No magic bullets – but we need to make some changes

November 5, 2014

Dear Member:

The provincial by-elections are over, and we now have elected a new premier and health minister. If things go well, we will now be able to create some stability in the health portfolio and begin to rebuild our relationship with government. This will be welcome after several rocky years.

I have met Minister Stephen Mandel twice and I am impressed by several things: He is straightforward and he knows he must seek advice from experts on the front lines to get his job done. He appears sincere in his desire to find solutions to our long-term health care problems – but he also wants to see some measurable progress in the short term. As mayor of Edmonton, he had no patience with obstructive bureaucracy. I think that all of these attributes will be very helpful over the next few years.

In terms of the concerns I’ve discussed in my letters, further information has also become available in recent days concerning the number of continuing care beds that will be added in the next year and that will be required over the next few years.

Such information is welcome. We can see, though, that despite the addition of 400 beds in the last month, we will be faced with serious shortfalls over the next two years. Even if approval was granted for new beds today, the current process requires about three years to bring them into operation.

Finally, you will have noticed that oil prices have fallen significantly. This may be good news at the gas pump, but it will also have significant effects on Alberta’s tax revenues. Although the decline in the dollar may mitigate this effect, it would be unrealistic to think that more money for health care will be available unless we can clearly demonstrate that there will be real value in the extra expenditure.

So where does this leave us? First, we should remember that we have been struggling for 30 years to solve the continuing care bed problem. More beds are essential, but they aren’t available in the short term. Second, we have $18 billion devoted to health care and evidence that we overspend in acute care and underspend in continuing care, home care, social services and so on. Third, we have a new government with a new approach and few ties to the ways we have done things in the past.

This may be a very fruitful time to look at some significant changes in how we organize care in the community, especially for those citizens who require a great deal of complex care. I have received some very thoughtful letters with very good suggestions. They call for incremental change that could expand our ability to coordinate care, provide care with teams and avoid the use of acute care resources. I will be taking those ideas to the minister and his people, as well as to Alberta Health Services (AHS).

It is time to abandon the idea that there is a big, magic bullet that will transform our system. We will need many cumulative changes, some quick and some over time, to remodel the system. We can’t wait for the perfect set of solutions. We must start making some of these changes quickly.

Some will not work. We have to accept some failures in order to find better solutions. Some things may succeed better than we would have reason to expect, but sometimes you never know if it works until you try.

We just have to find ways to do things differently, but without destabilizing the system. This will mean attempting a variety of reforms in different cities and towns and then using what we learn to improve care in every location.

The bottom line is: We need to be able to provide the quality and appropriate care that will keep Albertans and their families together in their communities, in the best possible state of health and with the appropriate supports to break the vicious cycle of treatment, release, relapse and repeat treatment.

Please keep the ideas coming. I will keep you up-to-date on my meetings with the minister, with Alberta Health and AHS.

Email president@albertadoctors.org or leave a comment below.

Regards,

Richard G.R. Johnston, MD, MBA, FRCPC
President

1 comment

Commenting on this page is closed.

  • #1

    Paul Kantor

    Physician

    5:01 PM on November 05, 2014

    Your comments point to an underlying problem which is an "adaptive challenge, (not a physical challenge of beds- that is a symptom). The best option for addressing this adaptive shallenge and arriving at sustainability is to build in local accountability at every level of the system.

    Citizens in a Health Region need to know that their taxes are funding their local health care beds and services, Administrators need to know that local outcome measures will determine whether they are reappointed. Doctors need to be made aware of local expenditure profiles compared to other regions. This alone will allow people to take responsibility and ownership for their health care system.

    The current bureaucracy and opacity that exists is designed to obscure these elements from public scrutiny.,rather than to address them. Jack Wennberg of the Dartmouth Institute for Health Policy and Clinical Practice developed a very useful methodology for doing this on a regional basis over 30 years ago. Design a healthcare index report card, and publish it on a weekly basis I say. Behaviour will change very quickly if that occurs.

Alberta Medical Association Mission: Advocate for and support Alberta physicians. Strengthen their leadership in the provision of sustainable quality care.