Dr. Robert Martel: Nova Scotia needs solid health-care plan

The government of today is heavily invested in health-care reform.

Witness the behaviour of the minister of health as he tries to negotiate the health-care unions mine field.

Given the experience of past governments with this subject matter, one wonders why a government interested in longevity would risk so much political capital on a subject that has made grown men cry.

The simple answer is: costs are spiralling out of control and the province is in serious financial trouble.

So ask yourself, if one is to engage in high-risk behaviour, shouldn't there be a solid plan in place, a communication strategy to win over those that have to pay for it, an algorithm to assure cooperation from those who have to implement it and a yardstick to measure the outcome?

Perhaps there are, but where are they?

For those of us who have been around longer than any one government's life, we can safely say we have heard and seen it all before, yet the same mistakes are repeated by well intentioned but incomprehensibly naive individuals who clearly have demonstrated time and time again an appalling lack of subject matter expertise — especially front line experience — and yet have "bet the family jewels" on their particular version of a reform plan.

Moreover, they remain surprised that the results are the same.

Most expensive budget item

Millions of "borrowed" dollars have been spent on coming up with a special knife that will cut the Gordian Knot that health care has become.

It is the most expensive line item in the provincial budget, yet one would have to conclude that repeated budget over-runs, the clear lack of accountability for repeated managerial errors, are evidence that the managers and their overseers do not have a fundamental understanding of the system or how that reality can be financed on a go-forward basis.

A system with variables such as these, by default, is incapable of success:

1. Ever increasing cost of doing business
2. User expectations driven more by emotion than logic
3. Data systems that are incapable of providing timely information to decision makers both user and provider. 
4. A rapidly expanding demographic with a propensity for increased burden of illness. 
5. Diminishing taxpayer willingness to increase funding. 
6. A mandated level of service rooted in historic practice and insensitive to evidence.  
7. Professional associations resistant to change.

It is no wonder we have arrived at the tipping point articulated in Dr. Sam Campbell’s appeal for help at the largest Emergency Department in this province.

It is time to do things differently

Why is this a surprise?

Perhaps a better question: why are the taxpayers of this province not demanding better of those who are spending 50 per cent of taxpayer dollars on activity which, in some cases, has dubious to no benefit and in others is enabling road blocks?

After more than 30 years in this game, I have to reflect on what Dr. Campbell and many of his colleagues in emergency medicine are saying: it is time to do things differently!

We should no longer support a system where those that ultimately chart a course to destruction can only be judged at the polling station every four years.

We have studied the problem long enough and God knows if throwing money at a problem was a solution, we would have solved this problem years ago.

There are certain realities that need to be faced:

1. Can a province with less than one million people afford to provide the level of health service mandated by the Canada Health Act when increasingly larger amounts of that funding must come from an aging and reduced taxpayer group?
2. Should the current delivery model be sustained without an accountability and outcome framework to better understand value for money?
3. No system, whether it be a widget producing factory or health care, can undergo substantial and fundamental change without meaningful investment.

In that climate we have the urgency created by inertia; Dr. Campbell and several other Emergency Department directors are ringing the proverbial bell once again.

Is there anyone out there listening?

Dr. Campbell, indeed everyone involved in health care, want to do a good job.

To do the best job possible, evidenced-based tools are needed.

We have those but unless the environment is enabled to implement those tools, national benchmarks cannot be achieved — regardless of the good intentions workers may have.

There are content experts willing to provide the guidance required to achieve these goals.

It remains for health planners and managers to reach out to front-line workers in a meaningful way.

In my view, the solution to the current health-care crisis is in their work experience when it is harnessed to a robust data system and administered by individuals with sound management training who are tied to outcome goals.

And so what is the impact on rural Nova Scotians? Stay tuned.