the math and along side the stated need and advantage, the owners then determine: is there a business case for making this multi-million-dollar investment. It seems pretty black and white. And they need happy clinical staff to keep financially afloat and they know that many of the new technologies will help to keep them engaged.
In New Brunswick there has always been a provincial capital budgeting system in which the process of getting technology placed has been a bit of a mystery to clinicians, administrators, foundations and boards. In a province in which the system is, in effect, managed by government, it is hard to see that these decisions do not have a very large political overtone.
Physicians and other health professionals go to the annual meetings in which the newest of imaging, lab, and computer technology is on display with strong marketing personnel on hand to ensure that attendees get to see how these systems can revolutionize their practice. Having attended a few, I remember the sense of awe and returning home with a sense of how out of touch we often are. The Radiological Society of North America is one such meeting, held annually at McCormack Place in Chicago. Attendees are offered a steady round of workshops in addition to equipment from every supplier in the field with demonstrations given by professionals with great communication skills.
Physicians remain current in their practice by periodically attending such events, by attending professional meetings and by incessantly reading journals such as the New England Journal of Medicine, the Lancet, the British Medical Journal and many other that keep them up to date on best practice. And the best professionals I have worked with have a built-in drive to ensure that everything they do is based on best practice.
That is quite different from simply following fads which is easy to do.
So how does the province, with its newly minted boards and proceed to ensure that there is science and evidence and not sheer politics in determining what technology goes where?
The Health System Collaboration Council was part of Bill 39 that created the new health authority boards. Its stated purpose is to create a plan that will govern such decisions. It starts with picking up on the work initiated in 1992 when hospital regionalization was introduced under the guidance of Dr. Russ King, Minister of Health, and Jean Guy Finn, Deputy Minister. The process of defining the roles of hospital facilities was commenced as a first step in laying the groundwork for defining service levels in each over time through the governance process. That process of defining systems and structures got sidelined by a series of political interventions and has never been picked up and finished, apparently.
In this small province that needs to value and retain highly talented professionals, Technology Diffusion strategies must engage those professionals in a meaningful way. The old adage of “justice must be seen to be done” applies here. It is not practical to have each and every physician personally involved in Technology Diffusion decisions but they sure must know that there is a process and that their professional leaders, such as Departmental Chief or Chief of Staff or Staff leader, have a visible role and means of engagement in the process.
So, the job now for the Council and New Boards is to start over again by announcing a plan for health care reform that will define regional hospitals, clinical resources required and service levels, programs to be supported all as a precursor to laying out a plan of Technology Diffusion.
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 email@example.com or www.kenmcgeorge.com
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.