Time to bury ‘transformative change’?

Dead-body-in-morgue-006The headline is from the Toronto Globe and Mail where an OpEd piece mourns the fact that “Canada has just spent $83-billion (!) on the biggest public-policy bet of this generation. The bet was lost, predictably.” Where was this handsome chunk of change spent? On the Canadian health care system between 2003 and 2012. The Health Council of Canada – the official monitoring body has now pronounced on this investment:

“Yet the decade saw few notable improvements on measures of patient care and health outcomes….an unfulfilled promise of transformative change.”

The article by Jeffrey Simpson in the ‘Toronto Globe and Mail went on to say that money had mostly been spent in a way we are sadly familiar with here – ‘transformative change’ was going to be bought and how did that end up?

“Doctors, nurses and administrators were better paid for doing things in the same way they had before”.

The productivity argument – how we do things? – has to be linked to the quality situation – how well do we do things? Both aspects of health care are difficult both to collect data on and then  to tell people what that data means. In the absence of decent data, our NHS spending lurches from boom to bust in a way that is disconnected to outcomes and did anyone mention patient satisfaction?

We in the UK are in the middle of a row about Hospital Standardised Mortality Rates (HMSRs) a measure that some see as a vital marker of quality and others see as worthless. The stats for Mid-Staffordshire (no mention of Mid-Staffs is complete this days without the qualifier ‘appalling events at” ) were in retrospect clear early warning red flashing lights – yet dismissed and ignored at the time as were the patients and their families.

Let’s hope that health care in Canada has no such skeletons lurking in its hospital cupboards.

The positive and much quoted story in the Canadian healthcare system is the Ontario hospital where the widely descredited phrase ‘transformative change’ is still in daily and unapologetic use thanks to outcomes due to what one healthcare magazine referred as ‘the block-buster drug of the century’. What is this miracle formulation? According to Leslee Thompson the CEO of Kingston General hospital, it is Patient-Centered Leadership. She expands on this theme, saying:

To honour this approach in our hospital, we made the commitment that a patient will be at the table for any decision that has a material impact on their experience at KGH.

One more thought – let’s go with the flow  – MAC says that this success in implementing an approach so dear to our hearts means that Leslee gets our vote to run the NHS. After all Canadians now appear to be first choice for the all big UK jobs and making a success of the NHS may be the biggest one of them all.

What say you?

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