Thursday, February 7, 2013

Healthcare Ghost Busting Essay Series

From Longwoods publishing, a new series of articles about Canadian healthcare systems and reforms.

From the pen of the publisher
This is the launch of penned theatre by Hugh MacLeod who also plays the role of editor and discussant. The idea just appeared to him one late and awesome night. A few trial essays ("The Ghost of Healthcare Despair" and "Forging Complete Questions to Defeat 'The Ghost of Healthcare Despair'") were so well received...


  1. Courage A Rare Competency with Senator M. Kirby…Focus - Call for courageous leadership with a concrete national example of playing safe and tinkering - "mental health"

"Today only about one out of every five children or youth with a mental health problem gets any professional treatment.  A child or youth needing psychiatric help waits a year or more before seeing a psychiatrist.   Most importantly, psychological counseling services are a superb example of the two tier healthcare system that politicians of all parties say they despise."

2. Conditions Leaders Influence with M. Davies...Focus - Moving away from command and control cultures

"Unfortunately, our healthcare system in many respects still holds onto our traditional command and control systems, structures, and processes - where “accountability”, is often about “who is to blame.” Real accountability is about keeping agreements and performing jobs in a respectful atmosphere. It is about learning, truth, change and growth. It is not about fear and punishment. We need to learn from our “best mistakes” and continuously improve the system of which we assume stewardship."

Jennifer Jilks wrote:
Posted 2013/07/02 at 08:58 AM EDT
Truthfully, top down change will not work unless all believe in treating patients with respect. That is what it boils down to, and those who cannot or will not treat patients this way must be reported, and either disciplined or terminated.

3. Fragmentation vs Collaboration with J. Davidson…Focus - Numerous organizations advancing their own agendas 

"Organizations and systems wishing to transform must invest in skills development for their people. How do we identify the skills required to achieve systemic transformation?
Individuals, teams and organizations need different types of skills. Technical skills, or skills at doing the work of the organization, are needed to run the organization and to identify redesign opportunities. Analytical skills help people to investigate and make sense of information, as well as identify leveraged actions. People skills are necessary to help individuals and groups get along and work together. Organizational and communication skills enable people to keep work moving effectively. But how do we best enable people to draw upon these skills? The most important moment in your life is the present one. Now is the time to look within, to determine the actions required to serve the highest values of our organizations."

Jennifer Jilks wrote:
Posted 2013/07/02 at 08:56 AM EDT
The key is to have all staff members buy into modern values, up-to-date strategies and techniques. But the most basic is education, and respect for the patient, sadly lacking in some who serve Canadian patients from physicians, to nurses, to organisations (CCAC) to PSWs.

4. Shaping Canadian Healthcare Alignment  with Dr.  J Kitts…Focus - Silos, unconnected delivery systems, confusion and misplaced competition

These questions, connect nicely to a recent article by David and Karline Naylor titled “Seven Provocative Principles for Health Care Reform”
  1. Every set of national arrangements involves tradeoffs among quality, affordability and accessibility.
  2. Although overall healthcare systems are not transplantable, the merits of adopting good ideas from other countries are too often ignored.
  3. Simplicity in legislation and regulation trumps complexity. The more changes that are made concurrently, the greater the risk of unintended consequences.
  4. Every effective healthcare system imposes caps on spending and engages in strategic rationing.
  5. Fairness in finance and access to healthcare is an evergreen objective of health policy makers. However, fairness is seldom defined.
  6. Higher levels of spending do not correlate closely with quality of care but may instead lead to diminishing marginal health benefits.
  7. Transactional micromanagement of healthcare is suboptimal, whether publicly or privately administered.

5. Accountability For Performance with T. Closson…Focus - Alignment of targets, capability, reporting and transparency
"Although performance information is necessary for accountability, it is not sufficient. Health system accountability becomes real when governors and managers in provider organizations and their staff can effectively relate their work to performance information. In order to do so, four key success factors must also be present: 
  1. Rationalized system roles
  2. Aligned target setting
  3. Aligned incentives
  4. Capacity to improve performance"

Jennifer Jilks wrote:
Posted 2013/07/02 at 09:06 AM EDT
Where does the patient fit into all of this accountability? Mustn't we be accountable to report those who fail to perform well and with respect?

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