Success Stories from the Western Provinces featuring Dr. Robert Halpenny, President & CEO of the Interior Health Authority; Graham Whitmarsh, Deputy Minister of Health for BC; Dan Florizone, Deputy Minister of Health for Saskatchewan.
Dr. Halpenny introduced Dep Minister Whitmarsh.
Whitmarsh has only been in the post 3 months. He came over from the Finance portfolio. He has stated that the plan for Healthcare in BC remains constant. BC holds one of Canada's healthiest populations. However we still have over 44% adult obesity.
The current system is crisis based focussed on acute care, and not preventive. Also noted that we manage the health system differently than the patients experience it. The strategic plan remains to drive productivity and efficiency across the system. The entire map of the strategic plan was shown; it was certainly not easy to digest in a quick glance. The last update was as of March 2011. The plan is available online, and is worth a review to understand alignment between that of FacMed and the government over all strategy. 15 key result areas in the plan to be aware of. All HAs are asked to align their strategic plans with this plan.
A key point is a drive to a change in funding mechanisms. Major shifts in costs are made through thousands of small decisions. A new generic drug deal has been made, and major milestones in eHaelth will be achieved next year. Next year there will also be a smart health card available.
48% of the overall government spending is Health Care in BC. The demand for services increases by about 6% per year. The rise in Health Care budget this past year was more than the complete budget for the judicial system.
Insert plug for HST. The ability to continue to fund Health Care services was linked to maintaining the HST.
Health care resource need was linked most closely to general inflation and health inflation specifically. This was interpreted as good news as these are discretionary and controllable, and aging and general use increases make up 1/3 of the overall growth, giving us the ability to manage 2/3 of the growth.
A commitment was made to stick with the overall strategic plan as they have been, and not change horses midstream.
Dan Florizone was introduced. Dan is also a board member of the Canadian Health Patient council.
Dan suggested that we've had a fundamental rethink across Western Canada on health care in the last few years. He referenced the Patients First review, and noted that looking at things from a patient point of view is still a fairly new mechanism, and is only now maturing in it's approach.
First issue is that we need to fix access to health care.
Secondly, that we need to repair the overall approach to managing health care.
Dan discussed the metrics used to measure healthcare, and said that our traditional approach within government to compare only within Canada is useless and doesn't challenge us to grow.
We need a fundamental change in our thinking within healthcare in western Canada where we place the customer first, much like private sector vendors.
Dan stated that we need to consider that if things are free, the appetite is unending. We need to rethink the patients perspective in what they want. We think the they want specific services, but what they want is restoration of health, and not being a patient in the first place. It's a bigger picture view that is needed. We need to consider the whole of their health care journey.
Swedish healthcare system has a poster patient named Esther and each meeting or conference ends with "how did this help Esther?" This is an approach to personalize the over all solution to healthcare delivery.
Dan discussed an example of a situation where admittance in a hospital for a patient is improved, but it's only a partial and ineffective optimization because the overall situation is addressed. Esther can be admitted faster, but if the treatment time remains the same, or there's no improvement in post visit care, she sees no change overall and in fact may have longer waits.
We need to be careful not to micro focus and suboptimise solutions, but balance that with still improving Esther's journey.
In summary, Dans approach is to take a standard business view where we want to focus on the overall customer experience and fix it by having everyone fix their areas while keeping the big picture of how those improvements leverage each other.
A parallel was drawn between the airline industry and health care by Graham. He noted that success in the airline industry is achieved by what you do with the plans on the ground, not while they are flying. Also that engaging the clients is vital, but they will always talk about where things are today, but not where we are headed tomorrow. We need to balance the needs of today with the needs of tomorrow given how long it takes to apply significant change. Another point discussed was the difference between how pilots are engaged in the business of the airline and co dependent on the success, but that physicians are funded separately. It may be a model worth considering.
Dan spoke about a visit to Boeing where they looked at how the processes of building planes could be applied to helping patients. Dan made the point that while we may feel that health care is different and special and the models in the business world don't apply, he stated that's not true and we need to look for alignments and application of the things learned in commerce to health care. That visit was followed by a. Visit to Seattle Children's hospital where they have adopted a similar approach and noted 45 minutes from door to disposition.
Dan summed up his thoughts by saying we need to responsibly consider what patients REALLY want when they ask for specific services. What is at the root of their health care service requests?
Physician extenders and nurse practitioners were discussed in the sense of what the public appetite may be. Dan stated that nurse practitioners have been well received in Saskatchewan. Physician extenders have not been applied yet and he's not sure what the appetite will be. Graham said that BC would be a welcome ground for both ideas, and that it's a major priority for BC. dan argued that a team approach is crucial to overall health care success. He discussed models outside of Canada that are not successful because groups of people are forced to work together, but do not function as a team from a patient perspective. A lack of sharing information is detrimental to health care operating as a service industry.
Diane Doyle from Providence Healthcare in Vancouver asked what they think the skills and attributes needed by health care leadership are, and how do those get developed and transferred to staff.
Graham started with an observation around a lack of trust. Between HAs and Ministry. Frustration around perceived lack of organization certainly fills into this. Dan stated that collective planning is vital. Trust, hope, and an ability to rethink because solutions will come from the front lines.
A question was asked for progress updates on eHealth. Graham restated that key delivery milestones will be hit next year. There wasn't a specific answer. Dan said that automating broken systems just moves crap more quickly. It was pretty insightful, while obvious, and hopefully sinks in a bit as to what he's really getting at.
Dr. Halpenny asked the speakers how we align more closely with the private sector to achieve win-win scenarios for the patients. Dan challenged the vendors in the audience to think about how to bring Esther's perspective to meetings with health care professionals.
Mike Emery from MedTronic Canada asked where we sit with respect to remote monitoring, and how HSSBC will adopt improvements in technology in a way that the total ROI (or total cost of care) to the patient is considered?
Graham stated that remote monitoring is a key initiative to be undertaken. It will be be next major project undertaken starting next year. Graham also stated that in BC, any new technology is vetted against the strategic plan and should have a view to the total cost of care before adopting. Dan stated that centralizing everything may not be the ideal answer. Distributing care aspects via remote monitoring is important in how it can bring together virtual groups across Canada to focus on care for individuals.
The comment came up from Graham that we do not in BC have any good metrics for tracking the cost of provisioning health care to our citizens. W simply don't have the granular information we need to make the timely financial decisions.
Telus posed a question about how private sector integration and partnership can increase efficiencies. Dan said it's important to understand the concepts of value chain and supply chain. Stick to those things you are good at. There needs to be more outsourcing of peripheral services like cleaning, parking, etc. And have the health sector focus on health services. What is in the best interests of Esther?
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