Prescriptions for an ailing healthcare system

A few months ago, a senior official of the Nova Scotia Health Authority asked that I, and others, consider the impact of our comments on health care in Nova Scotia in media articles and interviews that we had provided over the last three years. That person told us our articles are contributing to a narrative of negativity and that is impeding their ability to recruit and retain health personnel.

That was a sobering statement that required reflection and careful consideration.

This week there were no less than five articles, op-eds and letters on healthcare in the provincial media. Each was thoughtful, some passionate, others inflammatory, few were complementary.

None offered solutions.

When a team takes ownership of its problems, the problem gets solved. It is true on the battlefield, it is true in business, and it is true in life.

One of the key qualities a leader must possess is the ability to detach from the chaos, mayhem, and emotions in a situation and make good, clear decisions based on what is actually happening.

The people of this province have been duped into believing that healthcare is a Gordian knot which no one has been able to untie. Political leaders have repeatedly fallen on their swords, especially those that have made bold gestures (closing rural hospitals), or made poorly-informed promises (every Nova Scotian will have a family doctor).

In both cases, leaders believed they were doing the best for their province but the foundation on which the decisions were built was made of sand, not concrete.

When health care tracks to 50 per cent of the provincial budget, everyone has an oar in the water, and political operatives know that more that anyone.

It has been said that the reason people oppose progress is not that they hate progress, but that they love inertia. Progress is impossible without change, and those who cannot change their minds cannot change anything.

The Nova Scotia Health Authority has achieved good things but it has made very serious mistakes. It is true that successes have received much less press than the failures. The response to criticism has been to cocoon and obfuscate which has exacerbated the problem.

Poorly prepared for the transformational change that gripped the province, with the collapse of health boards to a central governing body, the architects of the change did not appreciate their own deficits in both content expertise and transformational leadership skills. They lacked data sets on which to make informed decisions and did not realize it until it was too late.

Let’s be frank: It is unconscionable that in a first world country, patients are assessed in hospital washrooms, die on stretchers in emergency rooms, travel more than 100 kilometres to access primary care, and die on wait lists.

It is equally unconscionable for a system to hold on to past practices when there is evidence that changing the practice will have positive heath outcomes. Jurisdictions such as the Netherlands, Scandinavia and the United Kingdom have already proved this.

People seeking a health intervention want it provided by the most appropriate person in the most appropriate place. Sometimes that is by a paramedic, a mental health worker, a nurse practitioner, a social worker or a family physician. It is not always only one of them and more often than not, a bit of each. To claim the supremacy of one over another is counterproductive and has lead us to where we are today.

To solve this problem, we first must start with admitting we have arrived at a point in time where extraordinary measures are required.

Common sense would suggest that having ability, like being smart, inspires confidence. It does, but only while the going is easy. The deciding factor in life is how you handle setbacks and challenges.

For good ideas and true innovation, you need human interaction, conflict, argument and debate. We are bereft of all in the current dialogue around healthcare in this province.

Patti Melanson made a contribution to the welfare of the homeless and was recognized for it. Her passion was driven by inner strength and an inspired determination to change the status-quo. For all the recognition she deservedly received, there must have been times when she wondered where the compassion of fellow Nova Scotians was as she waded among the suffering. Her acts of caring have enabled a conversion on the road to Damascus by her selfless commitment to the human condition.

In an insightful article penned by Dr. John Ross last week, he called on the premier to act to change the narrative as the buck does truly stop with him and his cabinet. Premier McNeil did not create the mess we have in health care today, as we all know that other provinces are coping with similar problems, but he has failed to articulate clearly that Nova Scotia is one of the more challenged jurisdictions.

Leaders play a unique role in periods of crisis and chaos. Because if they don’t, they are not going to harness the power of all the people behind them. Let us not compound the problem by underestimating our abilities to address the problems.

Here is what could make a difference: First, the current leadership at the NSHA needs to change. They have had four years or more to communicate a strategy and operational plan to change the trajectory of health care. They have failed and so they must go.

Providing everything to everyone is impossible. The funding model does not reflect the reality of the demographic and burden of illness challenges faced by a population of less than 1 million people. A community needs assessment is required and a plan to address those needs must be developed with the community within the community.

Primary care is ill-defined and mired in emotional arguments when empires suit up to protect their own turf. The service payment model is archaic and needs to reflect the value each discipline contributes to primary care. Barriers have to be broken down by legislation if needed.

Emergency rooms have, by default, become the safety valves for a system in crises. It is a failed strategy which is contributing to the demise of primary care. An immediate solution is needed which will require extraordinary resource allocation common in any disaster response. There are content experts in this province who could be marshaled to address these issues.

In all life’s situations there are going to be very good days and very bad days. But it is rare that things are as good as they look, and rare that things are as bad as they seem. Having perspective, and challenging perspective are both important to making good decisions.

To the NSHA official, I say it is not writing about negative outcomes that perpetuates negative outcomes, rather it is ignoring that they exist. If health professionals with first-hand knowledge shared honestly what they observe every day, then it is likely that solutions would be found. Regrettably there are few Patti Melanson’s to inspire us to stand up for what is right and just.

Dr. Bob Martel

West Arichat