Thursday, April 10, 2008

Alberta Health Care Shake Up Has Lessons for Small Clinics

The new government in Alberta, Canada is planning a major shake-up with bold new ideas according to the Calgary Herald. Health Minister Ron Liepert is planning a new initiative with some laudable goals including a patient focused system with performance indicators and "serious" accountability. While I have no doubt that Minister Liepert's goals are altruistic I worry about the unintended effects they may have. Some of main concepts of the plan are:

1. Revenue neutrality
2. Centralization of Health Regions throughout Alberta
3. Zero Health Care Wait Times

Revenue neutrality (no new costs) in unlikely (at best) given the other mandates of the government. As reported, Alberta's re-worked Cancer Board has spiralling costs. Increased access and zero wait times cannot be achieved without adding space and personnel. If Mr. Liepert wants to achieve the latter goals he's going to have be more realistic with the electorate about the health care cost.

I've posted about the effect the NHS is having on disenfranchising doctors and nurses with centralization. The ill-effect of centralization is not because of accountability but because of lack of control. If the doctors, nurses and other health care providers shoulder the burden of zero health care wait times the least they deserve is the ability to mold their small part of the system to manage it. If the government is forgoing that option, I still think it's better to have a single point of contact at the provincial level so there is a direct line of responsibility for both the patient and provider.

The last goal of zero wait times is the most unrealistic. Minister Liepert says,

"One thing I've been beating on is that we need a health care delivery system that focuses on the patient," he says. "I feel strongly that the term 'guaranteed wait time' is just political-speak for admission of failure in the system.
"What it really means is it's OK to wait -- you're just not going to have to wait as long.
"But the system should function in a way that the patient doesn't have to wait at all."

In a perfect world, one person in, one person out and resources are matched to the need. But because there's variation in every clinic and health care system around the world that perfect match cannot be achieved. So the only way to have zero wait time is to have excess resources which equates to wasted time on the part of the doctors, nurses and health care providers, a precious commodity right now. I agree that guaranteed wait time is political-speak and of little value to the people on the front lines. It discourages the care providers that work so hard, and when it's attached to financing encourages "fudging" reports of actual wait times. So Minister Liepert is faced with the choice of allowing wait times that do not alter the quality of care or paying health care providers for greater idle time. Either way he cannot do it without adding more money to the system.

Minister Liepert is a former reporter, press secretary and marketing guru so I have little doubt that a lot of this is politics as usual and he's getting good advice from people that make a study of the health care system. But whether it's a provincial wait times or a practice management there's a lesson to be learned. Variation is a major cause of wait times. If you can first control the variation, then you can tame wait times.

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