“Gentlemen, we have run out of money. It’s time to start thinking.”
When Sir Ernest Rutherford, the frequently quoted New Zealand physicist said this, he was running a large lab that was not adequately funded to undertake the number of projects coming its way.
Not much has changed in this regard over the past century: resourcefulness and innovation have always gone hand-in-hand with managing funds and making meaningful progress. Yet, when it comes to Canadian healthcare –specifically improving our health system and making it sustainable – we need more than resourcefulness and innovation (which Canada has in abundance). We need collective and radical change.
Collective and radical change
Collective and radical change: this is my clarion call for 2016.
Why? Because incremental steps, as important as they can be, will simply not cut it for Canadian healthcare. We are all well aware of the problem. Our current system, designed in the 50s and 60s to deliver more effective acute care, is now overburdened by the demands of today’s larger and aging population. We have reached the point (some would say we’ve passed it), where this foundation must take the fast-track to its next evolution.
So, what does radical change look like? If I were to write a manifesto, it might look something like this.
1. Embrace technology, focus on patient engagement and harness digital information to involve people in managing their own health and wellness.
There is a lot of buzz about patient engagement. The Huffington Post lists patient engagement as the first of its top ten medical issues and trends to watch in 2016, stating that “Patient engagement was the ‘hot date’ of 2015. Now, 2016 must be about turning it into a lasting commitment before the passion fades.”
Passion aside, let’s pause here and consider what engaging patients (a.k.a ‘people’) really means. After all, there is no single model for patient engagement. It is not about putting more patients on committees, although there is value in this. Patient engagement is about equipping and empowering individuals to manage their own health and wellness. It reaches across a spectrum of care: from managing chronic disease, all the way to prevention to help people lead more active, healthier lifestyles.
People want to be engaged with their health. The ease of use and access to digital consumer technology is driving expectations for the same level of service in healthcare.
2. Transform ‘frequent flyers’ into self-propelled pilots
Chronic conditions come with a very high emotional cost to individuals and their families and their crippling financial impact to the health system is well known. Patients managing chronic disease – the so-called ‘frequent flyers’ who account for close to 50% of provincial budgets – are not at fault. They have been ill-served by a system that historically has not equipped them to effectively participate in their care and self-manage conditions.
According to KPMG, 72% of global leaders believe empowered patients create better value care, yet 89% believe their health systems are designed around organizations’ – not patients’ – priorities and they are not very satisfied they are meeting patients’ needs.
The benefit of providing technology that can enhance collaborative care between a patient and their health providers is compelling. Global research shows that patients who are less engaged cost the health system from 8 to 21 percent more than those who are engaged.
The fact is, patients self-manage chronic disease for about 5,800 waking hours each year while typically spending fewer than 10 hours with a healthcare professional. Imagine the potential value that can be delivered when we bolster these patients’ ability to engage and collaborate with their circle of care during those 5,800 hours. The technology exists, the demand is there and the opportunity to impact system sustainability is staggering.
3. Learn to collaborate in new ways across private and public sectors and throughout the healthcare ecosystem.
Last summer, the federal Advisory Panel on Healthcare Innovation led by Dr. David Naylor released its report recommending the five most promising ways the federal government could support innovation in order to improve accessibility and reduce costs. While patient engagement and empowerment tops their list, the report also underscores the abundance of Canadian innovation already at play in regions across the country that is not being embraced and scaled up, in favour of maintaining a status quo that is woefully outdated.
There are no easy answers here, but there is clarity: focus on integrating fragmented health systems and building stronger and longer-term relationships among government, private sector and providers. This will enable us, collectively, to dig in and get the heavy lifting done.
4. Connect the dots between patients, physicians, pharmacies and insurers.
Breaking down the silos that exist between patients, providers, pharmacies and insurers is essential to ensuring patients get the best outcomes. For example, physicians don’t necessarily see themselves as having a relationship with benefit plans – their responsibility is, understandably, to the patient. However, having information about plan coverage and other resources and options available to them at the time a care plan is being developed and before a prescription or referral is made is a primary opportunity to improve patient outcomes. Similarly, ePrescribing in Canada can dramatically reduce prescription error that is a very real risk with the existing manual prescription process.
5. Leverage our assets and assert bold leadership.
In his new book, In Search of the Perfect Health System, Dr. Mark Britnell lists 12 countries from which we can learn something about the perfect health system. Canada was not on that list. However he does note a few solid qualities we can build on, including: the high quality of our medical education; that we boast some of the best medical research facilities in the world; Canada’s active culture of community philanthropy for healthcare; not to mention our universal healthcare system.
Dr. Britnell also notes that Canadians are really nice, which I agree is also true. I would add that if we are to achieve radical change, we also need bold leadership to make large-scale decisions and move quickly.
We have what it takes
I believe we are making important strides.
When I think about health IT over the past year, highlights that come immediately to mind are British Columbia’s policy stakes that hold its health system accountable for creating true patient-centred care. What about Ontario’s unwavering commitment to advance the delivery of the province’s electronic health record (EHR) to enable integrated and coordinated health care for 6.75 million residents of the Greater Toronto Area. And consider Alberta’s bold step toward facilitating wellness and prevention for its population with the start of a personal health record (PHR) program that will make tracking tools and access to healthcare data available to all Albertans.
These are but a few digital health examples of Canadian innovation, resourcefulness and tenacity that give us important markers for the year before us. Each is grounded with a vision of health services that put citizens and patient engagement first. Each challenges the outmoded notion of provider-centric systems. And each enlists commitment from players throughout the entire health ecosystem – practitioners, government, health program operators and patients – to achieve collective and radical change.
What does collective and radical change look like? Maybe it’s as simple as taking the things that have proven to work in one jurisdiction and scaling them across the country. Is that too much to ask to sustain one of our most treasured and defining assets?