Access to quality healthcare is in crisis in Alberta and across the country!
- Timely access to quality care
- 911 crisis
- Emergency crisis
- Not enough family doctors
- Long waits to see a specialist
- Long waits for Surgeries
- Long waits for Tests, CT scans, MRI’s
- AHS not meeting the needs of communities
- Ever increasing costs ($24 Billion – Approximately 40% of all provincial spending, yet needs are not being met.
- 2 years of delays in care from Covid19 – higher burden of illness in our community
- Healthcare Professionals burning out and leaving practice early or leaving the province
- Many other issues
- Admit we have a Healthcare crisis (do not sugar coat it!)
- Negotiate in good faith and sign all outstanding healthcare contracts (AMA, AUPE, CUPE, HSAA) so we can retain the staff we have and attract new staff.
- Look at the Auditor General’s report from 2017 “Better Healthcare for Albertans” as a basis for system improvements.
- You cannot manage what you do not measure – Bring back the quarterly public reporting AHS originally had in place – 56 or more measurements at the 95%’ile level (19 times out of 20) …including staff morale and engagement.
- Strong Performance & Accountability measures and rewards for frontline staff and frontline management teams for achieving those goals.
- Dissolve the AHS board that is full of political appointees – it is not working!
- The government must take full responsibility for healthcare and appoint an interim emergency administrator as well as a team with expertise in healthcare management in place of the board.
- This team includes experts and experienced former healthcare Deputy ministers, CEO’s, HQCA leads, the Deans of the medical, nursing & allied health professional schools.
This team would include Representatives of the AMA, UNA, HSAA, AUPE, CUPE as non-voting members as well as leaders of our community (AUMA & RMA) and experts in healthcare economics, health policy and accounting.
Flow process engineer would be a powerful addition. For example, lean six sigma folks from Toyota, to create a high performing health system.
- Government ministries must be re-structured:
- Alberta Health & Wellness needs to become Alberta Health, Seniors and community support. AHS cannot function if the senior’s ministry does not work hand in glove to house and support our seniors. Close to 15% of acute care beds are filled up by seniors and the homeless who do not need to be in hospital.
- Education must become Education & Wellness –our schools can be used as community hubs. Put an ATCO trailer in every school parking lot and embed school nurses, mental health counsellors, physical activity & nutrition counsellors into all schools – especially the ones in higher risk communities for chronic disease. Consider attaching PCN’s (Primary Care Networks – with Nurse Practitioners) to the school system. We have a baby boom and not enough family doctors and pediatricians.
- When young people turn eighteen, they are let go by their pediatrician or they move away from home for work or school, so they are last in line in the adult system, and they are falling through the cracks.
- Stop replacing the Deputy Minister of Health every 17 months (this is the average). This is just silly! Get a health/policy/economic expert as a deputy minister and keep them there for the next 7-10 years and hold them accountable.
- Engage frontline staff in the solutions to providing better healthcare and improving the system. The unit clerks and environmental services staff can tell you what needs improving.
- Have frontline staff appraise their supervisors and clean house of the layers of middle management from the ground up (it cannot be done from the top down and staff will support this)
- There are thousands of jobs in AHS that are dependent on the system being dysfunctional and there are “kingdoms” that are created because of this. This must end and these staff and resources must be re-deployed to front line care.
- We must look at the centralized structure of AHS and transition to a system that maintains the advantages of AHS (centralized standards, bulk purchasing, standard computer, and data system) but move to local decision making. The CEO of a region must be able to connect to the community and deliver care to the needs of that local community.
- Hospitals need to move to a model of base funding plus activity-based funding. For example, if more surgeries are performed or the more complex ER visits there are, the more funding the hospital gets.
- Major city hospitals must have a transition/rehab facility (Built as a PPP) attached to them. As soon as a patient (especially seniors or the vulnerable) does not need advanced care – get them out of the hospital ASAP and support them with Physio/OT/Social work/Homecare to get them home ASAP with the proper home supports – and at this moment attach them to the Primary Care Networks – multidisciplinary teams with a family physician ultimately being responsible for the care, but supported by nurse practitioners as well as the rest of the healthcare team.
Create an Integrated Healthcare delivery model. Currently we have far too many healthcare professionals diagnosing and prescribing for the same patient. The scope of practice is great, but if they are independent, this is harmful to the patients. You take your new car to the same shop, so why would you take your body to 5 different diagnosticians with 5 different treatments? The solution is an integrated primary care system that utilizes evidence-based medicine and combines the best treatments of all healthcare professionals.
- The goal is to better manage chronic care in the community and to reduce the chance of readmission to hospital and reduce acute care costs
- Our young doctors are leaving town and the older ones are cutting back and retiring early at a time Albertans are sicker than ever due to 2 years of delays in care due to Covid19.
Revoke that part of Bill 21 that limits PRACID’s for our home grown and inform the medical residents of this decision so they do not leave the province. Prior to this bill, more than 80% were planning to make Alberta their home. After this bill, 75% were planning to leave for other provinces and the USA.
- the “Triple Tsunami of Illness.” It is not the seniors that are the issue, it is their kids and grandkids getting chronic disease at a much earlier age due to inactivity, poor nutrition and every increasing mental health issues and family discord.
We will have to evaluate, treat, medicate, and admit to hospital larger numbers of patients for a much longer period of their life span due to earlier illness and increased ability to deliver more care.
- The Incentives in healthcare must change! Presently the incentives are towards easy money for easy medicine – not necessarily dealing with chronic disease and high needs patients.
- Primary care networks – a great idea that needs to be better executed. Assigning $62 per patient just makes the incentive to roster younger, healthier, and easier patients.
Patients need to be stratified based on increasing risk factors, medications, diagnoses…increased chance of admission to hospital. PCN’s can then compete for sicker and higher risk patients and will have the funds to hire the allied health staff that can help physicians manage chronic care to reduce re-admissions.
- Doctors – Shortage of access to Family Doctors/Pediatricians/Geriatricians/Mental Health/Generalists – this is a tough one and tough work!
- First support the work of family doctors with nurse practitioners – the best NP is one who is partially trained by the department of family medicine
- Investment must be made to the faculties of medicine and AHS for practice assessments and upgraded education of:
- Our young people who have trained abroad and went to reputable medical schools– Ireland, Australia, Bahamas etc. Let us bring them back home and have them work in underserviced areas for two years as part of the agreement to repatriate them
- Foreign trained doctors living amongst us who are currently doing other jobs that do not include medicine. Canada has the most educated taxi fleet on the planet…again this is just silly to have our citizens performing below their potential.
- The long-term solution lies in training our own home-grown medical workforce – not only in urban Albertan, but most importantly in the 5 smaller cities and RURAL Alberta.
Yes, not only rural family medical schools (run by UofA& UofC medical schools), but RURAL HEALTH SCHOOLS – train all members of the team in rural areas.
- Work & Negotiate with the AMA to address income disparities between the type of doctor our society needs and the type of doctor we are creating (Overspecialization of healthcare). Many sub-specialists cannot find employment in Canada, so they have been leaving for the USA.
- To really fix healthcare, it will require the combined efforts of industry, our education system, federal/municipal/provincial government, families/communities/individual personal responsibility, and yes even healthcare professionals. We must address the social determinants of health:
- Economic Stability
- Social & Community Context
- Health & Healthcare
- Neighborhood & built environment
There are more solutions to come…this is a living document, and these are just a few of my thoughts after talking to thousands of healthcare professionals and everyday Albertans.
If you have innovative ideas and see simple solutions, please feel free to send them to our team.
Raj Sherman, M.D.
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