Essays April 2014

Top 10 Changes in Healthcare in Canada in the Last 40 Years

Tom Closson

These are my perceptions of the top 10 changes in healthcare in Canada based on what has caught my attention along the way in my 40 year career in healthcare management and policy development:
  1. Laparoscopic Surgery – The number of hospital beds used for surgery has plummeted (thank goodness or we would have no room for all the medical patients). Earlier in my career patients were often admitted several days before their surgery for education and remained in hospital many days after.
     
  2. Obstetrics – New mothers and their babies stayed in hospital for 5 to 7 days. My daughter-in-law after having her delivery took her baby home from the hospital after 5 hours.
     
  3. Mental Health – Many thousands of people with mental illness were cared for in institutions. Very few mental health beds remain as people are now more likely to be served in the community (although not as well as we would like) with the help of better drug management, day programs and various community supports.
     
  4. AIDS – I remember our strategic planning session at Sunnybrook in the early 1990s when we considered the scenario of our inpatient beds being overwhelmed by patients with AIDS. Fortunately, drug developments and public education have addressed this concern.
     
  5. Heart Attacks and Strokes – Prevalence of heart attacks and strokes have dropped significantly due to better lifestyles and therapies. Also, thrombolytic have had a huge impact on outcomes with immediate treatment.
     
  6. Laboratory Automation – Our ability to conduct multiple tests on samples simultaneously and quickly using technology with minimal human intervention has enabled low cost laboratory diagnostics and enabled their widespread use.
     
  7. Hospitalists – Rather than having multiple physicians come to the hospital to manage their patients, using hospitalists to be the most responsible provider for many patients has enabled more consistent and evidence-based care. The downside of course has been the challenge of maintaining the linkage to community-based care.
     
  8. Ehealth – Progress has been a lot slower than I expected it would be with Ehealth but most hospitals and community-based healthcare practices are now making very effective use of the functionality of internal computer systems and patient information exchange. Clinical decision support, electronic health records and productivity improvements are beginning to take hold.
     
  9. Performance Reporting – It wasn’t until the 1990′s that any meaningful performance reports were available to providers, system managers, policy analysts and the public. The system is a lot more transparent and accountable today but this could still be done a lot better and address all parts of the system.
     
  10. Structure – The number of organizations with their own CEOs and Boards has been in continuous decline. The purpose has primarily been to achieve economies of scale and enable integration of care across the continuum both horizontally and vertically. This has significant intuitive appeal but clarity regarding the best organizational design has proven to be somewhat illusive. 

About the Author

Mr. Tom Closson served as the Chief Executive Officer and President of Ontario Hospital Association from January 14, 2008 to January 2012. Mr. Closson served as President and Chief Executive Officer of University Health Network (Toronto), the Capital Health Region in Victoria (British Columbia) and Sunnybrook Health Sciences Centre (Toronto). In addition to private sector experience, his government experience includes roles at Ontario's Ministry of Health, Ministry of Community and Social Services and Management Board. He serves on the Board of Directors of LifeLabs and Health Quality Ontario. He has been Vice Chairman of Canadian Health Services Research Foundation since March 2014.

 


Comments

Alan Iskiw wrote:

Posted 2014/04/22 at 03:04 PM EDT

In addition to Tom's comments, I would add that there have been significant improvements in the treatment of cancer.

Stats from the National Health Service in the UK report that in the early 1970s, just over half of women diagnosed with breast cancer were still alive five years later. Less than a third of men diagnosed with prostate cancer were still alive after five years

The latest figures show that almost two-thirds of men diagnosed with prostate cancer are still alive five years later, twice as many as in the early 1970s. More than three-quarters of women diagnosed with breast cancer are still alive after five years, an increase of 50 percent.

Improvements in survivor rates have been noted for other cancer types as well.

 

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