Better health care means fixing bureaucratic failings

Posted on May 23, 2017 in Health Delivery System – Opinion
May 23, 2017.   ANDRÉ PICARD

Two years after Nova Scotia “de-regionalized” – merged its nine health regions into a single provincial health authority – an informal, blue-ribbon group has offered up a scorching analysis of the exercise.

It concluded that the Nova Scotia Health Authority, which has 23,400 employees and a budget of $2.1-billion, is a “non-system – disconnected, not communicating, non-agile, non-‘people-centred’ as well as [having] front-line staff and managers who feel helpless and unable to effect the changes they know have to happen.”

That is, sadly, a description that applies to many provincial and regional health administrative bodies around the country.

In fact, the small group that wrote this cri de coeur – including former deputy health minister Kevin McNamara, emergency doctor John Ross, geriatric psychiatrist Jeanne Ferguson, palliative-care specialist Robert Martel and family physician Dr. Ajantha Jayabarathan – serve up a timely reminder that virtually all the problems in our health-care system are engineering and administrative failings, not failures of medical care.

Mercifully, they do not suggest the classic Canadian solution of throwing more bodies into a mismanaged system but, rather, call for the system to be better structured and managed so we can allow the health professionals we have to do their work unencumbered by seemingly never-ending bureaucratic hurdles.

This is a knowledgeable quintet and they have good ideas. While the solutions are specific to Nova Scotia, again, the advice would be well-heeded in all regions of the country.

In their short report, they make seven recommendations, including:

“People do not naturally embrace change,” the authors of the report note. That is especially true of the bureaucracy, because our system tends to discourage risk-taking and rewards inertia.

Patients and taxpayers have a role to play here, too: They have to be less tolerant of mediocre access to care and expect more value for money for their tax dollars.

The defining feature of the system is waiting. That’s pathetic. And, for the amount of money we spend on health care, it’s unacceptable.

Still, when you’re in the right place at the right time in the Canadian health system, you get superb care.

But the journey in, around and out of the health system is far too often long, convoluted and disorganized.

We need to re-engineer the system, and one key element of the modernization needs to be better management. We need to spend a lot less time and money rejigging the organizational flow chart and focus on patient flow through the system.

Ultimately, it doesn’t matter if there is one, four or nine regions if there are no clear lines of authority, no accountability and no laser-sharp goals for improving patient care, individually and collectively.

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