Years of the health systems transformation conversation have led to one resounding conclusion: pretty much everyone agrees things need to change. And we even agree on some changes we need to improve patient experience, population health and work life of health-care providers while containing costs. So why don’t we to make the significant leaps forward needed to deliver more effectively on this quadruple aim?
New RCMP Commissioner Brenda Lucki recently shared an observation about two things humans can’t stand: a) change, and b) the way things are. We may not love change, but we certainly don’t love status quo in most health care settings. Orchestrating complex changes to transform health systems has proven to be well-nigh impossible. After two decades of different types of health accords, we are still talking about putting patients first, pharmacare, the need to focus on determinants of health and health promotion, to meet rapidly-evolving population health needs.
Colin Goodfellow, former CEO of Kemptville District Hospital, argued that we are “culturally affixed to a delivery system that is overbuilt and under-imagined for the age.” We are not standing on the cusp of difficult change in health care; it’s already burying and overwhelming us. In 2003, American nurse leader Dr. Tim Porter-O’Grady used nursing to illustrate the dramatic scope of the changes in hospitals, saying they signal “the end of nursing practice as we know it.” He observed that nurses are “now managing mobility rather than residency” and their job essentially is managing patient turnover. These truths do not mean the end of the nursing profession nor of great health care, but mean the end of practice as we know it.
You wouldn’t know about that sort of thinking if you looked at how we educate nurses and doctors—or how we regulate, deploy and reward them. Much of that is proving to be a stale mis-match for real system needs, and digital-era demands come into constant conflict with our industrial-era delivery models. But there are solutions; and one is to arm providers with the skills and authority to safely deliver the kinds of care needed in this century. Despite the relentless talk about inter-professional care teams, we continue to operate largely in rigidly siloed health professions. We are ruled by the understanding that the physician is the leader and owner of patients and care.
Unless and until we abandon our inter- and intra-professional turf protection, unlock the notion that no one owns competencies, and agree that only patients own themselves, we’ll be circling around for another decade. A strong federal hand would make a difference. And what we desperately need are courageous health leaders from all sectors who confront reality and help us make leap forward into the 2020s to deliver the care Canadians need and deserve. That leap means overhauling funding and payment models, optimizing scopes of practice and then using them, modernizing collective agreements, being much smarter about how we manage episodes and transitions of care, and creating the structures, services and funding to truly support people staying out of emergency rooms and hospital beds as much as possible.
Mike Villeneuve is the CEO of the Canadian Nurses Association.
Contributed to the Sixth Estate – The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Sixth Estate.