Healthcare Quarterly

Healthcare Quarterly 9(2) March 2006 .doi:10.12927/hcq.2006.18132
Longwoods Review

Set Clear Goals and Fund Them

Jeff Lozon


The NHS is to be congratulated on its successful initiative to lower ER waits, and there is much that Canadian decision-makers can learn from the experience. By setting clear goals and then funding them, decision-makers at the macro level are validated. Institutionally, ERs benefit from best of breed approaches and learning from successes.
But it is a classically good news/bad news scenario.

The good news is that the vital ER services that are often seen as synonymous with a high-performing system are demonstrating that the system can and does achieve major service improvements. No doubt this turnaround is part of a larger NHS overhaul that is bringing more benefits to patients at many levels and generating a type of enthusiasm and excitement in a renewed NHS.

The bad news is that, to improve ERs, there needs to be a coordinated system response and a sustained approach that we too often do not see in healthcare.

ERs are a classic example of how the ills of one part of the system can be seen as a symbol of overall system malaise. Indeed, in a broad health system, one of the key measures has to be how rapidly and effectively true emergencies are handled. But to improve this element of the broader system, attention must be paid to many parts of the acute care continuum.

Pre-hospital care needs to be strengthened, the service in the ER itself restructured and, importantly, within the hospital setting, the ER needs to be re-prioritized. And, finally, the overall hospital must be geared up to receive the patients who need admission rapidly and smoothly.

It remains to be seen how the system will respond to the multiple new measures that are being asked of it. Shorten ER waits. Reduce wait times for selected services. Improve patient safety. Balance budgets, and apply the latest and best technologies. All these are important and worthy goals, and they will need to be supported by resources and effective change-management systems.

Still, we should all learn from the experiences of the NHS in their efforts to improve this one element of the overall system. They have delivered results, and in so doing they have shown that broad system improvement is possible to the betterment of all.

About the Author(s)

Jeff Lozon
President and CEO, St. Michael's Hospital, Toronto


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