There’s an Opening for a New Sheriff in Town
When I was asked to consider writing another thought piece by Matthew Hart, the CEO of Longwoods Publishing, I asked myself, “Am I up for this? What’s the point?” But after some deliberation, I somewhat reluctantly decided to pull my thoughts together and write something. I suspect this will be my last opinion piece. As I near the end of my career, I figure it’s almost time for me to hang up my guns and spurs, as Annie Oakley might have said, and let the new and eager gunslingers ride into town. I am leaving behind a lot of positive hopes and dreams some of which, I hope, will someday become reality.
Through the years, I have been lucky to have been around pre-medicare, observe the welcome introduction of medicare – much to the envy of many, worldwide – and then watch it evolve over the years. Many say that medicare is a defining characteristic of who we are as Canadians, similar to the Americans describing their right to bear arms. For me, as a proud Canadian, I have wrapped myself in the medicare flag and devoted, pretty much, my entire professional life and volunteer hours to it.
But my pride in the system is now waning to the point where there are days when I am actually embarrassed about our performance. Just take the example of how we treat our seniors. The gross and blatant inadequacies of our long-term care (LTC) system – exposed for all the world to see during the COVID-19 pandemic – are neither sightly nor anything to be proud of. And what about the fact that we somehow can’t find the resources to ensure clean drinking water on many First Nations reserves? At the same time, we have no problem identifying the resources necessary to undertake another review of some health issue for which there have been multiple reviews carried out in the past but for which few, if any, recommendations have been implemented. The fact that progress on clean drinking water is happening primarily as a result of a class action lawsuit pretty much says it all.
There is almost no comparison one can make between our so-called health system and other health systems in the developed world wherein we are neither the top performer in quality nor overall system performance. Other countries don’t look to Canada’s healthcare system as a shining example of what to do. We rank among the top countries when it comes to spending per capita but in the bottom quartile when it comes to outcomes. One only has to read the most recent report from the Commonwealth Fund to see this in black and white. I ask myself why, and to be honest, the answer doesn’t seem to be clear anymore. Maybe, it never was. But why isn’t this an issue – a “burning platform” – so to speak? Instead, we hear lots of talk about the need for more funding and new structures, with little concrete action in terms of increased accountability and responsibility. And all we get are new and revised policies, regulations and procedures accompanied by reams of new reporting requirements, performance indicators and the like.
We have some absolutely stellar institutions and organizations with outstanding leaders providing world-class care and service, first-class researchers and scientists, dedicated and committed care providers, hardworking and caring volunteers and lots of funding. Why isn’t it all coming together? Or, maybe, it is and I just can’t see it. I can’t pick up a newspaper or news magazine in this country, or tune in to any news report (either online or on the television or the radio) without being bombarded with some story about doctor-and-nurse shortages, medical errors, unreasonable and medically unacceptable wait times, blatant marginalization of certain population groups resulting in gross inadequacies and inequities in care and service, high levels of staff dissatisfaction and burnout, strikes or threats regarding the same, shortages of all types of supply (e.g., drugs, people, equipment, etc.) and so on. It’s pretty disheartening for a system that purports to be caring and patient focused.
But at the same time, I am encouraged by the young leaders whom I see and talk with, and who are asking important questions, bringing new thoughts and ideas to the table and seem to be willing to push them forward. These are individuals with courage and enthusiasm for whom the status quo is not acceptable. These are individuals who do not accept “We have always done it that way” or “If it’s not broken, don’t fix it”, or “Let’s convene an expert panel to study the issue.” These are people who are demanding answers to important questions such as these: Tell me why this action or policy or decision is in the best interests of either the patient or the citizen or the community. Who will be accountable for the results? What does transformation really mean? What does integration really mean and what does it look like beyond the latest version of some organizational chart accompanied by some well-intentioned but meaningless platitudes? Why do we allow poor performances to continue? These are all important questions to which we need reasonable and actionable responses.
We have such capacity in this country to be world leaders on the health and healthcare stages but so far we haven’t been able to pull it off system wide. We have some excellent one-offs such as the lung transplantat program at UHN in Toronto, ON, the islet cell transplantation and diabetes research and treatment centres in Edmonton, AB, the dementia housing in BC and the SickKids initiatives in precision medicine in Toronto, ON, to name a few. But while there are specific examples we can cite, wholesale transformation seems to be out of our grasp – and I give, perhaps, one of the most glaring examples, that too, in population health and social determinants. We led the world in the ‘70s with the release of Marc Lalonde’s report titled A New Perspective on the Health of Canadians. It elicited a global applause even though significant amounts of this information was already known. But to have a modern federal government release such a document was viewed as cutting edge. However, after a few years, it went pretty much nowhere. As a country we simply shelved it. It’s a sad state of affairs that more than 25 years later, the World Health Organization, the World Bank, the World Economic Forum, Kaiser Permanente and other similar organizations are all on the population health bandwagon, and have acknowledged the importance of social determinants in advancing better health.
Meanwhile, we still don’t have comprehensive primary care and primary healthcare despite having spent multi-millions of dollars studying these concepts, developing models and implementing a multitude of pilot projects. Something always seems to interfere with our ability to effectively apply what we know to be true about how to improve and sustain better health. We seem to be stuck in the original paradigm of medicare, i.e., hospitals and doctors. It isn’t that they aren’t still important. But they cannot continue to be at the epicentre of improvement if we hope to transform to a system that promotes, supports and sustains holistic health and well-being, and isn’t just there for us when we are sick.
At the same time, I am also heartened by the fact that the Canadian public is better informed than ever before, and is demanding change. To some extent, we have to thank the COVID-19 pandemic for this. I am not sure that the warts and blemishes of LTC and, more generally, the way in which we treat our seniors as well as other marginalized groups, would have been so blatantly exposed for all to see if it hadn’t been for the pandemic. These are warts and blemishes that cannot and will not be swept under the rug. We have been aided in these efforts by dedicated journalists, such as The Globe and Mail healthcare columnist André Picard, who have successfully brought many issues directly to the eyes and ears of the general public. We have institutions such as the Canadian Institute for Health Information, ICES, the Institut national d'excellence en santé et en services sociaux, the CD Howe Institute and the Manitoba Centre for Health Policy, to name just a few, all of which are making significant contributions to an ever-expanding body of knowledge. We can look to them for assistance not only in understanding today’s realities better but, perhaps, more importantly, to help us move toward a bright, new future that encompasses the learnings from the past and allows us to move beyond them.
As a country, we have some excellent foundations to build upon with respect to our healthcare system but, moving forward, I hope we can think more in terms of revolution and not simply evolution. We deserve better.
About the Author(s)
Janet Davidson, OC, MHSA, LLD (Hons) is an independent healthcare consultant based in Halifax, NS.
Shawn Drake, MP, Workforce Edge wrote:
Posted 2021/08/19 at 10:27 PM EDT
My team appreciates the opinion and guidance; and we miss your wisdom on our Advisory Board. You always armed us for Revolution, and, taught us to listen. You can only blaze a trail...if someone cut through it first. Thanks Annie
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