One of the common threads throughout the various recommendations across all government ministries is the desire to find a better way of doing things. This covers many forms but the report made sure to not recommend across the board cuts or a hiring freeze. They feel that this only offers short term gains and will not be sustainable for the 7-8 years need to get back to balanced spending. Instead they are recommending making objectives more more evidence based. “The government should collect data and use it to evaluate whether objectives are being met and how efficiently.”
I interpret this to mean no ministry policy should be set with a strictly political view ignoring other evidence given from the specialists in those ministries. In other word don’t ignore your own staff. As we have seen on a local level, politicians ignoring staff often add time, cost and frustration to the design making process.
Most people in any profession genuinely wants the best for the organization, the people they serve and themselves. Its when an environment of illogical decisions, a lack of control and other such things will lead to people becoming frustrated and non caring towards their job.
Let’s talk about 1 example.
Health care is the largest spending areas that the Drummond report gives the most recommendations to. No wonder it is the area that most people expect to be well funded and to give them the results they desire in terms of service.
We are left with the challenge of reforming the health care system to make it operate more efficiently and give us greater value for money. This is not easy, especially not when every proposal for fundamental change is greeted in some quarters by cries that medicare will be destroyed if Proposal X or Recommendation Y or Scenario Z is adopted. The public debate in Canada has been poisoned in recent decades by a widespread failure to comprehend the issues or trade-offs that must be made; by knee-jerk reactions to worthy but complex ideas for change; by politicians (and media outlets) who have been too willing to pander to fear-mongering; by stakeholders in the health care system who, wishing to cling to the status quo, resist change; and generally by a lack of open-minded acceptance of the reality that change is needed now and that money alone will solve nothing.
One of the largest problems affecting the health care system, is that as a system designed for acute care it needs to be moving towards a system for chronic care. This is needed because of Ontario’s aging population. This will not only save money but improve the system which is a goal all citizens should desire. In multiple polls several common threads emerged.
In Ontario, a few simple messages emerge from the polling results that do seem robust: Ontarians regard health care as the single most important public policy issue; they are wedded to the single, public payer model; and they will not tolerate anything that causes deteriorationin access and quality of care. Also, there now seems to be less concern that all services be delivered under public administration, as long as the bill can be covered by an OHIP card.
The last bit should be noted as it gives some greater opportunity to think of more efficient ideas that will benefit all patients in the health care system. One of the most important is to integrate the “silos” that currently exist across the “system”. The report gives an excellent example of how the system breaks down.
Case Study #1: A 50-year-old woman has a mammogram. The results go to her family physician, whose office calls and asks her to come in for the nextavailable appointment, which is a week later. At the appointment, the family physician says the results are positive for cancer and that she will arrange for a needle aspiration. The family physician has trouble finding a radiologist to do the needle aspiration and it takes three weeks to have it performed. The radiologist then has difficulty finding the mammogram as it was done somewhere other than in his clinic, creating further delay. The aspiration shows suspicious cells and the family physician’s office calls the patient back and asks her to make another appointment to discuss the results. The family physician now wishes to do an MRI, and again there is difficulty getting it done in atimely fashion. Meanwhile, the patient is becoming frantic and taking a lot of time off work. When the MRI is done, the patient is again called back to the family physician’s office where the doctor tries to find a breast cancer surgeon to perform a biopsy as her preferred surgeon is on holiday. Three weeks later, the breast cancer surgeon performs the biopsy, which is found to be negative (i.e., cancer-free).
Case Study #1, What could happen: After a positive mammogram, the patient is referred electronically as a “Category 1” to a breast assessment centre. The patient goes online to her own record and links to the centre, where she can find and book an appointment at a time that suits her that is also within the Category 1 window for diagnosis and treatment. Through this online portal, the patient is also told how to prepare and what to expect at her appointment. When the patient arrives at the breast assessment centre within the proper time-frame set out by best practice guidelines, she sees a nurse practitioner expert and has her blood work done, a needle aspiration and an examination by doctor, all in one appointment. The patient then books her own followup appointment for four days later, which happens to be an early evening appointment so she can go after work. At the followup appointment, her results are discussed and are also available to the patient online,with email and text access to a registered nurse. That followup appointment avoids the unnecessary MRI and the patient is booked for biopsy. Again, the patient can see the results and discuss them immediately by email and phone.
This is just one example of how we have to start thinking of different ways to deliver services, not only for cutting a deficit but making it better for all citizens of the province. In recent decades we have had all three major political parties in power and we still have not got it right. It is getting better but the change needs to be accelerated and rethought in line with our situation in the 21st century.