A radical idea for meaningful change in health care: consistency

The final week of the Nova Scotia provincial election has taken on American overtones. The leaders of the Progressive Conservative and New Democratic Parties are pushing Liberal leader, Premier Stephen McNeil, to say that health care is in a crises.

In a leaders’ debate the Liberal leader said health care has challenges. The PCs and NDP have formed a united front to get the Premier say health care is in crises. Then what? Does that change anything? Does it impact their platforms and plans? Beyond throwing money towards health care, have they real measurable plans to improve the delivery of care? We’ve had decades of simplistic solutions, like tossing more money at health care, that haven’t resulted in better outcomes for patients.

Focusing on a phrase is what happened in the U.S. presidential campaign. Donald Trump focused his election campaign about the refusal of then President Obama and candidate Hilary Clinton’s to mouth the phrase “radical Islamic terrorism”. Saying the phrase doesn’t stop terror attacks.

Focusing on a phrase instead of a plan is what drags our provincial election to the level of what we saw in the United States. Do we want that?

I’ve long been critical of our health care system. And my frustration began long before this government was formed. I started this blog as far away from an election cycle as possible because I wanted us to have a substantive, sustained discussion about the problems, issues and concerns around the delivery of quality health care in Nova Scotia and hopefully share actionable ideas to improve it. I did that because the traditional election conversation about health care is to see who is prepared to toss the most money at it.

Study after study has said that more money isn’t a panacea for better health care. More money means solutions are more expensive.

Public memory is short. Our hospitals have been falling apart for decades. During 2009-11, I was told of 37 doctors who quit their practices in two communities. These weren’t retirements, they were physicians fed up with their working conditions. Later I met mayors and wardens who appealed to their local health authorities (under the nine-authority system) and the Department of Health to fix their hospitals and hire more doctors and nurses. Before the last provincial election a Valley mayor told me he was so fed up he refused to speak to the president of his local health authority.  In 2012 I attended a meeting in Berwick where an Annapolis Valley District Health Authority board member told those complaining about care they “didn’t know what they were talking about.” The idea that local decision makers are more responsive is fantasy. At least as it was managed in this province.

In thinking about how to help health care, I realized the problem is two-fold.

First, it’s the executives who, whether they sit in communities around the province or a health headquarters in Halifax, are too embedded in old thinking. We built a new system around cooperation, coordination and collaboration, but put it in the hands of people who have a history of being unresponsive. They drape themselves in a pretense of consultaion, but as doctors, nurses, surgeons and others have told me, meetings are called not to listen to concerns and ideas, but present top-down measures from people who haven’t been on the front lines in decades. These executives don’t recognize that change and innovation are about action, not simply peppering conversation and memos with the management catch phases du jour. Health executives have not shown themselves to be innovative or collaborative.

The second problem is the revolving door of health ministers. In the last 14 years we have had eight ministers of health and/or health promotion. Some have been responsible for multiple ministries at the same time. Here’s the list:

Rodney MacDonald – Minister of Health Promotion (2003)

Barry Barnet – Health Promotion and Protection, African Nova Scotian Affairs and  Communications Nova Scotia (2006)

Chris d’Entremont – Minister of Health and Acadian Affairs (2006)

Pat Dunn – Health Promotion (2009)

Karen Casey – Minister of Health (2009)

Maureen MacDonald – Minister of Health (2009)

David Wilson – Minister of Health (2012)

Leo Glavine Minister of Health 2013 to present.

Health is the biggest single file the government has. It deserves a minister’s full attention not just photo ops. As President Donald Trump learned, “It’s an unbelievably complex subject. Nobody knew health care could be so complicated.” Certainly the solutions presented in this provincial election seem pretty simplistic.

In Nova Scotia the average term of a Minister of Health is 21 months. The issue is this: when a new minister comes in it takes at least a year to come to grips with the file. Then, when they have begun to grasp the basics of it they focus on a pet project. That announced, there’s a cabinet shuffle and a new minister takes over. The cycle starts again and about the time the new minister understands the file we’re in an election campaign. More promises, more dashed dreams.

The other problem is that each new minister is advised by the same bureaucrats and health executives as his political opponents. Whatever party is in power, the status quo remains because the advice comes from the same people. Many years ago a senior bureaucrat in Newfoundland told me they had three people in their department whose job it was to talk the minister out of things. No doubt each health minister is surrounded by multiple advisors explaining why something can’t be done. Based on that we delude ourselves when we think we’re voting for change.

Perhaps the best thing we could do to help health care is to vote for consistency. The current Minister of Health, Leo Glavine, has been minister for the entire duration of this government. That hasn’t happened in Nova Scotia in over 40 years. Before he was minister he was health critic. No one has a better grasp of the file than him.

Glavine is not a flashy personality, so the public probably isn’t aware of all the heavy lifting done in health care in the last three-and-a-half years. There was the merging of the health silos to create better cooperation and use of resources and people and work done to prepare for a reorganization and replacement of the VG. Instead of a focus on the next election, health planning has been done for what’s best now and in the long term, so that in 10 years we won’t still be complaining about the same things we complain about now and complained about in the year 2000.

The radical idea to better health might be keeping a Minister of Health in place for eight years instead of 21 months. A long-term minister would have the confidence to take the lead in health care change and not have to rely on guidance by vested interests.

Other voices:





This entry was posted in Uncategorized. Bookmark the permalink.

6 Responses to A radical idea for meaningful change in health care: consistency

  1. Having a long term Health Minister a radical idea. Methinks you are being a bit tongue and cheek sayjng that. A better idea would be to privatize the buildings and maintenance. I spoke to a foreman recently working on Aberdeen Expansion and we both agreed the reason for delays and extras is the folks approving and pushing design are health professionals rather than builders.

    You are absolutely right though when you say that throwing more money at problem just makes solutions more expensive. I am weary of hearing people piss and moan about cuts when the fact is we always give Health moar money year over year. The problem is never going to be solved if we can’t even frame debate properly.

    • A faster, less involved solution is to change the executives. I have previously suggested we hire hoteliers to run hospitals. Hoteliers know building maintenance, housekeeping, human resource management, budgeting, catering, laundry, customer service. And they know real world costs. We would still need medical professionals to oversee the health care. This would be radical, but have a lower transition period and faster results.

      And I’m very sincere in having a long-time health minister. Premiers and Prime Ministers are given four years to make a difference. Health care can’t be turned around in months. Or it hasn’t. We need to stop wasting time and failing patients with constant changes of window dressing. Long term would turn the Minister’s position into one of meaning, depth and hopefully accomplishment.

      • Well we agree on something. That is good. I have reviewed over all my years of work literally thousands of drawings. Without exception the worst drawings by far are for hospitals and for schools. I could also add Wellness Center in Pictou and Rath Complex in Truro. I digress but it still is same underlying problem.

        Yet I don’t think it is fair to foist all the blame on the engineers and architects designing these buildings. Likely they are working from a limited budget. More often than not when these projects are in a conceptual stage the parameters for design are being set by a committee of health/education professionals. These projects it seems to me lack focus and appeal instead to a wishlist of demands with the proviso that any problems can be figured out later. The people overseeing it don’t care because it isn’t their money being spent. As long as it is a committee of the whole spending someone else’s money hardly matters who the executive is that is in charge. I realize that some projects require government to move forward. But cost overruns should not be part and parcel of how things get done. They seem to be right now.

        I would go further than you and privatize the buildings.

        When the drawings for new hospital hit my desk I see incomplete details and dollar signs. Why? Well that is simple. If it isn’t on contracts the work is extra in time and materials. So the next time you drive by a work site and see a bunch of guys standing around with their thumb in their asses rest assured the dime getting spent is likely from .gov.ns.ca

        This province and this country needs to leave behind the rhetoric that Health budgets are being cut. They are not being cut. You know better than I but when was the last time there was a cut in spending at Dept of Health. Maybe you can fill me in on that. Yet when I turn on TV all I hear are cuts here and slashes there.

        So put one person in charge long term. Ok. Probably would help. But first thing on list for this person would be to be honest about how much money we are spending. How much more money is getting spent on Health Care year over year. How about an honest conversation from this minister. Dispense with this narrative of health care cuts. I would like to think citizens of this province would be receptive to being spoken to like adults. But using the past as a guide chances of success don’t look good. They can’t handle the truth. Most want to live in a land of make believe.

        A while back I had a conversation with a Doctor of Radiology here in Antigonish. We were going back and forth about issues of the day. He got onto topic of government budgets. He thought there needed to be real cuts to all sorts of programs. Yet not surprisingly he left out his field. I asked him point blank how much is enough and should we consider actual line item cuts to health care. He didn’t answer question. Just ignored me. Says a lot about attitude. Don’t complain just give till it hurts. To him anyone who thinks like I do is an evil bastard who just wants to push Granny over the cliff.

        People have grown used to health care on demand. Too many seem comfortable going to McDonald’s for that Big Mac today all the while promising to pay for it next week. Then next week comes and another promise gets made. Eventually the clerk is going to refuse orders. And then what?

        In the end the reckoning will occur one way or the other. Right now there doesn’t seem to be many folks talking about the hard choices that are needed to be made. I just see more of the same.

        Tell me I am wrong.

      • I am not blaming engineers and architects for the problems in health care. There are three classic cockups in Nova Scotia:

        – building the Yarmouth hospital’s doors too narrow for hospital beds
        – the QEII labs that required $1 million fix before the hospital could open
        – the placing air intake and exhaust next to each other which created the sick hospital that harmed hundreds of workers and patients.

        Then there was the Truro hospital. The Auditor General detailed the problems with that project. If you search this site, I’ve already covered it. Truro was the prime example of putting people with no experience in charge of a capital project. So it is with any capital project. As I have previously laid out here, I know of no capital project since the construction of Government House which has come in on time and on budget. Yet, the executives and bureaucrats in charge are always surprised.

        At some point, those who are photographed turning over soil and cutting ribbons have to wear the responsibility.

        As for talk of cuts, I don’t hear Health Ministers talking of that. It’s always the executives cry about cuts. When Maureen MacDonald was Minister she spoke of freezing the funding for health care. The health authority executives immediately talked about the government’s cuts to care. The health executives pointed to inflation and said this is a cut. (I’ve also written about that – so search this site.)

        Whatever the problems in health care (staffing, facilities, funding/spending, for services, wait lists, etc.) is always comes back to the executives. Change ministers and you are supporting executive status quo.

  2. I am not picking on you personally. Sorry if you took it that way. I haven’t gone thru your entire resume here but I believe you when you say you have covered this. Anyways I agree the health ministers don’t talk about cuts but watch a few ads from election and one would think that health care suffers from a lack of money. That is all I am saying. The problems are more widespread than just executives. We have over past 50 years or so exalted nurses and Doctors to the point of Sainthood. They are now above reproach. .

    You wrote:

    At some point, those who are photographed turning over soil and cutting ribbons have to wear the responsibility….

    That ain’t gonna happen and you know it.

    • I believe that we can hold executives accountable. That hasn’t been done because the public haven’t rallied around the call. More and more people are talking about executive responsibility and tying compensation to patient outcomes. When we can properly focus our anger and show the political class the volume of voices, change will happen.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s