By all indicators, both national and international, our health-care system is not doing the job it should be doing, says Maureen McTeer, a specialist in medical law. “We are at a pivotal moment that requires fundamental change.”
Ms. McTeer and Marlene Smadu co-chaired the Canadian Nurses Association’s (CNA) independent National Expert Commission, which released its final report earlier this year. Drawing on extensive expert and public consultations across the country, A Nursing Call to Action: The health of our nation, the future of our health system recommends a nine-point action plan that calls for a fundamental shift in the way the health system and delivery of health services are designed, managed and measured.
“If policy leaders, as well as nurses and other health-care professionals, implement the recommendations, a fully sustainable health-care system can result,” says Ms. McTeer. “We will have a system that meets the real needs of Canadians, that addresses the need for acute care in hospitals and care at home or within communities for chronic conditions, as well as palliative and hospice care.”
Funded by CNA without third party or government contributions, the commission spent a year consulting registered nurses (RNs) and other health-care providers, educators, policy- and decision-makers, while spanning provinces and territories. Additionally, through a partnership with YMCA Canada, the commission met with Canadians of all ages in 19 cities across the country.
“The report gives RNs a blueprint to help us target which areas we need to lead change in and which health outcomes we should strive for,” says Barb Mildon, president of CNA. “Ultimately, everything we do must be evidence-based and evaluated against outcomes, since our overarching driver is delivering excellent care within a sustainable patient-centred, publicly funded, not-for-profit health-care system.”
Activities that CNA will undertake to build on the commission’s recommendations include convening multiple health professional and provider groups to reach a consensus on top five national health indicators to work toward, and partnering with YMCA Canada to advance health promotion activities at the community level.
Another priority recommendation for action is advocating for health impact assessments of all government policies. To illustrate the need for health in all policies, nurses in Saskatchewan have pointed out that, while the province subsidizes alcohol so it can be sold at the same price everywhere in the province, fruits and vegetables are unaffordable for people in its northern region.
“Nurses are asking, ‘Why wouldn’t we subsidize healthy food for people in the north? How, as nurses, can we organize ourselves and people in our community to call on policy-makers?’” says Ms. Smadu.
This transformation won’t happen overnight, she stresses. “But nurses have a great deal of credibility in their communities, and with this many dedicated professionals working persistently on these recommendations, change will occur.”
In order to achieve a sustainable, publicly funded, not-for-profit system, “we have to rethink what it is we mean by health care, what it is we are trying to achieve, and what needs to be done,” Ms. McTeer notes. “There are more than 268,500 RNs across Canada. As they act on these recommendations, there is potential for a ripple effect of large proportions. It is essential that nurses are leaders in this transformation, in part because of the trust that exists toward them, but also because it is in their nature to get the job done.”
9 actions for transformation from CNA's National Expert Commission
Ensure Canada ranks in the top five nations for five key health outcomes by 2017.
Set national health outcome goals that can be achieved through local solutions tailored to communities and the people who live in them.
Implement primary health care for all by 2017, including merging health and social-services workers in multidisciplinary teams, working in consultation with the citizens they serve.
Invest strategically to improve determinants of health, such as income, literacy and security of housing and food.
Identify the health and care needs of populations at increased risk of health problems (e.g., Aboriginal people, low-income Canadians, seniors, etc.), then focus health resources where they will do the most good.
Integrate health in the development of all public policies and create processes to support healthier lives for all Canadians.
Use the best evidence to develop and implement mechanisms to improve safety and quality across the health system.
Prepare service providers differently with new topics, teaching methods, science and research to match the system’s transformation.
Use technology to its fullest to enhance rapid access to evidence and best practices for providers, to information and education for citizens, and tools for communication and collaboration among health-care providers – all of which will enhance patient safety.
ONLINE? For more information, visit cna-aiic.ca.