What will it take to leap for­ward and re-de­sign health sys­tems in Canada

BY MIKE VILLENEUVE

Policy - - Before The Bell | From The Editor - Mike Villeneuve CEO OF THE CANA­DIAN NURSES AS­SO­CI­A­TION

Years of the health sys­tems trans­for­ma­tion con­ver­sa­tion have led to one re­sound­ing con­clu­sionW pretty much ev­ery­one agrees things need to change. And we even agree on some changes we need to im­prove pa­tient ex­pe­ri­ence, pop­u­la­tion health and work life of health-care providers while con­tain­ing costs. So why don’t we to make the sig­nif­i­cant leaps for­ward needed to de­liver more ef­fec­tively on this quadru­ple aim?

kew oCMm Com­mis­sioner Brenda iucki re­cently shared an ob­ser­va­tion about two things hu­mans can’t standW a) change, and b) the way things are. We may not love change, but we cer­tainly don’t love sta­tus quo in most health care set­tings. Or­ches­trat­ing com­plex changes to trans­form health sys­tems has proven to be well­nigh im­pos­si­ble. Af­ter two decades of dif­fer­ent types of health ac­cords, we are still talk­ing about putting pa­tients first, phar­ma­care, the need to fo­cus on de­ter­mi­nants of health and health pro­mo­tion, to meet rapidly-evolv­ing pop­u­la­tion health needs.

Colin dood­fel­low, for­mer CbO of hemptville aistrict Hos­pi­tal, ar­gued that we are “cul­tur­ally af­fixed to a de­liv­ery sys­tem that is over­built and un­der-imag­ined for the age.” We are not stand­ing on the cusp of dif­fi­cult change in health care; it’s al­ready bury­ing and over­whelm­ing us. In 2003, Amer­i­can nurse leader ar. Tim morter-O’drady used nurs­ing to il­lus­trate the dra­matic scope of the changes in hos­pi­tals, say­ing they sig­nal “the end of nurs­ing prac­tice as we know it.” He ob­served that nurses are “now man­ag­ing mo­bil­ity rather than res­i­dency” and their job es­sen­tially is man­ag­ing pa­tient turnover. These truths do not mean the end of the nurs­ing pro­fes­sion nor of great health care, but mean the end of

prac­tice as we know it.

You wouldn’t know about that sort of think­ing if you looked at how we ed­u­cate nurses and doc­tors—or how we reg­u­late, de­ploy and re­ward them. Much of that is prov­ing to be a stale mis-match for real sys­tem needs, and dig­i­tal-era de­mands come into con­stant con­flict with our in­dus­trial-era de­liv­ery mod­els. But there are so­lu­tions; and one is to arm providers with the skills and au­thor­ity to safely de­liver the kinds of care needed in this cen­tury. ae­spite the re­lent­less talk about in­ter-pro­fes­sional care teams, we con­tinue to op­er­ate largely in rigidly siloed health pro­fes­sions. We are ruled by the un­der­stand­ing that the physi­cian is the leader and owner of pa­tients and care.

Un­less and un­til we aban­don our in­terand in­tra-pro­fes­sional turf pro­tec­tion, un­lock the no­tion that no one owns com­pe­ten­cies, and agree that only pa­tients own them­selves, we’ll be cir­cling around for an­other decade. A strong fed­eral hand would make a dif­fer­ence. And what we des­per­ately need are coura­geous health lead­ers from all sec­tors who con­front re­al­ity and help us make leap for­ward into the 2020s to de­liver the care Cana­di­ans need and de­serve. That leap means over­haul­ing fund­ing and pay­ment mod­els, op­ti­miz­ing scopes of prac­tice and then us­ing them, mod­ern­iz­ing col­lec­tive agree­ments, be­ing much smarter about how we man­age episodes and tran­si­tions of care, and cre­at­ing the struc­tures, ser­vices and fund­ing to truly sup­port peo­ple staying out of emer­gency rooms and hos­pi­tal beds as much as pos­si­ble. Mike Villeneuve is the CEO of the Cana­dian Nurses As­so­ci­a­tion.

Con­trib­uted to the Sixth Es­tate – The views and opin­ions ex­pressed in this ar­ti­cle are those of the au­thors and do not nec­es­sar­ily re­flect the of­fi­cial pol­icy or po­si­tion of the Sixth Es­tate.

Af­ter two decades of dif­fer­ent types of health ac­cords, we are still talk­ing about putting pa­tients first, phar­ma­care, the need to fo­cus on de­ter­mi­nants of health and health pro­mo­tion, to meet rapidly-evolv­ing pop­u­la­tion health needs.” — Mike Villeneuve - Cana­dian lurses As­so­ci­a­tion

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