It is easy to write lofty words about the systemic problems within the current health care system, but not so easy to come up with pragmatic solutions. One of the problems in discussing and implementing reform is that we tend to get caught up in the weeds. When and if that happens, we start spinning our wheels. What is required is a vision from 30,000 ft. in the air — a big picture perspective. Despite the sustained and impressive response to the pandemic by the health care system, there are many long-lasting problems that need to be addressed.
Everyone seems focused on the immediate situation and not much attention has been given to defining and creating a truly modern and integrated service network. Fortunately, leaders have begun to recognize what is needed is to develop a vision of the future and enunciate it to all concerned. A sustained commitment by the political, clinical and administrative leaders, input from the system’s components as well as the public offering ideas aimed at helping the system operate with greater efficacy are essential factors if needed improvements are to take place.
New Brunswick has 72,908 sq. kilometers and population of 780,000. What should a 21st century health system look like? While it should still be recognizable, it would also be different, and better, than what we have today.
In our first article, we wrote about the pressing need for health care system improvement. We identified the problems, which are many. But before we can get into the specifics of health care reform, do we not have to address other issues such as municipal reform and education reform? One cannot be done in isolation from the other. We have to know population numbers and location, where services are now located and other background information. To initiate health care changes without the necessary information will result a less than optimal outcome. And it’s also important to remember that “putting too many irons in the fire” at once can cause it to go out. We have many people and groups with their own interests and agendas, and only a few will ultimately rise to the top and may have to modify or adapt their perspective for the benefit and sustainability of the province. Reforms in all sectors will need to be flexible enough to allow for the required future coordination between all sectors to occur.
In the golfing world, it’s all about keeping your eye on the ball. In health and long-term it’s about keeping your eye on the patient. And do you know what? Each patient is different. Each has their own DNA and their own health care situation. To try and develop a system whereby “one shoe fits all”, will simply not work. A well designed and operated system will have the needed flexibility to respond in a timely manner and do what’s necessary effectively and efficiently for any given person.
It is virtually impossible to write a comprehensive plan in one advertisement, but we do have a Planning Guide and Framework posted on our website www.coalitionnb.com. We have, however, summarized a few critical actions that should be taken.
- We must create a clinically sustainable, patient-centered service network that encompasses direct health care and public health services (prevention, response and education)
- We need clearly stated system parameters: vision, mission, values, goals and performance measures.
- We need a service network that encompasses both physical and mental health and includes all types of services such as prevention, detection and diagnosis, treatment, rehabilitation, long term and chronic care and management, inc. palliative care, and rapid response.
- We need a service network that is able to readily respond to the particular needs of large centers, smaller centers, rural areas, the elderly, the disabled, etc. This includes a robust pandemic and epidemic preparedness, response and amelioration capability.
These are a few visions and goals, but there are many more.
What are the prerequisites for system improvement initiatives to be successfully pursued?
First: A defined vision and mission, with goals to be achieved, that’s been approved by government, e.g. To ensure that every New Brunswicker has timely, reliable access to effective, quality and efficient health care services.
Second: An adaptable multi-year action Plan with required actions, priorities and sequences, and performance measures. The plan would address: What services will be available, Where they will be located, How they will be provided, Who will provide them, How to ensure enough skilled personnel, service sites, equipment, supplies and technology, Who has what responsibility, authority and accountability for service provision, management and performance.
Third: Government adoption of such a system improvement Plan, appointment of a knowledgeable team to implement it and ability to resist the temptation to override evidence-based clinical decision making when local or interest group pressure is applied to maintain the status quo. The Department of Health would be assigned to oversee and regularly report to the government on progress.
Fourth: Active cooperation from the province’s health care professional organizations. In particular, willingness on the part of the Medical Society, Nurses’ Association and others to work with the Department of Health to accelerate the process of Primary Health Care improvement so it becomes a solid foundation for the overall system by providing timely service access for everyone in the province. Tens of thousands of people waiting for years to get a family doctor is proof that changes must be pursued without delay. We need a new approach rather than to just keep doing the same obviously ineffective things.
Fifth: An integrated, comprehensive patient and provider electronic health record (including medications/prescriptions) and an administrative and clinical information system that together ensure service provision and resource management are efficient, effective and meet recognized quality standards — coupled with regular monitoring and public report on progress and population health needs and outcomes, as well as inputs and outputs. This includes the use of point-of-care electronic diagnosis and documentation tools. A comprehensive patient, provider and service communication network, including digital I.D. for secure access to and sharing of clinical information would also enable use of ‘medical apps’.
Sixth: Public understanding that while hospitals are important service sites, there is also a significant patient safety risk involved with hospitalization. Infection and cross-contamination are only two of the serious risks at play when one is admitted to the hospital. Therefore, patients need to be admitted for the shortest period of time required to deal with their clinical situation. Individuals also must be aware of and encouraged to take a continuing interest in and responsibility for their own health status – not only in terms of personal lifestyle choices, but also the environment.
When you look at New Brunswick’s health care costs, as compared to other provinces, we are in the middle. And other provinces are having similar problems. When Dr. Chris Simpson, who is from New Brunswick and a past president of the Canadian Medical Association, spoke to us over a year ago, he delivered a message that New Brunswick could be the laboratory for change due to our size. Others have expressed a similar thought, and it warrants serious consideration.
We know that the size of federal transfer payments may be in jeopardy in the future. However, if we could demonstrate to the Federal Government that we have an Action Plan that will positively affect system effectiveness and efficiency they may be inclined to help. Whenever significant changes are implemented, it generally requires an initial investment. We will need to build some new primary health care centers as well as adapt existing buildings to achieve sustained centers of expertise that benefit all New Brunswickers. We need to invest in new technology, new equipment and the necessary skilled people. In the end we could be a “model” that is envied by the rest of Canada and the world. I believe it is achievable.
To quote Winston Churchill, ”Fear is a reaction. Courage is a decision“.
Daryl Branscombe, President
Coalition of Concerned Citizens Inc.
For more information on the Coalition, please refer to our website or contact us at firstname.lastname@example.org