No memory, no change

Health care in Canada will never become what Canadians think it is until we get beyond the headline du jour and hold executives accountable for their continued failure to perform and reform.

This summer CBC radio had Toronto chef Joshna Maharaj appear on a regional phone-in show about the quality of hospital food. In 2011 Maharaj began working with the Scarborough Hospital for sick children to create more flavourful meals for patients. As news reports said at the time, “Out went bland prepackaged meals. In their place, meals using fresh basic ingredients, seasonal fruits and vegetables, and meats from local producers.”

Maharaj’s “changes got lots of media attention, support from foundations and seemed like a good idea. BUT, once she moved on, hospitals returned to their old habits and tasteless – and harmful – menus.”

About the time that Maharaj was working to bring flavourful and nutritious food to hospitals the CBC was reporting on studies which found a very real concern about malnutrition among hospitalized Canadians. Hospitals have dieticians on staff to speak with patients about proper nutrition, but, as was said, there is a disconnect between the advice and what’s available on a hospital tray.

Nova Scotia health care responded to these headlines by removing cream from their Tim Horton’s franchise operations and salt packages from patient trays and cafeteria tables, tho’ if you ask, salt can be produced. It’s sort of kept out of sight, like cigarettes.

We trust health care to know and do what’s best for patients in their care. But with a continued reliance on non-nutritious menus, which ensure malnourishment among those in long-term care, how can we trust? If they can’t get the basics of nutrition right, what else can’t they get right? How much patient decline is due to poor nutrition vs advancing disease?

It shouldn’t take headlines to create better care in our health system, but that seems how those in charge are prepared to work. Until the public demands, they ignore. Five years later, what has changed about hospital food?


Speaking of food – I continue to wonder why 160 white-collar workers at the Annapolis Valley District – Nova Scotia Health Authority offices in Kentville’s industrial park (15 Chipman) get subsidized lunches and two snacks a day trucked to them? How many other government workers enjoy this benefit? Could this become a new bargaining chip in union contracts? There is a push on to turn Valley Regional Hospital’s cafeteria into a profit centre, so is there a similar push to turn this executive perk into a money-maker for the health authority? Since Janet Knox has moved from Kentville to oversee the province’s health system is this a perk that has been expanded to all local health authorities? If not, the white collar workers across the province probably wonder why not?

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9 Responses to No memory, no change

  1. woof says:

    The admins have “threatened” for years that the food service dept would be privatized if they weren’t at least breaking even in costs. Too bad those same threats couldn’t be aimed at administration if they couldn’t improve their performances.

  2. It always takes headlines to make change. Light needs to shine to expose the rats.

    I don’t see this ending well. Year-over-year budget increases haven’t fixed the problem. They get more money and then get on TV and complain of cuts here and cuts there. It only feeds the tumour and won’t end well. And I am tired of hearing about it.

    Sooner or later the budgets are going to collapse. Math and power of exponents are a bitch. The last thing to go will be the hospitals. Health care is valued more then roads and police or fire departments. I can see a day when the only thing left that shines is the Hospital. On that day I will be able to stand on hill near my house and see it gleaming in early morning sun. The folks there still fighting over what to put on the menu. I won’t care then because I won’t be able to drive to the hospital because of roads being long neglected.

    This province used to make things to pay for our shitty choices. Not anymore. No money no problem. Just put it on credit card. The sooner we get rid of free health care the better. Then we can all pay own way. The proof for me is driving to town where I see what looks to be a majority of people who are overweight, eat poorly, smoke and drink too much. But there are no consequences for bad life choices anymore. I know women who weighs 300 pounds. She complains of back problems and worn out knees. She went to doctor recently and got the solution to her problems. A sign. Why fix it when you can instead advertise.

    I wonder if she would be eating so poorly if she knew she would have to pay for that knee replacement.

    And then people go to hospital and complain about the food. I say let them eat cake.

    • Thank you for reading.

      I can’t embrace any idea that suggests moving from a universal to private-pay health system. I know too many people in countries which have either a wholly private system, like the US or combination system, like the UK. Neither work for anyone beyond the infamous 1%.

      I recently had lunch with a couple from Chicago. They have a form of health care package via her employer. Their monthly contribution to the plan is basically a mortgage payment without a house or condo attached to it. Then they have a $1,500 deductible for each of them. That’s $1,500 they have to pay up front for each and every medical event/issue before the policy kicks in.

      Many Canadians believe that health care delivery in the US is faster than Canada. Yes and no. For some things it is, but in talking to Americans I hear similar complaints about access to doctors and care, which is also bundled into cost for both.

      As for healthy lifestyle choices, the US, even with their private, profit-driven system, has the most unhealthy population in the western world. I have to wonder if unhealthy lifestyle choices aren’t hereditary. Hereditary in that it’s how people were brought up. They grew up around smokers and took it up to fit in. They ate badly because that’s the diet they had growing up. One difference might be that a diet enjoyed by a previous generation was married to a lot more movement, like physical labour.

      You repeat what you know and if you only know or are only exposed to one way of living, then that’s all you know. So why aren’t we doing more to help expand knowledge?

      The gap in our current health system is that it is 99% focused on acute care delivery. There is basically no lifestyle education and assistance, like old-style home economics classes in school or what 4H used to (perhaps still does) provide. The final element would be to develop ways for citizens to exercise year-round. Exercise is a loaded word. I don’t mean going to a gym. I mean socialized opportunities like mall-walking groups and other things that are an opportunity for rural residents to move and unknowingly do good for their body.

      My final point is this: as a nation we agreed to a universal system of health care. We decided it was a value we embraced. We many not agree with all the choices that others make, but under our system they are entitled to care without fear of cost. You are concerned about unhealthy lifestyle choices, but what about athletes? People ski, snowboard and stress their bodies in many ways that we applaud, yet which also sends them seeking care. They can be just as costly to the system. We have a system, how do we make it function better? I believe that starts with executive accountability.

      • The American system is held up as an example of what is wrong with Private Health Care. And yes there is much that is wrong. However people fail to point out that Health Care has special regulatory status in USA. It is a mess because laws have been written to preclude competition. Each state requires a separate exchange for ACA. It pays to shop around but right now you cannot.

        Would you buy a car if you didn’t know how much you are going to pay.I wouldn’t. But hospitals cannot be forced to post prices in good ole USA.

        The government there also has shielded health industry from prosecution so that they don’t have to do this. I blame the governments of USA and medical lobbyists for letting this happen. If a true free market was allowed the prices would come down and it would become more affordable.

        As for lifestyle being hereditary. I don’t believe that at all. Unless one is going to take all agency away from a person. What is happening now because everyone is a victim, a special snowflake.

        You mention athletes, okay. Well at least they are trying and I still don’t think cost comes close to impacts of obesity, smoking and drinking. Why should I feel sorry for someone with diabetes that is 150 pounds or more overweight. I just think there needs to be a cost to bad choices.

        When is enough enough as far as health care spending. When it’s 60% of provincial budget? 70.
        There doesn’t seem any end to demands of customers for better service.

        As Executive accountability it only works if there is money to fight over. I think if you are going to fix something you do it from bottom up.

        I will accused of being uncaring. Maybe I am but people can’t the truth. The Health Industry is just one manifestation of lack of interest in responsibility and consequences in our world in 2016.

      • Where is your proof, what facts do you rely on to say if the US government stepped aside that American health care costs would decline? That may be part of some economic theory, but everything in the US suggests otherwise.

        In the early 1990s a Rockefeller Commission found that if America spent $2 billion a year in pre-natal care for low-income mothers, the system would save $10 billion a year in costs for heroic treatments for pre-mature babies, babies born with addictions and other diseases. Hard to believe, but it lots of places in the US, young people don’t know doing craic or smoking or drinking while pregnant is bad for the baby.

        You’re obviously a new visitor to this site. From the beginning I have asked how much is enough for health care to work the way Canadians think it does? No one has an answer. Fundraising isn’t an answer, it’s an industry.

        You think the solution comes from the bottom up. Well, we’ve tried that for the last 30 years and we have the same complaints, problems and issues. We have toyed, tinkered and tampered with every aspect of health care, staffing and hospitals, but one: the executives. We have cut, re-thought, re-aligned, re-jigged, re-staffed, re-imaged and re-tooled the bottom and middle ranks and after decades failed to improve performance and patient outcomes. If all the rest has been tried, you have to finally look at management.

        In the private sector if you failed to improve outcomes, you would be gone. Not in health care. For example, the VG’s water has been toxic for over 30 years. It is do bad you can’t do anything more than flush a toiler with it. Where else in the western world would that be allowed in any public building, let along the region’s leading hospital? Why was no one fired for lack of action? Annnnnnnd, the same executives who complained about needing more space, neglected to tell the public they had two vacant floors at the Dartmouth General Hospital. Why were these floors vacant? Because management couldn’t decide what to do with them. Executives had decades to make a decision and didn’t.

        We have numerous doctors leave the province – two dozen left one Cape Breton hospital in two years, six left Yarmouth in 11 months – they didn’t retire and no one asked them why they were leaving. Well, whenever there are mass resignations of senior staff, you look at management. Health care didn’t.

        When it comes to poor lifestyle, I don’t blame people. Some don’t know any better. That may be difficult for you to grasp, but living near a university you probably would be surprised that there are people in this province and country who are illiterate. I’ve seen people who live so far off the grid that they didn’t know how to work a hospital elevator.

        And then there’s the price of poverty. It cost money to eat well. Fresh fruits and vegetables cost more than sugary stuff. The poor are usually obese because they don’t have access to fresh food. Or it’s out of their price range.

        You may not think that treating those who have injured themselves through extreme sports equals the cost of smoking and obesity. I can’t remember the figures, but I don’t care. That’s not productive. We have a system which could help those with lifestyle issues, and doesn’t. It’s not about being victim or a special snowflake, it’s about knowledge, poverty and access to support (which isn’t $$$, but someone to suggest meal alternatives and other changes.)

        You might be surprised to know that when Winnipeg studied ER usage, 59% of those seen by a doctor were under the age of 9. The cases weren’t necessarily medical emergencies, just kids with usual kid problems, like stomach flu, a bump from a fall, etc. brought in by anxious parents. The preconceived notions of who is tying up that city’s ERs were not the elderly and those with poor health, just the opposite.

      • I have been reading your site for a while. Where is my proof. Where is yours. Nothing gets cut when it comes to health care. Nothing. They get more money then go on TV and complain about cuts. It is a joke. If one didn’t take the time to read financial statements it would be easy to conclude that they are getting less year over yearL It is time to starve the best.

        I think we spend too much. If you disagree tell me what is the number should be.

        I say at very least freeze budgets for the next ten years. No cola, nothing. And why is that. Well we can’t afford what we got. The only thing guaranteed is that next year things are going to be worse. More people will be retired less people will be working. Yet everyone will be their hands out looking for their free stuff.

        It is laughable that you think cutting privileges at the sandwich truck is going to make any difference. I won’t because it can’t. If free market was allowed to work it would get cheaper because the people providing health care would be forced to work for less or have no job.

        This guy does a better job then me of explaining it.

        >>link removed by website<<

        He has done many posts talking about this. Sixty or seventy years ago folks had no free health care because they didn’t need it. They could pay for it out of their pockets when they needed help. As it stands now health is held ransom by those in industry aided and abetted by the bought and paid for government policy wonks.

        Call me heartless if you want but we are no better off then that couple from Chicago. The only difference is we can pretend we have no problem because the taxes being spent are coming off someone else’s cheque.

        It is easy to blame all the problems of healthcare on how it is delivered. Folks stand around pointing fingers at some CEO’s out of control expense claims. And as long as fingers are getting pointed elsewhere then hard choices dont have to be made when one looks in mirror in morning.

        Something that I and the person who doesn’t read does everyday.

      • The food perks enjoyed by the white collar workers in Kentville aren’t a food truck. That would be an acceptable alternative. No, they have a dedicated food services worker (maybe a second – they used to have two) for their offices, plus on-site kitchen for proper handling of the pre-made food, plus dining area for 160 people. That adds to HR costs, rental space and utilities. Plus those meals are driven from the hospital to offices 5-k away. That’s a truck, driver, gas, insurance, maintenance. It’s also food costs and kitchen prep staff at the hospital. I don’t know where dishes are done, if they are cleaned on-site or packed, loaded on to the truck and driven back across town.

        If these people are afraid of gems, the hospital has a private dining room for executives (not that they’re there – all executives have two sets of offices in one town), plus several unused classrooms. Why are they so special that they can’t go out to eat like every other worker?

        And while this isn’t considered excessive by the executives, as a cost-cutting measure they reduced hospital cafeteria hours. It closes mid-afternoon. Nurses and other staff working a night shift, families who might be at the hospital long hours because of the condition of a patient, are expected to brown bag it.

        Sadly, in health care millions mean nothing. Until that changes we’ll continue to piss away cash. Another great waste: ambulances. The bulk of their calls are to act like a glorified cab service driving mobility-challenged people to hospital for non-emergency tests and appointments. If more communities had a paratransit system we would save millions each year. We shouldn’t be tying up emergency equipment and teams of paramedics so someone can have blood drawn or an x-ray or some other necessary, but non-emergency procedure. In Halifax ambulances are used to drive people between neighbouring hospitals on the same block.

        Nothing gets cut because the public is too lazy to be anything but cheerleaders and health executives long ago learned how easy it was to intimidate politicians. You want to make change, track what happens and ask questions. Consistently.

        Zero budgeting is silly. We don’t know what the future brings or what extraordinary events will happen.

        My beef isn’t merely with CEO expenses, it’s their skill set and ability to deliver what is expected from them. Everything takes five-to-seven years. Whether you trained to be a doctor or a nurse, how does that prepare you to effectively manage billion-dollar budgets? What do you know about building maintenance, HR, catering, laundry, transportation and purchasing? Doctors and nurses should focus on actual care and leave operations to people who understand them, like hoteliers.

        Executives get comfortable doing what they have always done. Until 2015 we had nine health silos, plus the IWK. There was no cooperation or coordination between health authorities. Since merging into a provincial authority and the IWK, an additional 700 hip and knee surgeries have been performed because patients were given the option to travel outside the geographic territory represented by their previous health authority to a facility where there was an available OR and surgeon. That’s effective and efficient and good for patients. That’s 700 fewer people in pain, and less draw on the system and families.

        The merging of health authorities also cut eight CEOs and 20 VP positions. There are more cuts to come. It’s only about a $5 million saving on their salaries, but it’s a start. That money is available for re-allocation.

        You talk about everyone having their hand out. This overlooks the fact that we all contribute to the system via our taxes. This isn’t some gift from Ottawa or Halifax. Who contributed to the education of all those working in health care? Who paid for the buildings, equipment, supplies, etc. Each contributes according to their ability – as defined by taxation.

        And you also assume that everyone is going to need health care. You know what, some people just die. They weren’t necessarily sick. Their life ended. How often are people surprised that so-and-so dropped dead? The real expense comes in the last 40 days of life – assuming you don’t just die – for any aged patient, whether they are 8 or 80. And actually, less money is spent on heroic measures on older people because of health care’s three-tier DNR form that they push, and I mean push, on older patients on admission.

        My final point is that a system such as ours is more favourable to medical professionals because it removes a lot of the business and practice costs. Yes, US doctors earn much more than their Canadian counterparts, but that doesn’t mean they take home more. They have much greater practice costs from the heavy insurance they carry, their larger office operations because of the number of insurers (if the patient is insured) and cash flow issues caused while chasing down payments.

        The media used to love to run stories of doctors who left to set up practice in the US. But they didn’t write about how often those doctors returned to Canada. It was almost 100% return after four years.

        I was very young when our health system changed from a user pay. Doctors were happy. In retrospect, I remember my mother coming home with two shoe boxes full of unpaid invoices from her doctor (she was in bill collection). She was aghast that people couldn’t pay their doctor bills. Our system is better for doctors from a cash flow position. Many doctors are too young to know this.

        Now I have other things to write.

  3. So your solution is to give them more money. Fantastic.
    As Enstein said long ago the definition of insanity is doing the same thing again and expecting different results

    • You are not reading with comprehension. My idea is to demand accountability for money spent, decisions taken and patient outcomes. That has not been part of the previous – and current – job

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