A number of current events have prompted this journal entry. We've recently heard from the Health Council of Canada, soon to be moth-balled, where Jack Kitts, chair of the Council's panel was quoted as saying:
"Most Canadians think that they have good health care; yet, the evidence suggests the system is not as good as they think it is."
The newest report from the HCC discusses how the health reforms that governments have taken in Canada have not created the transformation required. So good to hear some honesty about wait times and the failure of billions of tax dollars to make any significant change. Some of you may take this as negative but after so many years of being advised that to lead in health care we must take part in Groupthink it is a relief to see an evidence based report that confronts reality.
And that made me reaffirm my thinking:
The happy thoughts and attempting to deliver "the right care, to the right people, at the right time, in the right places" might not be working the way the decision-makers intended.
Why is this?
With so many talented, dedicated people trying to innovate in health care, why are the changes not resulting in the improvements that were anticipated and why are there so many unintended consequences?
Quite possibly, it is because we have defined the wrong problem(s) to be solved.
I'm a keen reader of the Harvard Business Review Blog Network and an article by Bart Barthelemy and Candace Dalmagne-Rouge from September 13, 2013 caught my eye. Here are some snippets from "When You're Innovating, Resist Looking for Solutions" :
"...as soon as you start thinking of a solution, you unconsciously begin shutting off possibilities for getting a deeper understanding of the problem and therefore of finding a truly breakthrough solution....It's better to stay in what we call the "problem space" for as long as possible."
"So go deep. Look for underlying issues. What's the real obstacle you face? Once you've found it, go deeper still. What's the essence of that obstacle?"
"Search for different viewpoints."
"Don't be afraid to bring outsiders into the discussion."
"Staying in the problem space, in particular, can be difficult."
Over the past decade, decision-makers, consultants, politicians, bureaucrats, Ministers of Health and Deputy Ministers as well as organized physician representation have been focussed on efficiencies, doing "more with less", teams, ehealth, coordinating care, improving "value" (however that is defined) and big data.
But what if the essence of the problem isn't really related to any of these things?
What if the areas mentioned above make the health care situation worse by moving tax dollars for health care to other endeavors that don't improve care or improve access or improve health?
Isn't the problem we are facing in health care really the inability of government to fund all of the medical services required and demanded by a population that has grown to believe that government can provide for all of its needs?
If we want to find solutions in health care that improve access, maintain or improve quality, and decrease government costs to a sustainable level then we need to redefine the problem with long term vision.
According to a recent report from the Society of Actuaries and Canadian Institute of Actuaries released September 17, 2013, Canada's current health care system is not sustainable over a 25-year horizon. As reported by the Rock Hill Herald, the study predicts that provincial and territorial governments' annual spending on health care will increase by approximately 133% from 2012 to 2037 and the expenditures will be close to 86% of governments' own source revenues.
*Growth rates will make it almost impossible for provincial and territorial governments to service their debts and program other services such as education, social welfare and infrastructure."
*There are two key causes of growth in the proportion of the budget: real growth in health care expenditures largely due to the aging of the population and reduced growth in GDP as the working population grows much slower that in the past."
*The revised Canada Health Transfer formula anticipates the future share of the federal government will drop to 14% by 2037, further reducing the amount available to provincial and territorial governments for other program expenditures."
"This report's findings confirm that funding future health care expenditures will be challenging for provincial and territorial governments even if the CHT remains unchanged."-Gary Walters, member of the report's Project Oversight Group.
Which brings me to the article I first spotted in the Kelowna Daily Courier a few weeks ago regarding the plans of the Westbank First Nations to build a 100 bed private hospital. The first phase would include 10 operating rooms and full lab and diagnostic services. Tentatively called the "Lake Okanagan Wellness Clinic", it would use public funds to treat aboriginal people but would also treat Canadians paying out of pocket including joint replacement surgery and cosmetic surgery.
There are also plans to conduct research into diabetes and heart disease and "treat people long-distance using closed-circuit TV".
The National Post reported on this exciting health care development in the last few days and so far I have not heard any vociferous backlash from DoctorsforMedicare or Friends of Medicare or other loud union-backed groups that prefer to support creating and maintaining dependency on a health care system unable to meet the overall demand for care.
Perhaps by defining the problem in health care as an overwhelming dependency on an overburdened public health care system we can move to truly innovative solutions that create more opportunity for care, strengthen initiative and support truly vulnerable populations.
I am hopeful.
Once again, thank you for your support over the years and for your ongoing participation in this important health care dialogue. I truly value my contributors.