Why save our secret system? We ARE the weakest link

Divide and conquer seems to best describe the modus operandi for Nova Scotia’s health care system.

Nova Scotia’s system is reminiscent of the television game show where the intemperate short-haired female host dismissed contestants with the phrase, “You ARE the weakest link.”

That program came to mind when reading a newspaper headline that the four Atlantic premiers meeting in Newfoundland “talked of presenting a strong, united front as they prepare for talks with Ottawa on renewing health and social funding transfer agreements.”

Nova Scotia is lucky the other provinces still let us in to the group because when it comes to going to Ottawa for funding, we are the weakest link. We persist in having the bulkiest health care administrative system in the region. In 2010 we spent $49 million to support 10 CEOs, 72 vice presidents and 182 directors and even then there were administrative vacancies! Prince Edward Island operates with one health care authority. New Brunswick dropped from eight authorities to two, one for each official language. Newfoundland, which has unique geographic challenges, has five.

If we are going to Ottawa for increased funding we need to show serious change and a willingness to meet standards.

When it comes to discussions about Nova Scotia health care I am reminded of President Bush in New Orleans after Hurricane Katrina telling the head of FEMA, “You’re doing a helluva job Blackie.” Everyone knew that wasn’t correct, but the President’s handlers thought saying it forcefully enough would make it true.

With so many health bureaucracies, no one clear picture is available to citizens to know if we have an effective system. Any problems are treated as a one-off experience and rarely does the news of what’s happening in one health district travel to the next so that we can connect the dots to see if it is truly unique or a systematic problem.

Ours is a highly compartmentalized structure that neatly keeps details from seeping out into the public domain. Part of the systematic opaqueness is due to the irregular information sharing by each authority. There are no reporting standards, so some websites offer little more information than a hospital address. Others are full of happy smiling people and happy smiling ideas. The IWK, for example, lists as a 2010-11 accomplishment that they “acted as a trusted advisor to the government”. Isn’t it presumptuous to describe yourself as such? Isn’t it for the government to decide this?

But then how can there be problems in a system that doesn’t recognize problems? The IWK’s website says any complaint is being listed as and considered “feedback”. This ensures that everything at the IWK is as rosy as all the happy pictures on their website. Under this type of PR whitewash, the IWK could be mired in complaints yet cheerfully go to the government and community promoting all the “feedback” they receive.

Too bad for them the medical establishment didn’t get that memo. In October Dr. Allen Finley, head of Nova Scotia’s pediatric pain management clinic told an international pain conference it’s unreasonable for children to have to wait eight months to get into the IWK Health Centre’s pain management program. We think wait times are for elderly Nova Scotians waiting for joint replacement, but it’s everyone. He said, “This is way outside what I would describe as acceptable.”

Interestingly, Finley believes pediatric pain is under-reported in Nova Scotia. That seems to be a wide-ranging trend in this province. By purposely not studying or tracking certain information our health care officials and the Department of Health can pretend everything is fine. It isn’t. Dr. David Zitner, a health policy fellow at the Atlantic Institute for Market Studies in a letter to the editor noted that while Capital Health participated in a 2004 Canadian Adverse Events Study (this tracks medical errors), “In 2011, it is impossible to learn from Capital Health whether the promise to reduce the number of people suffering preventable death, disability and dysfunction has been fulfilled because no one has bothered to report if the rate of preventable mistakes is higher, lower or the same as reported in 2004. Moreover, the Nova Scotia government, as a regulator of health care, hasn’t bothered to ask or report to the public whether mistakes are increasing, decreasing or staying the same.”

The Adverse Events Study says 24,000 Canadians die in hospital each year due to reversible medical errors. A report in the April issue of Health Affairs in the United States says current methods for tracking hospital errors may be inadequate and skewing data and that hospital errors are now believed to impact one–third of hospital admissions. Is our system any different?

It’s this secrecy that allows unacceptable situations to continue. For example, the province has a goal to unload patients from ambulances to hospital in 20 minutes. As of March 2011, Capital Health, which is the only health authority to publish their reports so kudos for that, can take 133 minutes to off-load a patient to the QEII Health Sciences ER.

For those of us mislead by television to think medical teams are waiting curbside to come to the aid of our sick and suffering even 20 minutes seems a long time. Capital Health has promised to improve their response time by 10 percent per quarter. That means they won’t meet the provincial target until September 2015! How in gawd’s name is a four-year wait acceptable to either the medical team, health authority, Minister of Health or Premier of Nova Scotia? This appears to be little more than a vacant promise to be left for the next government to clean up.

In his report to the province, Dr. Ross said in some hospitals every admission seems to be a surprise. These numbers back up his observation.

If we’re not tracking performances or outcomes how can anyone defend or claim that our health care system’s structure is functioning in our best interest?

What we can do is listen to the people who work in heath care. The Accreditation Reports for Capital Health, IWK and the Guysborough Antigonish Strait District Health Authority (GASHA), which are the only authorities to make public their reports, contain some disturbing findings.

For example, when asked if: “senior management considers patient safety when program changes are discussed?” Only 56 percent of Capital Health and 55 percent of IWK employers could agree. That’s almost half of front line workers who don’t agree that patient safety is considered.

Asked if they had enough time to complete patient care tasks safely, only 60 percent of Capital Health and 64 percent of IWK employers could agree to that. 40 percent of front line workers don’t feel they can give the care required!

Questioned about medical errors, workers were asked to agree, disagree or be neutral on the statement: “I believe that health care error constitutes a real and significant risk to the patients that we treat.” At Capital Health only 73 percent disagreed, meaning 27 percent agreed or were concerned. At the IWK only 70 disagreed. In GASHA 67 percent agreed with the statement. This says that a significant portion of problems, misdiagnosis, improper treatments and errors are covered up. If they’re covered up, no one is learning from the mistakes, the public isn’t being served and our loveds one are continuing to be put at risk.

Asked if they believed health care errors often go unreported 18 percent of Capitol Health, 19 percent of IWK and 52 percent of GASHA employers agreed!

When asked, “I feel that I can trust this organization”, only 48 percent of Capital Health and 52 percent of IWK staff said they could trust the organization.

When almost half or more than half of your employees can’t say they trust their employer, there’s a problem.

Among the platitudes on the IWK website is this: “We have a lot to measure up to, and we are consistently tracking our process against key performance measures, rationales and targets.” Not according to the accreditation surveyor who wrote, “The team uses a list of corporate project goals and objectives. However, the written goals presented are not measurable or specific to ambulatory services.”

Websites may be full of words and photos, but there’s little substance and concrete examples that make the case for keeping Nova Scotia’s massive bureaucracy.

It’s ironic that when Nova Scotia has amalgamated services or reduced management it’s worked. The IWK reduced the size of their board of directors from 26 to 17 “in order to be more efficient and effective.”

The Department of Health’s website refers to the 1995 restructuring of the emergency health services system which went from 50 service providers to three. A 2001 consultant’s report praised the restructuring, saying, “This process has been extremely effective as demonstrated by the number of major improvements that have occurred over the last few years.”

Why are we now afraid of change? Why are we protecting a dysfunctional organizational structure that by every standard is failing?

Appearing on CBC’s Information Morning, health care consultant Mary Jane Hampton described health care sustainability as a “slow motion train wreck.”

We need to put people ahead of politics and do what’s right and necessary to change tracks now.

Recently a political operative said, “Political imperative impedes accomplishment.” Let’s not have that as the epitaph for health care. Let’s stop being the weakest link.

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6 Responses to Why save our secret system? We ARE the weakest link

  1. I recall that the Ross Report was supposed to be a watershed for healthcare. Whatever came of it? I get the impression that the system suffers from paralysis. This is hardly surprising, typical of government. Personally I’d advocate for a parallel private system, like Australia. Nothing like a bit of diversity to broaden perspectives and make things move.

    • Like all government reports and studies, the Ministry and health authorities received their copies of the report, thanked Dr. Ross for it and would look at it. In other words, shelve it. More waste.

      As for a parallel private system, I disagree with you. I have friends who live and work in both the UK and US. Having a two-tiered system isn’t the answer. It makes what is available to those at the lower end of the economic scale less effective. In fact, it drives up costs for both the private payer and public purse. This is a topic I plan to address next week.

      • I don’t look to the USA as providing the alternative model. I shared your opinion, until I had spent enough time in Australia. I have never experienced the UK system, so I can’t comment on your friends comparison. I have benefited (sometimes) from treatment in the following countries: New Zealand, Canada, USA, Australia. They each have their pluses and minuses — depending upon how you draw the box within which you make comparisons.

        Presently I am paying (from my own pocket) for treatment in the USA. It’s somewhat experimental but there are good scientific reasons to believe that it could lead to less expensive and more effective treatments for all. (Providing bureaucrats don’t stuff it up.) So I don’t agree that this deprives “those at the lower end of the economic scale”.

        I’m not convinced that medicine by “government insurance” is intrinsically better or worse than that by “private insurance”. Both have the disadvantage of third-party interference in matters that are really of a very private nature.

        But I digress, your goal is not to make a better system, rather to make the system better? Now that’s a story in itself.

      • I’m trying to be pragmatic. I think a lot can change for the better if we have a different management/administrative set up. That’s the one area which has been sacrosanct. I fear if we try something grander or more ambitious we will end up in a worse situation.

        The reality is that America is the country with biggest political, social and economic impacts on us. We have a Federal government which always first turns South first. It’s the country and example the bulk of Canadians are familiar with. It’s also the system that the current crop of health administrators reference.

        In the American system, you get great care if you have money. Yesterday I was told of 60-something person I know writing a $100,000 cheque for his health care plan. He can do that, but there are many honest, hardworking elderly Americans who can’t. Because America has a profit-driven system, those middle-class and marginal neighbourhoods and illnesses don’t get much money or motivated medical professionals.

        A week ago in The Chronicle Herald the CEO of the IWK referenced a 61-year-old study on obesity. Well, obesity is an even greater problem now than when the study was conducted. What have they do to address it? They have talked among themselves. The health care profession has become an industry of professional talkers and researchers. It’s full of people who study issues, but they don’t actually find solutions. And in all their decades of talk, no one has talked to or listened to patients or patient-families. That’s why I think we can make it better – ditch the talkers and replace them with results-oriented executives.

  2. Gary MacLeod says:

    The studies are countless on how to make our health care system more efficient.

    We have had countless federal studies, provincial studies right down to departmental studies to bring about efficiency to our medical system but nothing changes, in fact things keep getting worse. Governments continue to play the financial shell game with our tax dollars by pretending to be doing something to improve health care delivery. It is nothing but a distraction while they chip away at the foundation of the health care system and they will continue to do so until the foundation collapses leaving the public at the mercy of a privately run health care system in the near future.

    Welcome to American style medical care.

    • I remember hearing a federal politician once say the best way to handle a problem is to study it until it solves itself. Sadly, the current leaders in health care are incapable of healing the system. They’ve had over a decade and been unable – or unwilling or unmotivated – to do it, so time to clean house and hire motivated executives.

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