Canada's health care system sucks

[Sir Bandelot]

In regard to the hospital in PEI, there is no way that the hospital administration did not know that the ER was running so poorly. With people waiting for 12-14 hours, this couldn't have been an isolated case. Likely also that the management has tried to get government to provide more resources for the ER (ie, give us more money). There are often remedial steps that could be taken, to mitigate the problem of long wait times but sometimes the management refuse to take them, seeing it as a short term solution to a long term problem and wanting to put more pressure on the government to meet their demands. In doing so they create a crisis, to give themselves a political advantage.

I have seen where they will close beds and reduce services, even lay off staff but never reduce the level of management. The absurdity of the situation is that it ultimately leads to a dysfunctional organization that does not provide adequate health services, but is full of bureaucrats. And THAT, is what's wrong with the health care system. NOT, the concept of socialized health care with the idea of equal access for all.

It worked much better years ago. Now ask yourself, what is it about the system today that is so different from the past? Corporate business strategy applied to health care, with little regard for the patients who are in fact used as pawns in this game. That is whats causing these problems.

[Smallc]

Only 3 hospitals in PEI have 24 hour ERs. 2 are in Prince County, and one is in Queens County (this hospital). Queen Elizabeth Hospital is the only one in the centre and for the entire east side of the island. If they could get the Kings County Hospital to be a facility with a 24 hour ER, this would be less of a problem as QEH would be less busy.

Edit: Where did you get the 12 - 14 hr wait numbers?

Edited August 4, 2010 by Smallc

[punked]

Only 3 hospitals in PEI have 24 hour ERs. 2 are in Prince County, and one is in Queen's County (this hospital). Queen Elizabeth Hospital is the only one in the centre and for the entire east side of the island. If they could get the King's County Hospital to be a facility with a 24 hour ER, this would be less of a problem as QEH would be less busy.

Edit: Where did you get the 12 - 14 hr wait numbers?

See these are the types of ideas we need.

[Smallc]

See these are the types of ideas we need.

The Kings County Memorial Hospital only has ER services from 8am to 10pm. I believe that's an improvement from before, but it should be a 24 hour facility. There is also an urgent care centre at one hospital, but it too has short hours, and again, wrong side of the island.

[Sir Bandelot]

Edit: Where did you get the 12 - 14 hr wait numbers?

Its on page 3 of the Guardian article.

[Wilber]

I also hope she gets better.

However, and I guess this isn't a very nice thing to point out but oh well, one might also say that it was up to an able family member to arrange, her son perhaps...

No problem if I had been made aware that it was necessary. In BC we have gone from individual hospitals to regional health authorities in the past few years. Hospitals used to coordinate with family doctors but apparently no more. My father didn't find out until he called their GP himself yesterday. Their doctor wasn't aware of either incident. A lesson learned from experience. No one tells you that you are on your own in such circumstances.

[Smallc]

Its on page 3 of the Guardian article.

Thanks.

[Smallc]

No problem if I had been made aware that it was necessary. In BC we have gone from individual hospitals to regional health authorities in the past few years. Hospitals used to coordinate with family doctors but apparently no more. My father didn't find out until he called their GP himself yesterday. Their doctor wasn't aware of either incident. A lesson learned from experience. No one tells you that you are on your own in such circumstances.

A regional health authority system should increase coordination, not the opposite. Sometimes, unfortunately, oversights happen. What we have to do is learn from those oversights. Hospitals should be sending records to family doctors....even better is electronic health records that are being rolled out across the country.

Also, your individual hospitals are still individual under a RHA system. The hospitals are simply put under an umbrella for better coordination of all types of things. IMO, it actually works very well. We've used it for years now here. The only problem is that smaller hospitals will often loser services to larger Regional Health Centres, but then, that's also a good thing in many ways.

Edited August 4, 2010 by Smallc

[wyly]

In regard to the hospital in PEI, there is no way that the hospital administration did not know that the ER was running so poorly. With people waiting for 12-14 hours, this couldn't have been an isolated case. Likely also that the management has tried to get government to provide more resources for the ER (ie, give us more money). There are often remedial steps that could be taken, to mitigate the problem of long wait times but sometimes the management refuse to take them, seeing it as a short term solution to a long term problem and wanting to put more pressure on the government to meet their demands. In doing so they create a crisis, to give themselves a political advantage.

there is little management can do...management does not train medical staff to correct shortages...management does not provide money, it makes do with what the government gives out....

I have seen where they will close beds and reduce services, even lay off staff but never reduce the level of management. The absurdity of the situation is that it ultimately leads to a dysfunctional organization that does not provide adequate health services, but is full of bureaucrats. And THAT, is what's wrong with the health care system. NOT, the concept of socialized health care with the idea of equal access for all.

there's a couple of popular misconception...management is the first to be let go when there are cuts because unlike unionized staff they have no recourse...plus unlike unionized staff their wages can be frozen...

It worked much better years ago. Now ask yourself, what is it about the system today that is so different from the past? Corporate business strategy applied to health care, with little regard for the patients who are in fact used as pawns in this game. That is whats causing these problems.

what was different in the past was there were more doctors...there were more doctors who were willing to be general practioners, now doctors are staying in school to become specialists(way more money) so there no longer enough GP's to keep open all those private clinics that handled the cases that are now flooding the ERs...and our demographics are changing the population is aging and the population is still growing there just aren't enough doctors...

[bloodyminded]

I also hope she gets better.

However, and I guess this isn't a very nice thing to point out but oh well, one might also say that it was up to an able family member to arrange, her son perhaps...

!

I'd tread carefully, my man.....

[edit]: never mind, I see that no offense was taken.

Edited August 4, 2010 by bloodyminded

[Sir Bandelot]

there's a couple of popular misconception...management is the first to be let go when there are cuts because unlike unionized staff they have no recourse...plus unlike unionized staff their wages can be frozen...

Sorry but it is sheer fantasy.

what was different in the past was there were more doctors...there were more doctors who were willing to be general practioners, now doctors are staying in school to become specialists(way more money) so there no longer enough GP's to keep open all those private clinics that handled the cases that are now flooding the ERs...and our demographics are changing the population is aging and the population is still growing there just aren't enough doctors...

Shortages of professional staff, be they doctors or otherwise are also a management issue. In many cases they have been artificially created. Again the draconian business concepts of manipulating supply and demand come into play.

Edited August 4, 2010 by Sir Bandelot

[Michael Hardner]

The only thing that will fix the system is money and people. There is nothing else that can fix it. There is enough money now, there just isn't enough people.

A system that allows everyone the same access isn't broken at all. There's nothing wrong with the system itself.

There is something very wrong with the system.

The fact that the people inside have no independent monitoring of their performance, and that the public has to rely on sporadic press reports of failure to glean what is going on means that the system isn't accountable enough.

[Michael Hardner]

Well, I was leaving unstated there the idea that everyone would get at least a fair level of care, which is what we have now.

With what little information that gets out, we can see that the level of care isn't always adequate, as came out with the emergency cancer surgery statistics in Ontario. You have also been reluctant to indicate what a good level is.

My take on it is that the system needs to be measured independently for costs and service levels, and watched by the public.

[Michael Hardner]

It worked much better years ago. Now ask yourself, what is it about the system today that is so different from the past? Corporate business strategy applied to health care, with little regard for the patients who are in fact used as pawns in this game. That is whats causing these problems.

And I maintain that aligning with business strategy is a good thing, if the goals are keyed towards service levels and costs. Unfortunately, the system is run with too much of an eye on short term political goals.

[Sir Bandelot]

My take on it is that the system needs to be measured independently for costs and service levels, and watched by the public.

THat would seem to be a good idea in principle, but opens up the question, who's watching the watchers. To some extent these independent groups exist, as with organizations like CCO. Yet it remains inneffective. Corrupt, corrupt, corrupt. And as stated the information used to measure success also gets manipulated. This should not be very surprising, given the amount of money and jobs involved in the system as a whole. As the saying goes, follow the money, and you'll find the criminals.

My take on it is that the system needs to be re-structured entirely, so that medical staff have the most say in how frontline operations are to be run. Administration should be confined to counting beans, and nothing more. They should be kept to a minimum level in number and in level of pay. Because only the medical staff have the most important priorities in mind, to provide health care. If a hospital is not doing that, why does it exist? It is the very reason d'etre, and all else is an impediment to that process, including and perhaps even foremost, administration.

With the right people in charge, who have got their priorities straight, it will work. It worked in the past.

[bloodyminded]

And I maintain that aligning with business strategy is a good thing, if the goals are keyed towards service levels and costs. Unfortunately, the system is run with too much of an eye on short term political goals.

The problem is that the cherished notion that "business is efficient" is a mischaracterization. Business is efficient so long as efficiency is profitable; inefficient if that's the profit direction.

I'm personally not one of the big slammers of the American system (which I consider both inferior and superior to our own); but the business model is not efficient in health care terms. Hell, the bureacracy is bigger and more complicated than ours (the opposite of what free market enthusiasts would predict, interestingly); and i don't mean it is bigger in conformity to populaiton (ie ten times bigger and more complicated); it's far worse than that.

Edited August 4, 2010 by bloodyminded

[Michael Hardner]

THat would seem to be a good idea in principle, but opens up the question, who's watching the watchers.

Exactly ! WE have to watch the watchers. Any project to initiate a change in the system needs to declare it's key success metrics, and needs to measure results, and this needs to be done publicly.

This is a long and difficult process, and will initially fail. As such, politicians can't rush in and try to "fix it" after the first few changes.

To some extent these independent groups exist, as with organizations like CCO. Yet it remains inneffective. Corrupt, corrupt, corrupt. And as stated the information used to measure success also gets manipulated. This should not be very surprising, given the amount of money and jobs involved in the system as a whole. As the saying goes, follow the money, and you'll find the criminals.

Yes. The new government in the UK is demanding that departments publish their budgets online, for example.

The system needs to be monitored, and also people need to understand that the first few attempts at real change will yield failures.

My take on it is that the system needs to be re-structured entirely, so that medical staff have the most say in how frontline operations are to be run. Administration should be confined to counting beans, and nothing more. They should be kept to a minimum level in number and in level of pay. Because only the medical staff have the most important priorities in mind, to provide health care. If a hospital is not doing that, why does it exist? It is the very reason d'etre, and all else is an impediment to that process, including and perhaps even foremost, administration.

Absolutely. Frontline staff are stakeholders in any change. A hallmark of terrible organization is top-down change mandated by people who don't have experience with reality. Unfortunately, though, what we have now is stasis. With complex systems like this, the frontline workers grow weary of mismanagement, and dig in their heels to resist change. It's completely understandable, and that situation has to be recognized.

The big problem to my mind with administration is that they tend to hunger for their own staffs and their own budgets.

With the right people in charge, who have got their priorities straight, it will work. It worked in the past.

There needs to be a tripartite solution put forward with workers, managers and the public working together. To my mind, it may be better to start fresh somewhere rather than reform existing systems. Build new hospitals using best management practices, validated by healthcare professionals, and accountable to an interested and involved public.

As these new hospitals start to thrive, delist the older organizations.

[Michael Hardner]

The problem is that the cherished notion that "business is efficient" is a mischaracterization. Business is efficient so long as efficiency is profitable; inefficient if that's the profit direction.

What I take from that statement is that there are businesses that don't need to be efficient to be profitable, and therefore are not efficient. That is true, in my experience.

I'm personally not one of the big slammers of the American system (which I consider both inferior and superior to our own); but the business model is not efficient in health care terms. Hell, the bureacracy is bigger and more complicated than ours (the opposite of what free market enthusiasts would predict, interestingly); and i don't mean it is bigger in conformity to populaiton (ie ten times bigger and more complicated); it's far worse than that.

The American system includes middlemen who profit from administration. It's also got more flexibility in some ways, and likely has more innovation. I base this on my dad's experience in Florida, where he could go to a number of cheap clinics to get minor health matters dealt with, paid per visit. There's less central control, so that makes sense.

The issue with our system is, to my mind, that there's no direction to it.

[bloodyminded]

What I take from that statement is that there are businesses that don't need to be efficient to be profitable, and therefore are not efficient. That is true, in my experience.

The American system includes middlemen who profit from administration. It's also got more flexibility in some ways, and likely has more innovation. I base this on my dad's experience in Florida, where he could go to a number of cheap clinics to get minor health matters dealt with, paid per visit. There's less central control, so that makes sense.

I can go to a free clinic to get minor health matters dealt with, and I'm glad it's not just "cheap."

[Michael Hardner]

I can go to a free clinic to get minor health matters dealt with, and I'm glad it's not just "cheap."

The point is that allowing other providers to come in provides a service that a single provider may not be able to provide as easily. I'm not suggesting charging user fees here.

[bloodyminded]

The point is that allowing other providers to come in provides a service that a single provider may not be able to provide as easily. I'm not suggesting charging user fees here.

Sure, I understand you're keen on exploring options, which I see an an untrammelled good.

Just so you don't misperceive my intent.

[Michael Hardner]

Sure, I understand you're keen on exploring options, which I see an an untrammelled good.

Just so you don't misperceive my intent.

And to let you know where I'm coming from - I don't want a two-tier system, nor do I want fees but my ultimate concern is better care. I believe that an overhaul is needed now, that the system has evolved into something too unwieldy to be managed with our management infrastructure, and with limited public insight into what is happening.

So I don't want a US or French style system but if it means things get better then yes I'm all for it. I think a publicly monitored and audited public system would work fine if the politicians didn't interfere with it.

Ontario's eHealth is an example of hundreds of millions spent on a political football with no publicly valued result yet coming from it.

[Mr.Canada]

And to let you know where I'm coming from - I don't want a two-tier system, nor do I want fees but my ultimate concern is better care. I believe that an overhaul is needed now, that the system has evolved into something too unwieldy to be managed with our management infrastructure, and with limited public insight into what is happening.

So I don't want a US or French style system but if it means things get better then yes I'm all for it. I think a publicly monitored and audited public system would work fine if the politicians didn't interfere with it.

Ontario's eHealth is an example of hundreds of millions spent on a political football with no publicly valued result yet coming from it.

Something has to give or by the year 2030 $.70 of every 1 tax dollar collected will go to health care if we continue down the same road we're on now. It just isn't sustainable, something has to change. The only way it'll change is if we start charging a small fee every time people go to the Dr. Some people run to the Dr. for a runny nose, this is absurd. It's this sort of waste we need to cut out. People will think twice before going if they have to pay a small fee each time. This is just one idea but the system as it is now cannot support itself, impossible.

Maybe the government needs to get out of health care altogether. Have it run privately with public/private dollars, get some private sponsorship. Keep government guidelines and rules of coarse but take Doctors and nurses of the public payroll. This will save many Billions of dollars. Doing this will force the unions to bring their wages down instead of holding the government hostage, every couple years. If they were private the hospital could just fire them and rehire new people.

Same thing for education, private sponsorship partnered with public dollars will save Billions.

[Michael Hardner]

Something has to give or by the year 2030 $.70 of every 1 tax dollar collected will go to health care if we continue down the same road we're on now.

The comparisons I see on tax dollar are relative to the tax base, and there have been discussions that that number has changed due to overall cuts.

But these things are the basis for initial discussions: namely, how do we measure cost efficiency ?

Sadly, we haven't really got a benchmark for that that the public is familiar with.

Same thing for education, private sponsorship partnered with public dollars will save Billions.

And the issues are the same - how do you maintain national standards and prevent private profiteers from neglecting their obligations ? We all need to pay attention, that is how.

[Mr.Canada]

The comparisons I see on tax dollar are relative to the tax base, and there have been discussions that that number has changed due to overall cuts.

But these things are the basis for initial discussions: namely, how do we measure cost efficiency ?

Sadly, we haven't really got a benchmark for that that the public is familiar with.

And the issues are the same - how do you maintain national standards and prevent private profiteers from neglecting their obligations ? We all need to pay attention, that is how.

I don't know but the people who make these decisions need to start talking about it before it's too late Michael.