Remember the television game show where the intemperate, short-haired female host dismissed contestants with the phrase, “You ARE the weakest link”? I thought of that program reading Tuesday’s headline that the four Atlantic premiers meeting in Newfoundland “talked of presenting a strong, united front as they prepare for talks with Ottawa on renewing health and social funding transfer agreements.”
Nova Scotia is lucky the other provinces still let us into the group because when it comes to going to Ottawa for funding, we are the weakest link. We persist in having the bulkiest health care administrative system in the region. In 2010, we spent $49 million to support 10 CEOs, 72 vice-presidents and 182 directors — and even then, there were administrative vacancies!
Prince Edward Island operates with one health care authority. New Brunswick dropped from eight authorities to two, one for each official language. Newfoundland and Labrador, which has unique geographic challenges, has five.
If we are going to Ottawa for increased funding, we need to show serious change and a willingness to meet standards.
When it comes to discussions about Nova Scotia health care, I am reminded of George W. Bush in New Orleans after hurricane Katrina, telling the head of FEMA, “You’re doing a helluva job, Blackie.” Everyone knew that wasn’t correct, but the president’s handlers thought saying it forcefully would make it true.
Nova Scotia has so many health bureaucracies, it’s purposely impossible for citizens to know if we have an effective system. But then, how can there be problems in a system that doesn’t recognize problems?
The IWK’s website says any complaint is listed as and considered “feedback.” Under this type of PR whitewash, the IWK could be mired in complaints, yet cheerfully go to the government and community promoting all the “feedback” it receives.
Too bad for the IWK that the medical establishment didn’t get that memo. In October, Dr. Allen Finley, head of Nova Scotia’s pediatric pain management clinic, told an international pediatric pain conference that making children wait eight months to get into the IWK’s pain-management program “is way outside what I would describe as acceptable.”
Interestingly, Finley believes pediatric pain is under-reported in Nova Scotia. That seems to be a wide-ranging trend in this province. By purposely not studying or tracking certain information, health care officials can pretend everything is fine.
Dr. David Zitner, a health policy fellow at the Atlantic Institute for Market Studies, notes that while Capital Health participated in a 2004 Canadian Adverse Events Study (this tracks medical errors), “In 2011, it is impossible to learn from Capital Health whether the promise to reduce the number of people suffering preventable death, disability and dysfunction has been fulfilled because no one has bothered to report if the rate of preventable mistakes is higher, lower or the same as reported in 2004. Moreover, the Nova Scotia government, as a regulator of health care, hasn’t bothered to ask or report to the public whether mistakes are increasing, decreasing or staying the same.”
This secrecy allows unacceptable situations to continue. For example, the province has a goal to unload patients from ambulances to hospital in 20 minutes. As of March 2011, it can take 133 minutes to off-load a patient to the QEII ER. Capital Health has promised to improve its response time by 10 per cent per quarter. That means it won’t meet the provincial target until September 2015! How is a four-year wait acceptable to the health minister or premier? This appears to be little more than a vacant promise to be left for the next government to clean up.
If we’re not tracking performances or outcomes, how can anyone defend or claim that our health care system’s structure is functioning in our best interest?
What we can do is listen to the people who work in heath care. According to the Accreditation Reports for Capital Health and IWK, staff have doubts about their employers. Asked if “senior management considers patient safety when program changes are discussed,” only 56 per cent of Capital Health and 55 per cent of IWK employees agreed.
To the statement, “I feel that I can trust this organization,” only 48 per cent of Capital Health and 52 per cent of IWK staff agreed.
There’s a problem when almost half of employees can’t say they trust their employer.
It’s ironic that when Nova Scotia has amalgamated services or reduced management, it has worked. The IWK reduced its board of directors from 26 to 17 “in order to be more efficient and effective.” According to the Health Department’s website, the 1995 restructuring of the emergency health services system, which went from 50 service providers to three, “has been extremely effective.”
Why are we now afraid of change? Why are we protecting a dysfunctional organizational structure that by every standard is failing? Recently a political operative said, “Political imperative impedes accomplishment.” Let’s not have that as the epitaph for health care.
Allan Lynch is a Valley-based writer, author and publisher of the blog: helphealthcare.ca.