A surgeon’s prescription for change

Dr. Jan Sundin is another voice summarizing the problems of, and suggesting solutions, to the problem with health care in Nova Scotia.

It is an important read:

http://thechronicleherald.ca/opinion/1357320-n.s.-health-care-system-overpopulated-with-administrators

Dr. Sundin provides a précis of our problems:

“…the major problem with Canada’s system is that it is too politically influenced. … our health care system has always been the playing field for the politicians, especially before elections.”

And let’s not forget how health executives have played politicians. Especially before elections when otherwise camera-and-microphone-shy executives find time to pop up with a wish-list that forces politicians of all parties to promise to write more and bigger cheques.

“what we need are properly trained professionals who know what is practically possible with a defined amount of money and what would give the most bang for the buck.”

“Our system is grossly overpopulated with administrators, many of them incompetent because they have no background in health care or no training in how to manage it. They think it can be run like any other business organization, not realizing that health care is recognized as one of the most complex of organizations.”

Under the new merged provincial health authority, Nova Scotia marginally reduced the executive ranks. However, the cuts weren’t as deep as originally planned. That wasn’t based on need, but budget. The severance packages would have been unpalatable. So we maintain executive redundancy for the sake of optics.

“It deals with sick people (patients, not clients or health care consumers) in their most vulnerable position in life and who should be the centre of attention.”

““patient-centred care” should be more than a slogan. There are now hordes of middle-managers or “clipboard nurses” running around, spending most of their time at meetings but never seeing a patient.”

I suspect the slogan “patient-centred care” is really a reminder to managers to stay on message when speaking to media and politicians.

“Get rid of the routine laboratory order sets which are useless, expensive and sometimes dangerous if interpreted by incompetent people.”

Medical professionals have suggested to me that many tests are ordered less as either a placebo or preemptive measure against a potential malpractice suit.

“Training of physicians themselves has also deteriorated.”        

“Luckily, we have now got rid of most of the hospital boards. They had no function, serving only as shields to protect government when things did not go well.”

I would add that many of the health boards and boards in other public sector organizations were/are rubber stamps for the executive. We are never told when, and if, boards ever said no to the executives. Other than acting as cheerleaders, what did they accomplish?

Dr. Sundin goes on to offer ideas and thoughts on composition of boards, what types of medical infrastructure would be most efficient and effective, and raises a really interesting idea regarding rethinking the formula on which health care equalization payments are based.

Those of us who have ever had contact with government spending understand Dr. Sundin’s comments regarding wasteful purchases.“Our wasteful tradition starts every March, when unnecessary items are being purchased so the whole budget will be used up before the fiscal year ends. If they don’t do this, institutions are afraid next year’s budget will be cut. Unused funds cannot be carried over to the next year. So instead of saving this money, to be able to pay for a more expensive but more suitable device the following year, the money is used up on unnecessary items.”

Bingo! In my newspaper career, which was spent in Nova Scotia, New Brunswick and Ontario, we used to see a substantial increase in government advertising from late February to the end of March as departments burned through any surplus cash. Federal and provincial governments, of all stripes, have been shocked when it was mentioned to them. Their faux horror reminds me of the scene in Casablanca where the police chief, just before collecting his winnings, is “shocked” to learn there is gambling at Rick’s. I wonder if various Auditors General would find an imbalance in end-of-fiscal-year spending?

More and more medical professionals, patients, patient family members and knowledgeable outsiders are so exasperated by the ineffective status quo, dated thinking and managed messaging that they are speaking out. There is uniformity in their experiences. There are critics of the system and those who manage it because of the on-going failure of those who oversee the system to produce results. Dr. Sundin mentions how executives like to operate health care as a business. If that is their vision, they should also be prepared to be fired, as happens in business, for failure to meet set performance targets. We launched a march to change, but it still relies too heavily on an old guard with vested interests, who are too slow to act and too secretive.

For over 30 years the VG site has declined because of diferred maintenance. Patients and professionals have complained about conditions at the VG. Given the history of care for these buildings, why would we trust design, construction management and operations to an executive class who have not shown themselves capable of caring for physical infrastructure?

http://thechronicleherald.ca/opinion/1357314-surette-job-1-at-victoria-general-preventing-another-white-elephant

https://helphealthcare.wordpress.com/2012/04/03/our-hellish-history-of-hospital-construction/

 

 

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