I think we have all heard or lived horror stories that involve waiting in an Emergency Department for hours and hours in order to see a physician. Some of us have loved ones who were admitted to hospital and then died, not from the initial diagnosis but because they contracted an infection or fell and broke a hip after admission. Often the system is blamed for this.
If we talk with health care professionals we hear repeated stories about lack of resources and inadequate staffing levels that are coupled with more and more demands as our increasingly aging population grows.
There appears to be a disconnect between the aspirational goals such as availability, affordability, as well as continuum of services that are often developed by politicians or upper management but do not appear to be evident in the present system.
When we talk about “system” I usually think about a human body. Each person has various parts that need to not only function properly on their own but also work together with the other body parts in order for the person to function in a whole and healthy manner. When one of more parts fails to fulfill its role, the whole body is negatively affected. For example, imagine having a kidney stone in an otherwise healthy individual. One relatively small stone can jeopardize the well-being of the individual and prevent the rest of the body from functioning appropriately.
Sometimes our expectations are not realistic. We make put a great deal of pressure on one body part without preparing property. Remember the last time that you went on a physical outing that resulted in blisters, aching muscles or torn ligaments? By placing too much demand on body parts, our whole body can suffer.
Our health care system is similar in many ways. We may strongly support the aspirational goals that were laid out but, at the same time, be upset that they are not operationalized in a way that we would expect.
There are times that our health care system fails when one part is not fulfilling its role properly. I recently heard Ron Liepert, the new Minister of Health for Alberta, state that our province doesn’t have a shortage of health care workers. Instead, he argued, that we have our health care workers doing the wrong things and need to reorganize the system. I know myself, for example, that physicians are often the place where clients go to talk about their marriage problems or financial woes before they are referred to see ;me for psychological services. Mr. Liepert proposes that we set up teams that include a variety of professionals who can assess and provide services that identify and match the needs of the people before they have been seen by the wrong department or professional.
This will not only require reorganization but also education so that people will understand how to access the services.
A few years ago I remember meeting Willie Brown who was then the mayor of San Francisco. I listened to an interview that he gave on the wharf. The news reporter asked him about what he planned to do for the homeless. Mayor Brown replied by saying “We don’t have a resources problem. We have an allocation problem”. He went on to explain that there were 80 empty beds the previous night while people slept on the street and that the system had failed to get those who were sleeping on the street into the beds.
We complain about the healthcare system but do we know exactly what it will take to revise it? It seems to me that it will take new eyes that will look at the present system and be honest about what needs are not being met. Honest assessment of needs by listening to those who are suffering will then allow appropriate interventions to be developed and implemented. This will require open-mindedness of everyone involved. For example, in the future initial assessment may need to be done by a Social Worker in the hospital rather than a physician.
Attitudes change slowly and will not only take wisdom but also time.
Health care professionals will need to learn to work together more effectively in order to provide seamless and efficient services. Patients will also need to be willing to change the traditional ways that they would access the system.
We say that we want change but in order for this to happen, we will need to be rea