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.