Changing ‘That Won’t Work Here’

By Laura Kennedy, Pablo Navarro & MED6288 Policy & Decision-Making Class 2016

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Canada’s health care system seems to be in a perpetual state of review and restructuring, posturing and promising, hoping for change that is glacial in pace if it happens at all. For the past twenty years, the country has wrestled with how to change a healthcare system that is increasingly inefficient and unsustainable. We have had the Romanow Report (2002), Health Accord negotiations, patient-oriented research initiatives, the Naylor report (2015) and herculean efforts to digitize our health information system. And yet, for all our effort healthcare continues to consume greater slices of our budget and as Minister Jane Philpott, among others, has plainly stated: “We’re paying some of the highest costs in the world for health care and we’ve got a middle-of-the-road health care system.”

Despite the attempts to adopt or adapt evidence-based interventions and field-tested best practices, and despite all the thought and effort and funding that has gone into improving health system performance, decision makers, and administrators are constantly confronted with variations on a theme: “that won’t work here.”

The source of all this, we believe, is what many have rightly pointed out that Canada’s health care system’s lack of performance is intricately linked to a lack of integration: siloed health care and misaligned incentives. As a result, we have witnessed low levels of innovation and uptake, failed ‘big program’ initiatives, and countless pilot projects left to die on the vine. It would seem that, regardless of top-down policy and direction, health authority and primary health restructuring, there are some elemental challenges that are impeding moving toward a more effective, responsive and inclusive health care system.

Leaders are starting to look at the institutional and professional cultures that form the foundations of health care in Canada. Dr. Ryan Mieili in Saskatchewan is calling for a fundamental shift toward upstream interventions that puts prevention ahead of treatment for many common and well-understood conditions that lead to chronic disease. Dr. Danielle Martin makes it clear that the problem of ineffective treatment is not a lack of funding resources but a lack of coordination and cooperation among patients and health service providers. And Dr. Carl Nohr of Alberta has suggested perhaps the most obvious yet most ambitious change in perspective: a social contract for physicians and their patients that demands physicians take into account the broader consequences of their decisions. This “stewardship” model explicitly recognizes the finite resources that the health care system has to work with and the crucial role patients also have in being responsible stewards of that system.

Stewardship places the health service experience in the context of two key dimensions: quality of patient care and financial sustainability. Without effective stewardship, the health care system will never be able to achieve any of our shared long-term objectives of patient-centred, integrated, and high-value care. The role of patient engagement, one of the more constructive and productive movements of the past ten years, is crucial to stewardship. As Dr. Nohr eloquently said: “Historically, health care was something done to patients. Currently, it is something we do for patients. We need to move to an era where healthcare is something we do with patients.”

 

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