That fundamental reform of healthcare throughout Canada is required has been increasingly obvious for at least two decades, long enough for five full-term governments and a whole generation of health professionals to do something about it. There have been some changes. Healthcare’s governance has been partially devolved to some provincial regions and elsewhere de- and re-centralized without conclusions drawn about the most effective model to achieve change. Teamwork in primary care has been fostered through a wide variety of programs but no evidence has appeared as yet strong enough to trigger policy decisions to drive widespread adoption of multi-professional teams as the best way to provide Canadians with 24/7 primary, home, and community care. Mental health and addiction have finally appeared on the radar but remain far from optimally linked into what is glibly referred to as “the system”. The latter continues to lack coordination, collaboration, or even effective communication among its elements; “siloism” lives on. The collection, distribution, and management of clinical and health information remains barely out of the starting gate as banking and many other sectors continue to pull away, reaping the potential of the digital (new industrial) revolution. Canada is teased as the home of pilot projects that never get scaled up or adopted. National and provincial reports on healthcare’s reform abound. What’s lacking is action.
It is clear that short of the country’s having a severe and prolonged crisis, our governments are not soon going to grasp the nettle of making fundamental changes to Medicare, setting up arms-length governance for “the system”, national or provincial/territorial, or making e-health a reality. But change we must, and now. What can be done?
Two do-able actions are propitious.
The first is for institutional “players” in the regions into which provinces and territories naturally divide – hospitals, primary care, long-term care, mental health, community services, etc. – to get together and devise ways of working together; in short to create regional systems of healthcare. Regional health authorities (RHAs) (Ontario’s LHINs) might be able to help support such experiments in system-building, perhaps with some funds but at the least with advisory bodies structured to provide for an appropriately mixed membership of experienced providers of healthcare services and community leaders with patient and population perspectives. But new models of working together could be planned and at least partially executed with or without any supportive action. The only imperative of those proposing local/regional system-building is that every proposal have a robust and practical plan to evaluate, in short order, the results measured in financial, clinical outcome, and patient and family satisfaction terms. Sometime down the road that evidence will be useful.
The second is for health professionals – family physicians, specialists, nurse-practitioners, nurses, physio- and occupational therapists, home care providers, etc. – region by region, to seize the initiative to form coordinating bodies to identify the issues that constitute barriers to the ready transfer of patient responsibilities among them and ways to reduce or eliminate them. This too could be done under the aegis of a RHA/LHIN but here too such quasi-governmental sponsorship need not be necessary. A region’s health professionals could do this all on their own.
These two actions would foster regional experimentation on how, within the limits of existing central policy, to improve and enhance the communication and coordination among the elements of a healthcare system. An equally important objective would be to improve patient and family satisfaction with the services provided, their outcomes, and if not save money at least achieve qualitative improvements for no additional cost.
Local and regional experimentation of this kind is now inhibited by the deadening effect of central governments’ (and too-often RHA/LHIN’s) top-down bureaucratic control of virtually every initiative and action within the so-called system. The potential of such experimentation is cut short by a sort of one-size-fits-all mentality probably derived from governmental fear that any variability in outcomes will put the political imperative of inclusivity in jeopardy. Every element in “the system” is heavily stressed after many years of budgetary stringency; providers are jaded by incessant demands for consultation on every operational aspect that too-often leads nowhere except to the expenditure of time fruitlessly away from the bedside.
What’s to be done? Enable local/regional experimentation by providers and consumers on how to build among them the foundation of an effective and real health/healthcare system.
Authored by members of the Queen’s Health Policy Council: