Change Accelerator: COVID-19

 

Our business is at an inflection point. We can continue down the path we’ve been on … or we can make the significant and difficult changes necessary…”,[1] and so it may be with healthcare after COVID-19. Many crises have been predicted to produce lasting changes to society’s status quo ante, changes subsequently proven minimal to ephemeral[2]. It is just possible, however, likely even, that some long-advocated changes to healthcare’s organizational structure and ways of working will have been shown to be so effective that they will remain imbedded in the ‘new normal’ when the crisis is over. Normally a slow evolutionary process, often in the face of determined resistance, the pace of change in healthcare may prove to have been accelerated by tiny RNA virus particles infecting their new human hosts.

A telling example is the use of ICT[3] to supplement if not replace face-to-face with virtual contacts between people and their care-givers. Increasingly enabled and enriched by technology’s development over many years, the necessity of social distancing combined with decisions by governments to remunerate physicians for providing services virtually by telephone, e-mail, visual “apps” and the like, has almost instantly overcome previous objections and warnings raised against its use. It is hard to see this being ‘dialed back’ when the COVID-19 crisis is over.

Witness also the once intractable ALC[4] issue; necessity has proved again to be the mother of invention. Collectively, healthcare’s providers, working together region by region, have shifted ALCs out of acute care hospitals to create there the capacity to accommodate anticipated surges of patients suffering COVID-19’s worst life-threatening symptoms. It’s a good move for hospitals and for those acutely ill with the new virus but we don’t yet know its effect on the health and quality of life of those ALCs in their new out-of-hospital environments.

Also, a newly calm and controlled environment in ERs[5] has replaced that of crowded waiting rooms, ‘hallway medicine’, and ambulances lined up in the parking areas short months ago. Has this new normal been the result of family physicians now caring around the clock, on weekends, and as well for those absent patients? Or are they ill at home avoiding care they would have sought previously out of fear of contracting COVID-19 in an ER or clinic?

Such questions remain to be answered before the changes should be made permanent. But there is no doubt that the COVID-19 crisis has demonstrated that previous thought intractable problems of this nature can be resolved, and quickly, by local/regional care providers working together as integrated systems, using their own resources and ingenuity. Will such bottom-up, collaborative planning and execution continue to prevail when the COVID-19 crisis is over? There have been many as yet unsuccessful to failed attempts[6] to transform Canada’s infamous “field of silos” into systems of health and healthcare services. Will the stimulus of this crisis provide successful examples of how to build real systems successfully where top down direction by government Ministries and their proxies have failed?

We will await answers when the crisis has ended.

Duncan Sinclair
Don Drummond
Chris Simpson
David Walker
**Members of the Queen’s Health Policy Council


[1] Gavin Hattersley. Trouble brewing: Is Canada’s craft-beer industry headed for a spill? The Globe and Mail, 25 January, 2020

[2] Andrew Coyne. This changes everything unless it doesn’t. The Globe and Mail, 10 April, 2020

[3] Information and Communication Technologies

[4] Hospitals with many beds filled with patients classified as Alternative Level of Care, no longer requiring the sophisticated care of a hospital but there being no available alternative capable of providing the level of medical or supportive social care they still require

[5] Emergency Room/Urgent Care Centre

[6] Including the newest, Ontario Health Teams

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