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May 27

The health care “system”.

You know, language is powerful. We throw the word “system” around in relation to our health care in such a way as to assume that it actually exists, a “system” of health care. Webster’s online dictionary has 15 different variations of the definition of system, but the jist is this: “a group of independent but interrelated elements comprising a unified whole; … the whole scheme of created things regarded as forming one complete plan or whole”. Umm…if that’s a system, then that’s not what we have in health care in Alberta.  Now, we have the independent bits, and a whole bunch of created things…but we don’t do a great job of interrelating or integrating these things into a complete plan, or a unified whole—not even close. At least not yet.

To be fair, I do believe we are trying to get there.  Many people, myself included, have been really involved in projects focused on improving access to health care services for patients—getting people the help they need, when they need it. You know, we have made some progress in Alberta, especially in getting people better access to a family physician—but wow– do we ever have lots of work to do, and we sure do have to get beyond the project stage! When you are on the other side of the desk as a patient, or have a family member there– you understand really quickly how un-system like our “system” really is. I have two people in my family with chronic conditions. Neither one has experienced anyone sitting down, and really listenening to the multifaceted nature of the problems they are experiencing as related to the chronic health problem, in the context of their lives. As a result, they sort of lurch along, managing the best they can, getting in for short appointments when they have flare ups (often times with other practitioners because they can’t get in to see their own physician or team), and bearing almost total responsibility for connecting all those disparate dots of treatment when they next see their own doc…because with all the miracles of the computer age…providers still don’t communicate with each other very well. Providers don’t THINK like they are part of a system of health care, a system that should be anchored around the patient’s health experience and need. They think of their piece of the puzzle, and sadly, that’s often where it stops. All too often it falls to the patient (or the patient’s relatives) to tie all the pieces together—and guess what—they forget things because they are sick, and tired, and often desperate for help—help when they need it, not in weeks, or months. And, it isn’t JUST about QUICKER access (although that’s important too), it’s about building a SYSTEM. Connecting the disparate parts and addressing the desperate need.

Just to illustrate: a quick story. A ER nursing manager that I know truly understands the interconnected nature of systems—she knows that the folks who show up in ER with serious health problems often have had the system break down for them in terms of access to primary care—better access there may have prevented the problem from getting to this point. Then, she knows the system has broken down again when these folks wait hours, or even days in the ER for an inpatient bed. Several months ago, she attended a workshop on improving patient flow through the emergency department. Teams from all over the country proudly showed results where they have shaved “two full minutes” off procedures in the ER, or got patients from the waiting room to a gurney in the ER an hour quicker. Now, as this manager related this to me she shook her head and asked: what good is a quicker procedure when the patient hits the wall when a bed is needed? And what are we doing to prevent the need for the procedure in the first place? 

Until we actually and authentically start to THINK LIKE A SYSTEM, we will keep perfecting the parts and leave the patient holding the glue.

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