What to do about health infrastructure
December 5, 2014
Dear Member:
You have likely seen or heard about this week’s media and Legislature activity around our aging health infrastructure. This is a serious matter. At a system level, well-maintained hospitals and care facilities are a critical issue for patients and the profession’s mission to provide timely, quality care.
Yet this is not a new phenomenon. I had a summer job in 1974 as a medical student with a government agency that was examining these problems. After issuing a report on facilities, the Commission was disbanded. Frankly, while attention has peaked this week, the problem has been discussed for many years. Individual members could no doubt say much about what infrastructure in disrepair looks like, as they work around it every day.
But how did we get so far down this road?
I believe that what’s happening reflects one of the challenges our system faces. Health infrastructure dollars are often allocated more for purposes of political expediency than for a long-term vision of what the system needs. We have built incredible modern structures when funds were flowing in while neglecting the maintenance of those we already had. When times were tough, there were no funds to do the mundane, everyday work of maintenance either.
How do we start making things better?
Health care in Canada is not simply a business, but we can still use business methods to calculate the present value of current and future costs and benefits or to make wise decisions on investment. We have had very competent people involved in health planning in this province. They know how such methods can be applied. I can only assume, therefore, that the calculations have been made in the past, but the resulting recommendations ignored.
I am not discouraged by this, though. If that is the challenge, it can also be the solution.
We need a new commitment to rigorous decision making. Let’s apply the science of medicine along with techniques of business and economics where they can be useful. Let’s find ways to de-politicize some of the decision making, because in many cases, the political answer is simply not the right answer.
As physicians we have a role to play in this. When considering infrastructure investment – or investment in primary care, health information technology or any number of important areas – we are the experts when it comes to the potential impact on patients. We can help identify the expected benefits, the risks of harm arising from under-investment and the value of investing in quality. This is really important input into broader questions that society needs to answer. These include considering what we value as a society as well as the boundaries between individual and social responsibility.
We will also need to look to our own practices as physicians and learn to apply the techniques of business and the economics of cost-benefit evaluation. We should support evidence-based decision making and embrace quality-driven projects such as Choosing Wisely. If we expect the public to invest in the places we offer our valuable services, then we need to assure them that we are doing what we can to create the most value for the money spent. Government can’t do it alone.
This province has many hard decisions ahead in every area of health spending. We now have a minister who has a strong public record that shows he is not afraid to invest where it makes sense. From my dealings, he has shown that he respects and wants input from providers. We have an opportunity before us to place at least some of the decision making about investment on a sound footing, informed by what patients need.
Your emails and comments continue to provide ideas and guidance. Please keep them coming. Email president@albertadoctors.org or leave a comment below.
Regards,
Richard G.R. Johnston, MD, MBA, FRCPC
President
1 comment
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Patricia E.Simonds
6:49 PM on December 05, 2014
As a physician who retired on Dec.31/13, I can recall(well before 1974)how conscientious the cleaning staff at the old Misericordia Hospital maintained the state of hygiene throughout all parts of the hospital. Of course, the 'old fashioned' flooring consisted of 2 main components:Battleship style linoleum & terrazzo. I was dismayed to see how it became 'fashionable' to install carpeting in large areas of hospitals such as the UAH. What a wonderful 'bug catcher'. Then they wonder about hospital acquired infections! I doubt that you would have to call someone from NASA to figure that one out.
Then take the construction of the 'new' Misericordia. Build a hospital on muskeg & bring in a Brit construction firm that had no idea of what was necessary to deal with the temperature extremes that we encounter in this part of the world.
Over the years, while either a patient myself, or visiting a family member or friend that has been hospitalized in any of the major Edmonton institutions & one can frequently see examples of what one can only in the most gentle terms, refer to as 'filthy'. What use of all these studies re antibiotic resistant staph when frequently someone who has just undergone surgery is placed in a room that has another bed(s)where a patient with a 'raging infection' is placed? I have had to thank my very good immune system for saving me thro' 3 separate hospitalizations. While in the Glenrose, one of my fellow patients was on a 'pus-pump' 22 hours per day. A lovely woman & unbelievably uncomplaintive or demanding but we had to share the same bathroom & her purulent discharge was located in her lower back. Well I could go on for pages, but why bother? Stupidity has a decidedly better batting average than intelligence. My mother was born in 1904 & as a child, I can clearly recall her stating that most persons of her age, inclined to view hospitals as places where "people went to die". I guess that every 100 yrs. just repeats the mistakes that were not addressed during the course of that century.