Bu­reau­crats must come clean or fail on health re­form

The Guardian (Charlottetown) - - EDITORIAL - Jim Vib­ert Jim Vib­ert spent 10 years as a po­lit­i­cal re­porter and ed­i­tor with the Hal­i­fax Her­ald; and 14 years with the Nova Scotia gov­ern­ment where he set up Com­mu­ni­ca­tions Nova Scotia.

There’s some­thing wrong with the sys­tem. That’s where unan­i­mous agree­ment on health care starts and stalls. Take the start, leave the stall. The gov­ern­ment, health bu­reau­crats, the med­i­cal com­mu­nity, care­givers, pa­tients and po­ten­tial pa­tients agree. It has to change.

The big, trou­ble­some, dev­il­ish de­tails — what, how, when, and some­times who and where — are in dis­pute.

Take it a step fur­ther. Most folks con­cede that cost con­trol is vi­tal, while the qual­ity of and ac­cess to care must im­prove. Which el­e­ment of that com­pound de­serves more em­pha­sis splits opin­ion again. Never mind. There is broad con­sen­sus that each is a com­po­nent of suc­cess.

Here’s the thing: Sys­tem sur­vival de­pends on sweep­ing and suc­cess­ful re­form. It has to be done with­out un­due dis­rup­tion to day-to-day op­er­a­tions. Like the blues, it don’t come easy.

There is a sure­fire road to fail­ure and the Nova Scotia Health Au­thor­ity is on it. De­feat and chaos are cer­tain un­less the health bu­reau­cra­cies come clean.

Some folks at the health de­part­ment ac­tu­ally get that.

Lead­er­ship at the NSHA tor­tures us with a mix of mes­sages, from “don’t worry, be happy” to the more muted “you can’t han­dle the truth.”

It’s your choice whether be­ing pa­tron­ized or dis­re­spected is more cloy­ing.

Con­versely, top staffers at the de­part­ment are step­ping up and out. In in­ter­views this week they ac­knowl­edge re­form is a frag­ile work-in-progress, com­plete with road haz­ards, high hur­dles, cer­tain and le­git­i­mate frus­tra­tions, but progress nev­er­the­less.

Re­fresh­ing can­dour and un­var­nished truth, re­spect­ing that Nova Sco­tians as own­ers and users of the sys­tem have the in­her­ent right to know the big pic­ture, the trou­ble­some de­tails, and ev­ery­thing about their per­sonal health, earns them the cred­i­bil­ity to move to pro­posed solutions.

Last week a key com­po­nent of the in­te­gra­tion and use of in­for­ma­tion tech­nol­ogy as an en­hance­ment to care suf­fered a ma­jor set­back. One of its pi­o­neer­ing users and cham­pi­ons said she had to dis­con­nect from My­healthNS be­cause of its in­or­di­nate ex­pense and de­mands on time.

Two se­nior de­part­men­tal of­fi­cials with un­ruly ti­tles but well­cul­ti­vated out­looks on health care’s fu­ture didn’t de­fault to the usual, cir­cu­lar gov­ern­ment talk­ing points to ad­dress the set­back.

The de­ci­sion of Dr. Ajan­tha Jayabarathan (Dr. A.J.) was the most pre­dictable topic on the ta­ble but there was no at­tempt to spin it away.

Se­nior ex­ec­u­tive di­rec­tor, in­vest­ment and de­ci­sion sup­port Chris­tine Grimm and An­gela Pur­cell, di­rec­tor, fee for ser­vice and mas­ter agree­ment, were dis­ap­pointed but un­der­stood A.J.’s de­ci­sion. Nor did they dis­pute the need for im­prove­ments to My­healthNS.

Noth­ing less than changes to the doc­tors’ fee struc­ture — one of the sys­tem’s tougher nee­dles to thread — can cor­rect the de­fi­cien­cies that Dr. A.J. iden­ti­fied.

Of­fi­cials in the health de­part­ment, even se­nior ones, can’t get that done so they can’t say if the flaws that forced A.J. to with­draw can be cor­rected.

How­ever, they did re­veal the road map to make that hap­pen, sug­gest­ing there is a plan to try.

These are trou­ble­some de­tails al­luded to above. They are man­age­able, but ex­ist within the con­text of com­plex and com­pet­ing in­ter­ests. Com­pro­mise, time and money are all el­e­ments of the fix.

My­healthNS is a piece of a big, am­bi­tious plan that cul­mi­nates with some­thing called One Per­son, One Record.

Over­sim­pli­fied, that’s a se­cure IT plat­form by which play­ers across the sys­tem are per­mit­ted ac­cess to pa­tients’ med­i­cal records as re­quired for treat­ment.

All of the above is a lot of de­tail and too much con­text pre­ced­ing the crux.

The health bu­reau­cra­cies — the NSHA and the de­part­ment — can hold their cards close to their vest and guar­an­tee an­other fail­ure, and per­haps put the fi­nal nail in the cof­fin of de­pend­able pub­lic health care in Nova Scotia.

Or, they can open up to Nova Sco­tians with the hard truths and give them­selves a fight­ing chance at win­ning the pub­lic pa­tience they need to get the job done. There are en­cour­ag­ing signs the de­part­ment is mov­ing in that di­rec­tion.

“Trust us, this will be bet­ter,” is nei­ther us­able in­for­ma­tion nor an ex­pla­na­tion. It asks Nova Sco­tians for a leap of faith they will not take, nor should they. The gov­ern­ment and its mam­moth de­liv­ery struc­ture over at the NSHA can ei­ther lay all their cards on the ta­ble or fold. Their call.

Newspapers in English

Newspapers from Canada

© PressReader. All rights reserved.