Access to quality healthcare is a complex issue and very challenging to deliver across the country due to an aging and ailing population, a large and underpopulated country and many other factors. In Alberta, add to that growth pressures from a growing economy and increasing population!


Problems:

1. Timely access to quality care

  • Long EMS response times and Emergency waits
  • Not enough family doctors
  • Long waits for surgery & to see a specialist
  • Long waits for Tests, CT scans, MRI’s

2. Underlying cause of Canada’s healthcare crisis

  • Under investment in the community care system and primary care education (family doctors) & prevention – across the country
  • 2 years of delays in care from Covid19 – higher burden of illness in our community
  • Healthcare Professional shortage and burnout – staff are cutting back or leaving practice early
  • “Triple Tsunami of Illness” – a chronic disease in seniors, working adults and their children at an earlier age

3. Solutions

  • Admit we have a Healthcare problem
  • Get the ALC patients (“Bedblockers”) out of the hospital – this will solve the ER, EMS & surgical access crisis

1. World-class Danish Style home care, home hospice care & community supports – DATS & CHOICE programs

2. Change policy so that DAL facilities can function as Auxiliary hospitals for seniors and the vulnerable and accommodate LTC & Hospice care

  • Restructure PCN’s into an integrated team based multidisciplinary Primary care system that provides for continuity of care (doctors, NP’s, PA’s, mental health, pharmacists, physio/OT working as teams in the “Medical Home” model of care – Kaiser Permanente does this well in the USA.
  • Family Doctor shortage

1. Retain the doctors we currently have – physician retention benefit
2. Support family medicine with an integrated multidisciplinary PCN team (NP’s, PA’s, pharmacists, mental health, physio/OT)
3. Bring Alberta kids home for Ireland/Australia/foreign medical schools and invest in family medicine residencies (urban and rural)
4. Foreign trained doctors residing in Alberta – invest in their practice assessments and invest in updating their training – made in Alberta Rotating internship
5. Increase medical school seats at U of A & U of C medical schools with a priority towards joint family medicine/NP education
6. Rural Primary Care Health education campuses – “70:70 Rule” – 70% of young people live and work within 70 km of where they train. Investments into training Rural family doctors (medical students and family medicine residents with multidisciplinary teams especially in the 5 smaller cities)

AHS Issues

1. Look at the Auditor General’s 2017 “Better Healthcare for Albertans” report as a basis for system improvements.

2. 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.

3. Strong Performance & Accountability measures for a high-performing healthcare system:

    • ALC patients (“Bed blockers”) must be out of acute care in 72 hours 9 times out of 10
    • From time of presentation to the ER and admission to the correct hospital ward, admitted patients must be in the right bed with the right doctor & nurse in 8 hours 9 times out of 10
    • From time of presentation to the ER, EMS must be back on the streets in 45 minutes 9 times out of 10

4. Rewards for frontline staff & management teams for achieving these goals

5. Government organizations must work together – DAL, Seniors and community supports must work with AHS.

6. Layers of AHS management – Engage frontline staff in solutions and have them appraise their supervisors and reduce the layers of middle management from the ground up

7. There are many jobs in AHS that are dependent on the system being dysfunctional. If the system worked well, many staff and resources can be re-deployed to where they are needed.

8. 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 & data systems, HR, legal, finance, capital planning) but move to local decision making.

9. 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.

10. Major city hospitals must have investments into transition/rehab. As soon as a patient (especially seniors or the vulnerable) does not need advanced care – get them out of acute care staff ASAP and support them with an Integrated PCN team (Family doctor, Nurse practitioner, Physio/OT/Social work/Home care to get them home or into DAL/LTC/Hospice care ASAP with the proper supports

Government Issues

1. Education & Wellness –our schools can be used as community hubs and it’s time to bring back the school nurse and embed mental health counsellors, physical activity & nutrition counsellors into 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.

2. Stability in the civil service – Stop replacing the Deputy Minister of Health every 17 months. Get a health/policy/economic expert as a deputy minister and keep them there for the next 7-10 years

  • Social determinants of health – To really fix healthcare, it will require the combined efforts of society, our education systems, federal/municipal/provincial governments & even personal responsibility.

1. Economic Stability
2. Education
3. Social & Community Context
4. Health & Healthcare
5. Neighborhood & built environment

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