While the recent article on the people side of health care (Editor’s Notes, Dec. 16, 2002 — click "Related Articles" link below to read editorial) is both timely and needed, I believe that there are four issues that are still just below the surface.
First, as your article so clearly identifies, the current system has the wrong focus. If the Kirby and Romanow reports show anything, it is that all of health care should be re-focused with patients/clients at the centre rather than government. If we are truthful, we will recognize that the current Canada Health Act is more a prescription for insurance than it is for actual health care. The role of governments then should be to clearly outline what coverage will be available to every Canadian. Leave the actual delivery to providers.
Doing this would address how we might transition to a focus on “teamwork and collaboration of professionals” because the focus would be on the patient/client needs rather than government fiat. It is clear, at least to me, that as long as the primary goal of a politician is to get elected and then re-elected, meaningful, long-term focus will always take a back seat to what is politically expedient, and funding, budgets and long-term planning will always be difficult. Perhaps the best thing we could do as part of any restructuring is to de-politicize the current system.
The second issue that lies just under the surface but won’t go away is that of finding and keeping health-care workers when the system is under a mandate to change and restructure.
Ask care givers and the one thing they lament is the lack of full-time work with benefits. Unless this issue is addressed as part of any new initiatives, Canada will continue to experience shortages, workers will burn out and initiatives to attract new workers may fail. Perhaps starting nurses’ registries, where hospitals contract to access “just in time” employees is a concept whose time has come. The registry would be the employer of record and could potentially provide stability and benefits even if a worker had to work at several locations in order to be full time.
A third issue is one that Lou Tice of the Pacific Institute calls self-efficacy — that is a person’s belief that their actions will positively affect an outcome. Ask nurses and they will tell you their self-efficacy is not very high. This critical issue must be addressed if one hopes to “revitalize the spirits of health-care workers.”
The final issue, given the above, is that a “national average” in terms of standards of care or availability of service will not be acceptable. Call it two-tier, user pay, co-pay or any number of other emotionally charged words, the reality is that no system that proposes to put the patient/client’s needs at the centre of it will prosper if a pre-established “average” care is all that one can access just because that is what the basic insurance will cover. Let’s get that on the table for real discussion too.
The Wealthy Living Project