One size should fit all
Health-care systems across Canada must be held to a national standard
Decades ago when I worked in finance, I often joined company discussions about new software. While off-the-shelf software packages were becoming readily available, some companies still opted to build their own accounting, purchasing or email programs.
Custom systems were almost always an expensive indulgence. They cost more than canned software, harboured bugs that took ages to address and, when problems arose, left companies virtually hostage to the programmers who built them. But they did flatter the egos of executives who believed only they understood the unique needs of their organizations and business environments.
The variability of health-care systems across Canada reminds me of the folly of custom-made solutions.
Take advance-care planning. I’d argue that its goals are to have everybody document their wishes for care in the event they can’t speak for themselves, and to ensure that patients, in retrospect, are pleased with their decisions. I also believe experts can research ways to achieve these goals and determine which province, or hybrid of provinces, is closest to the mark.
Is Nova Scotia getting it right with one form used by patients to state their wishes and name a substitute decision maker? Or is Alberta with its Green Sleeve which contains a few discrete choices, such as whether a patient wants all interventions or for care to focus on preparing for imminent death? How about B.C. with its 56-page explanatory booklet and choice of two forms depending on the cognitive state of the patient? Or another province? I don’t know, but I believe we should invest the time and effort to find out.
As a profession, doctors practice evidence-based medicine. They follow research in their fields and seize on new information that improves their ability to diagnose or heal. Thus, ulcers are now treated with antibiotics rather than stress reduction techniques, and individuals with back pain are encouraged to get moving rather than go to bed. We don’t treat prostate cancer one way in Newfoundland and a different way in Saskatchewan, and that’s a good thing.
But when it comes to designing health-care systems, evidencebased decision making goes out the window.
Why haven’t we determined which advance-care planning system works best, then packaged it and duplicated it across the country? Why are we taxpayers funding each province, no matter how tiny, to create its own laws and regulations and procedures and protocols? Why do we do this not just for advance-care planning, but for virtually every aspect of our provincial healthcare systems?
There are unique challenges, such as serving rural residents and those in Indigenous communities, or helping those who don’t speak English (or French in Quebec). But typically these differences are more pronounced within provinces than between them. They do not justify the many varied practices that exist.
When we have 10 provinces and three territories creating 13 custom-made solutions, this is not our tax dollars at work; this is our tax dollars on a spending spree, buying 13 items where one would do. And we can’t afford it.
One of the simplest ways to boost performance in business is to innovate in areas where it makes a difference and use established best practices everywhere else. When it comes to health care, it’s well past time for our provinces to do the same.
Grey Matters is a weekly column by Wanda Morris, the VP of Advocacy for CARP, a 300,000 member national, non-partisan, non-profit organization that advocates for financial security, improved healthcare for Canadians as we age. Missed a week? Past columns by Wanda and other key CARP contributors can be found at carp.ca/blogs.