Canada health care crisis

[OftenWrong]

Hospital administration should not be run by non-medical people. This change took place about 30 years ago. I was there and saw how the long-term effects took hold.

Over a period of time they expanded the role of administration, yet they reduced hospital beds. In our hospital here they shut down about 400 beds between 1990 - 2010.

It was noted that while they preached openly about "fiscal restraint" in the clinic, they helped themselves to the biggest slice of the pie. And having nice christmas bonuses, parties to celebrate their various achievements all expenses paid, an wit all de trimmings.

Compounding the problem is the influence of insurance people and lawyers. Once these folks are calling the shots, it's game over.

[Michael Hardner]

Just now, OftenWrong said:

1. Hospital administration should not be run by non-medical people. This change took place about 30 years ago. I was there and saw how the long-term effects took hold.

2. Over a period of time they expanded the role of administration, yet they reduced hospital beds. In our hospital here they shut down about 400 beds between 1990 - 2010.

3. It was noted that while they preached openly about "fiscal restraint" in the clinic, they helped themselves to the biggest slice of the pie. And having nice christmas bonuses, parties to celebrate their various achievements all expenses paid, an wit all de trimmings.

4. Compounding the problem is the influence of insurance people and lawyers. Once these folks are calling the shots, it's game over.

1. To be honest, this is a misconception by professionals that good managers are not their equals, at heart.  The cost of having Doctors run hospitals is that you have hospitals run by people who aren't the best at it.  

I recall the revelation to a hospital that they could schedule MRI visits in the evening and reduce wait times by months.  No capable business manager would have allowed such a situation to happen as to have an essential service shut down at 5 pm just because.

That said, the medical people need a kind of veto over decisions that's clear.

2. Bed reductions aren't "bad" on their own.  Certainly a context needs to be shown in terms of trade offs.

3. Transparency is needed, but also - if an administrator were theoretically to save millions and keep services intact wouldn't it make sense to offer incentives to attract people who are able to do that ?  Unfortunately the value of a nurse doesn't scale up to the value of an excellent health CEO - do you see what I mean ?

4. If we had an informed public, able to understand trade-offs, and listening to both the cost and quality side I am 100% convinced this problem would be solved.  Instead we have micro-managing cost cutters on one side, and bleeding hearts frankly on the other.  The public and the patients lose.   Harper put something called CIHI in place to help form an informed public on such matters.  I pushed it on this board for years but even here people are more interested in ideology fights than informing themselves on boring issues and making a better "public"

I do feel strongly about this situation - that it's our fault as Canadians we allow this to happen.

 

[OftenWrong]

15 minutes ago, Michael Hardner said:

1. To be honest, this is a misconception by professionals that good managers are not their equals, at heart.  The cost of having Doctors run hospitals is that you have hospitals run by people who aren't the best at it.  

I recall the revelation to a hospital that they could schedule MRI visits in the evening and reduce wait times by months.  No capable business manager would have allowed such a situation to happen as to have an essential service shut down at 5 pm just because.

That said, the medical people need a kind of veto over decisions that's clear.

2. Bed reductions aren't "bad" on their own.  Certainly a context needs to be shown in terms of trade offs.

3. Transparency is needed, but also - if an administrator were theoretically to save millions and keep services intact wouldn't it make sense to offer incentives to attract people who are able to do that ?  Unfortunately the value of a nurse doesn't scale up to the value of an excellent health CEO - do you see what I mean ?

4. If we had an informed public, able to understand trade-offs, and listening to both the cost and quality side I am 100% convinced this problem would be solved.  Instead we have micro-managing cost cutters on one side, and bleeding hearts frankly on the other.  The public and the patients lose.   Harper put something called CIHI in place to help form an informed public on such matters.  I pushed it on this board for years but even here people are more interested in ideology fights than informing themselves on boring issues and making a better "public"

I do feel strongly about this situation - that it's our fault as Canadians we allow this to happen.

 

No duh. Everything said here was the argument put forth at the time these changes quietly took place. Yes yes... the best people cost the most money.

Wrong. I say it is wrong in the context of health care, and I only say this anecdotally. The best people in health care are there for another reason, not the money. Not even the money, and I can demonstrate the times when nurses sacrifice their own personal time to work long shifts, due to the fact there are staff shortages. Staff shortages due to the fact that business managers don't want to fill positions with medical people who cost more.

It's a misconception that you're either a doctor or the hospital president. These people were both. They still saw patients, and ran the management side of things at the same time. Talk about efficient.

Don 't like my theories? Well, the thirty years that followed speak for themselves. Cost went up out of sight, and services crashed and failed. End of the golden age in health care in Canada.

Exactly who's fault is it that a hospital cannot provide enough services to the community, if not the administration? I have to do my job and meet my goals, or I'm let go. Is there anything they should be held accountable for?

The answer is to have them all dismissed. Fired, removed.  Rrrrouted...

[Michael Hardner]

1 hour ago, OftenWrong said:

 

1. Wrong. I say it is wrong in the context of health care, and I only say this anecdotally. The best people in health care are there for another reason, not the money.

2. It's a misconception that you're either a doctor or the hospital president. These people were both. They still saw patients, and ran the management side of things at the same time. Talk about efficient.

3. Don 't like my theories? Well, the thirty years that followed speak for themselves. Cost went up out of sight, and services crashed and failed. End of the golden age in health care in Canada.

4. Exactly who's fault is it that a hospital cannot provide enough services to the community, if not the administration? I have to do my job and meet my goals, or I'm let go. Is there anything they should be held accountable for?

The answer is to have them all dismissed. Fired, removed.  Rrrrouted...

1. I don't believe that I'm wrong across the board.  I wasn't talking about the medical teams, though, that's true.

2. That's crazy IMO.

3. Why do you think that happened?

4. I feel like you came around to agreeing with me in the end.

 

[OftenWrong]

2 hours ago, Michael Hardner said:

1. I don't believe that I'm wrong across the board.  I wasn't talking about the medical teams, though, that's true.

2. That's crazy IMO.

3. Why do you think that happened?

4. I feel like you came around to agreeing with me in the end.

 

Im not agreeing with you, since you haven't said much of your own ideas merely countering what I've said.

You think it's "crazy", but the reality was one of the best health care systems in the free world. That is no more. It was delivered by people who were passionate about health care, not upwardly mobile careers in insurance sales.

[Michael Hardner]

11 minutes ago, OftenWrong said:

1. Im not agreeing with you, since you haven't said much of your own ideas merely countering what I've said.

2. You think it's "crazy", but the reality was one of the best health care systems in the free world.

3. That is no more. It was delivered by people who were passionate about health care, not upwardly mobile careers in insurance sales.

1. I said: "Organization and management professionals are professionals and a domain of expertise on their own.  Medical people have weight and perhaps even veto over organizational changes but they should not be in charge of organizations, normally, IMO.  Paying people more as an incentive is an option, so to say that someone gets paid a lot doesn't say whether they provide value for the $.  I also say that an informed "public" (and I don't mean all voters, the general public or the masses really) will help us have better discussions.

Those are ideas I don't see often.

I thought you were agreeing with me because you put some blame on poor administration.

2. Ok, so what declined ?  I think that organizations need renewal and the comments you make about Healthcare have been echoed in Education, Policing and General Services too.  And the echoes come from people inside the system.  

Organizational renewal is hard, and success is hard in a world where every misstep is broadcast as evidence of failure.

3. I used to hear this from teachers too - that the "suits" were "others" who only cared about money.  Maybe, but that's evidence of bad management right - if they act that way or even if they are perceived that way ?  Let's stop thinking of managers and sales people as selfish c***ts should should be got rid of.

The question is: Who should the managers be listening to - which classes of stakeholders ?  It seems to me to be: Patients and providers, as people, and taxpayers as the ultimate bosses.  It sounds simple but I have seen that triangle used in management, generally, and it's a great way to think of things.

If anybody answers automatically with "spend more" or "cut" then they don't understand the concept of providing help for $, which is what this is about.  A smart "public" understands this, which we have never had.

 

Edited February 8, 2023 by Michael Hardner

[SpankyMcFarland]

Great players often don’t make great coaches. Healthcare could benefit from new thinking outside the box, perhaps managers from entirely different industries. With that said, managers new to the game have a steep learning curve and they better master the lingo because they’ll be challenged on it by the health professionals. 

Edited February 8, 2023 by SpankyMcFarland

[eyeball]

On 2/8/2023 at 7:18 AM, Michael Hardner said:

4. If we had an informed public, able to understand trade-offs, and listening to both the cost and quality side I am 100% convinced this problem would be solved.

This seems like a really big if given how little enthusiasm there is amongst our betters to have the public's nose in our business.

Quote

I do feel strongly about this situation - that it's our fault as Canadians we allow this to happen.

I hear you brother.

[Michael Hardner]

10 hours ago, eyeball said:

1. This seems like a really big if given how little enthusiasm there is amongst our betters to have the public's nose in our business.

2. I hear you brother.

1. We have to connect with others who care and demand a platform or make one.

2. ❤️

[SpankyMcFarland]

In my town we’re rapidly heading for a fully foreign-trained group of family practitioners. The locals can do just as well money-wise doing shifts in walk-in clinics and ERs where they don’t shoulder the full-time burden of caring for a practice load of patients. In addition most of them want to live in the big city, something that they and the medical school aren’t exactly anxious to advertise to the general public. The incentives to work as a small town GP are grossly inadequate here. I think the future of community care outside the city will be nurse practitioners and Zoom. Hell, ultimately, private NPs by Zoom. We’ll just need to palpate your credit card first. 

Edited August 27, 2024 by SpankyMcFarland

[herbie]

Our local hospital has found a unique way of never having Emergency Room closures it is never mentioned on the news hour like other small town ones in BC.

It has "diversions". Sign on the door to go to the ER in the next town, and ambulance drivers are forwarned to take you there instead. So even if the doors are locked and there are no doctors on staff, it is not closed and show up on the stats.

[eyeball]

1 hour ago, SpankyMcFarland said:

The incentives to work as a small town GP are grossly inadequate here. I think the future of community care outside the city will be nurse practitioners and Zoom.

NP's and Zoom/phone is becoming the standard where I live too. The incentive to live here is probably helped a little because it can be a desirable place to live for some people but yes doctors, GPs especially are getting harder to come by. Trips out of town for specialists has always been pretty standard most of the time. 

We have a number of remote communities around us that are only accessible by boat or floatplane so we have a centrally located hospital with an ER doctor on staff 24 hrs a day. It's usually pretty user friendly in a pinch and they're expanding/upgrading it so that's good.

The desire to age in place is strong here and a growing trend amongst older long term residents is to build a suite or convert a BNB back into into a residence for a care provider when the need arises.

It's different now but not hopeless.

[CdnFox]

2 hours ago, eyeball said:

NP's and Zoom/phone is becoming the standard where I live too. The incentive to live here is probably helped a little because it can be a desirable place to live for some people but yes doctors, GPs especially are getting harder to come by. Trips out of town for specialists has always been pretty standard most of the time. 

We have a number of remote communities around us that are only accessible by boat or floatplane so we have a centrally located hospital with an ER doctor on staff 24 hrs a day. It's usually pretty user friendly in a pinch and they're expanding/upgrading it so that's good.

The desire to age in place is strong here and a growing trend amongst older long term residents is to build a suite or convert a BNB back into into a residence for a care provider when the need arises.

It's different now but not hopeless.

 

Never mind remote communities - they're doing rotating closures of emergency rooms like Mission in the lower mainland and other places around the lower mainland as well.  When i moved from vancouver it took me 5 years to find a new family doctor and the local clinics simply don't have time for anyone. 

It's pretty bad. 

[SpankyMcFarland]

12 hours ago, herbie said:

Our local hospital has found a unique way of never having Emergency Room closures it is never mentioned on the news hour like other small town ones in BC.

It has "diversions". Sign on the door to go to the ER in the next town, and ambulance drivers are forwarned to take you there instead. So even if the doors are locked and there are no doctors on staff, it is not closed and show up on the stats.

Lovely. That reminds me of South Africa where the electricity company doesn’t have power cuts or failures. No no, it’s ’load shedding’, like something excessive is being dealt with for your benefit. 
 

 

[SpankyMcFarland]

Well, enough bad news. There’s always somebody doing good work to lessen the queues. I mentioned in another post that in Ontario an orthopaedic surgeon performed 14 hip replacements in one day, the sort of thing they manage in Belgium of all places. Each one takes only 35 minutes. The surgeon spends his day moving back and forth between two ORs. When one procedure is finished, the cleaning team come in and get the room ready before the surgeon is finished with the other case. 

https://www.cbc.ca/player/play/video/1.7054389

https://hospitalnews.com/hyper-throughput-operating-rooms-increase-efficiency/

https://deo.care/professor-corten-belgium-efficiency-for-direct-anterior-hip-surgery/

There is a catch to such extraordinary productivity. OHIP won’t pay for that number so they have to fund the excess through donations at the moment. 

In my local hospital the surgeons would be lucky to be allowed 2 hips on a list. At the moment the province is trying to move the orthopaedic surgeons to other more remote hospitals now and then where there is available OR time.

You’d have to wonder whether one centre could do a large proportion of Canada’s hips and knees more efficiently and with fewer complications than hundreds of independent institutions? Maybe one centre in each region, however defined, run by one national group? Quality control would be a much simpler issue then. Yes, there would be endless arguments about the money but it might be worth a try. Whatever happens, there’s no question that Humber Valley have just set the bar a lot higher. 
 

 

 

 

 

 

 

 

 

 

Edited September 2, 2024 by SpankyMcFarland

[CdnFox]

3 hours ago, SpankyMcFarland said:

There is a catch to such extraordinary productivity. OHIP won’t pay for that number so they have to fund the excess through donations at the moment.