​The Language of Health and Long-Term Care Reform: new to most in the system

The public service provides the stability and due diligence required in order for a society to benefit from government-legislated or approved services.  Maintenance of roadways, water and sewage systems, providing emergency measures services, policing and ever so much more.  Government legislates, the public service executes and regulates.  That system has served our civilization well for centuries.

New Brunswick has been blessed, over many years, with superb public servants, many of whom are called back into service long after retirement by other agencies and governments, the private sector, and more.  Brilliant would be a label attached to some of the leading civil servants with whom I have worked.  Loyal and dedicated would also apply to many.

Every service regulated and overseen by the public service, however, needs to be changed regularly in order to prevent stagnation and to ensure that public funds are used wisely based on current knowledge and best practice.  Such it has been for generations with such things as ferry services, property assessment systems, public education, natural resources, the fishery to name just a few.  Failure to adapt would mean, for instance, fish stocks could be depleted prematurely or lumber becomes scarce or rivers become unduly polluted.

So, it is with health and long-term care.  Methods of care implemented 50 years ago are, in many cases, totally outmoded today. While the health and long-term care impact of the aging population has been forecast for nearly half a century, many methods of administration and regulation remain changed only at the fringes. 

Thirty years before hospitals were regionalized in New Brunswick, experts knew and wrote detailed reports on what would be happening if New Brunswick failed to adapt.  In 1992 the journey finally commenced.  But instead of reform being a marathon, it took the form of the one-hundred-yard-dash.  The needed changes in the organization of practice and the integration of health systems failed to develop because the process was stopped in mid-stream.  Still today our electronic health records lag years behind other advanced jurisdictions.  Diagnostic Services are still functioning in silos rather than as an integrated whole as intended.

And the backlogs in Emergency Departments continue to grow as a blight on our health system while too many people do not have timely access to efficient primary health care services.

Why is that?  Why do we not see the major change that so many prominent professionals dream of?  Why does the Nursing issue just continue to fester and create headlines periodically?

It is a question of language.  When advocacy groups meet with elected officials and senior civil servants to discuss issues that are of keen interest to them and the public, an order may go to those in the affected department to do something.  Doing something could involve gathering sufficient facts as to write a report or extensive briefing notes for the Minister to enable him/her to respond to the interest group.  The action may be the initiation of a small committee or working party to examine “the issue” in more depth.  It could even extend to getting a regulation changed or, even, a piece of legislation.

This is all part of the normal “to and fro” of public service.  Any of these activities could be defined as “change”:  a regulation; a process; a set of forms that enable a process.  Meanwhile, the civil service staff remain fully occupied in maintaining the services of government:  processing grant applications, processing family support benefits, rental supplements, collecting the mountains of data required to keep the functions of government running smoothly.

No routine function of government, if improved, will improve the major issues facing the health and long-term care systems nor the public they serve.  The issues that cause the headlines, anger, and eventually, litigation, stem from old methods, old concepts, implemented years ago and never changing with the times.  The long waits in Emergency stem from the deeper problem of structure of primary care services set in place decades if not generations ago.  The literature has shown that there are many options and that New Brunswick has no reason to tolerate this terrible service.

Yet the Department of Health cannot fix it; the Medical Society cannot fix it; the health authorities could fix it but would have to take some bold, unprecedented action that is supported by the provincial government.  But why does nothing happen?

It’s the language barrier!  And we are not talking about our two official languages.  And dare I say that deflecting the conversation to the merger to create one health authority simply avoids the real issues of fixing what is really broken in health and long-term care.

It has been said by those of us outside government circles that politicians and civil servants use “government speak”.  Much focus on headlines, photo ops, creating reports that, with their title and glossy front cover, imply that action is soon on its way!  And the public is once again lulled into complacency as the wheels of government move on to the next big report and set of headlines.

New Brunswick can have the Health and Long-Term Care System that it deserves only when “government speak” is replaced with “reform and transformation-speak”.  To do what needs to be done to resolve the issues outlined over and over in my book and my columns, and by many other authoritative sources, focused action is needed and the use of “transformation language” needs to be commonplace.  You can announce hiring more nurse practitioners or recruiting more doctors as if either would make a dent in the issues felt by the public.  You could ask each family doctor to take on 50 more patients.  But those will not resolve the real issues.  They are just more band aids.

Transformative health care is that which is being experienced in Sault Ste. Marie, Ontario or at the PRIME Program in Winnipeg or at the Primary Health Centre in Taber, Alberta and many more places across the country.  Transformative health care happens when health care professionals are faced with just how poorly current systems function and how much more satisfying it is to see people get the right care at the right time by the right professional, whatever designation that professional may have.

Our elected officials need not be threatened by the use of transformative language; many members of professional groups and the much of the public are ready for the kind of leadership that transformative change implies.  Transformative change may, however, be threatening to those wonderful civil servants who now have to learn to re-design the plane while flying it.  Disconcerting for sure.

Avoiding changes that are needed to improve health and long-term care is not only a bad idea, but it is irresponsible given the effects on people and the level of public spending involved. The indicators for New Brunswick make a strong case for transformation, not incremental change.  The mood of physicians and nurses, as two of the anchor groups of health and long-term care, is such that transformation with engagement would be welcome.

So, the public policy question to government simply is:  do we really want to resolve problems and chart a new course or do we want to avoid the short-term efforts required and continue with the patterns of periodic change of forms?  Let’s be the province of three languages; add Transformation speak.
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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. His email address is [email protected].  His book, Health Care Reform in New Brunswick, can be purchased at several retailers and at www.kenmcgeorge.com