2004 11 01 Archive

Wednesday, November 24, 2004

The Saskatchewan Institute of Health Leadership has posted the speech given by Steven Lewis at our final retreat. From Access Consulting, Steven’s speech focused on our health care system. Besides being a tremendous public speaker, Steven makes several valid points regarding the state of our system. You can find Steven’s speech on the SIHL website.

Wednesday, November 10, 2004

At the beginning of the week I had the chance to give a presentation to the physicians and receptionists at the local medical clinic on Advanced Access. Advanced Access is a program that I experienced while in the UK. Through simple system changes, patient wait times for appointments with their GP were dramatically reduced. Now the majority of patients in the UK are seen within 48 hours of requesting an appointment. More information on the UK’s Advanced Access program can be found on their website.

The Health Quality Council has begun working with several sites across the province in implementing Advanced Access. My intention was to introduce the idea of Advanced Access to the clinic, field any questions or concerns, and see whether it was something that we thought would work. We have decided to take the first step by starting to track the background data (patient demand), and then sit down as a team (with the HQC), analyze the results, and see where to proceed from there.

The presentation I gave to the clinic can be found here.

Tuesday, November 02, 2004

The Saskatchewan Institute of Health Leadership (SIHL) that I participated in, concluded at the end of October. During the two day wrap-up we presented both our group and individual leadership challenges, as well as had numerous discussions about healthcare in Saskatchewan.

One participant in particular, Dr. Gerrit Van Wyk, made several points that I think summarize several of the problems and challenges facing the healthcare system. With his permission, I have described them below.

The first valid point, describes the need for a systems model of illness in society. “White et al (1961)(verified by Green et al 2001) examined illness patterns on both sides of the Atlantic and found that during a month, 75% of adults are likely to experience symptoms of unwell, 25% will consult a family practioner, 10% will be admitted to a hospital, and 5% will be referred to a specialist. If this data is transferred to a bell curve, it becomes obvious that “health” is a continuum or fuzzy spectrum… A systems model of “health” conceptulizes that “health” is a process rather than an event, is a very useful and powerful model for planning all aspects of health care and could easily serve as a vision of health… This model has huge implications and may be used for budgetary planning, resource planning, drug planning, the creation of functional integrated information systems, changing mind sets, and so on.”

Traditionally, healthcare dollars have been spent on the areas that only a small percentage of patients access (hospitals, specialists). By thinking of healthcare as a system, money can be re-routed to those areas that the majority of patients access, and to those areas of prevention and health promotion. In other words, prevent the problem rather than treat the problem.

Dr. Van Wyk also came up with 6 key points on our healthcare system:

1. Healthcare problems are not unique to Canada. The problems are worldwide.

2. The reason we can not fix the problems is because we are stuck in a paradigm or mindset that we can’t fix them.

3. There is often a lack of information or feedback on the system — perhaps as a result of how most health systems are managed. For the most part, leaders are appointed rather than elected. This style of system can lead to “hush-hush” attitude as there is often a lack of accountability.

4. We lack consensus on what health is — a lack of vision or goals.

5. The structure of the industry often resists the needed change.

6. On the topic of waitlists and the political issue that it has recently become…Dr. Van Wyk reinforced the idea that, to physicians, no waitlist is acceptable.

Dr. Van Wyk has also written a book which encompasses many of his ideas on systems thinking, entitled A Systems Approach to Social and Organizational Planning.