“Our current health system has been designed around the people who deliver the care. It is time to realign the values of the health system so that the patient is again made the centre of attention.”
That is just one of the refreshingly frank comments found in For Patients' Sake, a new report out of Saskatchewan, one that should be mandatory reading for every politician, health administrator and health professional.
Patient-centred care and family-centred care are the buzz terms du jour. But there is a lot more talk than innovative action.
Offering up convenient, timely care, making it easy to navigate the system, actually communicating with patients, and treating them with respect do not seem like radical ideas but, sadly, they are not the norm.
Far from it.
There are too many vested interests, too many silos and always too little time to listen. Health professionals want to deliver high-quality, compassionate care (and, despite the barriers, often do). But they are too beholden to systems and constrained by traditional ways of doing things to put patients and their families first.
Saskatchewan, to its credit, decided to move beyond the rhetoric.
In November, 2008, Health Minister Don McMorris announced the Patient First Review, under the leadership of long-time health administrator Tony Dagnone.
There have been many federal and provincial reviews of the health system over the years, so the move was greeted with a lot of eye-rolling and yawns.
But the strength of the Patient First Review is that it focused on two key questions:
- Is the health system putting the patient first?
- Is the health system achieving good value in care delivery and system administration?
The other strength was Mr. Dagnone himself, a man with a Tommy Douglas-like passion for medicare, coupled with an insider's knowledge of the system's strengths and weaknesses.
In the half-century since the foundations of medicare were forged out of Prairie populism and the pursuit of social justice, Canada has built an excellent universal, state-funded insurance program. (Or, more precisely, 15 vaguely interlocking systems, but that is a discussion for another day.)
But the underlying theme of Mr. Dagnone's report is that, along the way, we have lost sight of who the system was designed to serve: the patient and, by extension, their family members.
What is needed to repair this fundamental flaw, he said, is not more rejigging of bureaucratic structures but a change of culture and a rethinking of priorities.
“Patients ask that health-care workers and their respective leadership see beyond their declared interests so that the interest of patients takes precedence at every care interaction, every future contract negotiation and every policy debate,” Mr. Dagnone wrote.
“Only in this way will we achieve a patient- and family-centred health system for Saskatchewan citizens. Similarly, government leaders and policy-makers must keep the patient front and centre when policies, programs, and new models of care are designed and implemented.”
The formulation of that statement is noteworthy. “Patients ask” is used because the commissioner did extensive consultations with patients and families.
Mr. Dagnone did what is so rarely done in the day-to-day operations of the health system: He asked patients what they wanted and then he actually listened to them.
There is a vast reservoir of untapped patient knowledge that we need to tap into to improve medicare.
What the commissioner heard is that the system performs relatively well. The care is good, but not good enough.
So where does medicare fall down on the job? In a few areas:
- Convenience and timeliness: There is too much waiting and it's not easy to get in the right door for care, so people end up in ERs by default.
- Lack of co-ordination: Patients do not move seamlessly through the system; there are often big cracks to fall through at transfer points.
- Lack of equitable care: Patients want reasonable access to care but feel they are discriminated against based on where they live, their age, their ethnicity and other factors.
- Lack of communication and information: When someone is sick or injured, they are frightened. They crave basic information but everyone is too busy.
- Lack of electronic health records: Patients hate repeating their medical histories over and over and tests are oft-repeated because of lack of modern records.
- Lack of respect: All too often, patients feel they are treated as a bother to health professionals. Patients are not cost centres, they are the raison d'être of the system.
Mr. Dagnone does not use the term but reading his report one is left with the sense that the No. 1 frustration with medicare is the total lack of customer serv-ice. That does not seem like an insurmountable barrier.
In fact, Mr. Dagnone concludes that there is no need to dismantle and reinvent the health system but rather the need for a collective will and vision to implement fixes and change the culture of caring.
“Patient First must become more than a mantra. For the sake of patients it must become a movement that is embraced by all who have a stake in creating healthier communities.”
