Better Healthcare for Albertans is the name of the report that Merwin Sayer, Alberta’s Auditor General, and his very capable team produced and released in May of 2017. While this report was built on their investigation of the past and present operations of the health system in Alberta, we believe their findings and comments would fit for many other jurisdictions. Their report notes three underlying factors:
- Fragmented structure of the health system
- Lack of integration of physician services and the services of other care providers
- Lack of sharing and use of clinical information
They also say that since the 1990s, the Auditor General has conducted over 40 audits on aspects of the Alberta health system and while some recommendations made in the past have been implemented, others have not and “weaknesses noted in our findings keep emerging, and re-emerging, over time, because their root causes have not been resolved.”
They also state that the report is not an audit. It is an analysis of what has frustrated a comprehensive shift toward best-quality care, and what can be done to overcome the challenges standing in the way.
Achieving the highest quality healthcare available depends on moving purposefully toward what is known as integrated care.
We certainly appreciate that this is a report rather than an audit, and it is written in a way that we all can learn from their research and comments. Here is what they define as integrated care:
“Integrated care means a system centred on patients, not on administrative needs or the traditional ways of doing things.
Patients would find that an integrated care system has essential features that our current health system does not.”
This is the report’s description of how an integrated care model works:
- Teams of providers in primary care, acute care and continuing care work on a single plan for each patient, designed to meet that patient’s care goals.
- Each individual patient’s health information flows to all of that person’s care providers.
- Decision support tools bring the latest medical knowledge to bear wherever the patient receives care.
- Care is delivered in the most appropriate location – for example, in a community setting rather than in a hospital whenever possible.
- Patients are engaged in their own care, receiving information and taking part in the decisions.
- Constant measurement and benchmarking of care quality and patient outcomes by everyone in the system keeps care at a high level.
The Auditor General investigated a number of different systems around the world and learned from the most successful. We encourage you to read at least the At a Glance piece which provides some of the key messages from the full report. It goes on to say:
“In every successful system, all the parts work together. And quality of care is paramount. By adopting a framework for integration, these organizations have spurred advances in every aspect of healthcare delivery.”
This all makes sense, doesn’t it? A fully integrated and informed team (including the patient) using the best of the current toolbox to meet the patient’s care goals. It is absolutely the right thing.
Shouldn’t Alberta’s consolidated provincial structure be in the best position to facilitate this integrated care model? It should be, but it hasn’t.
The Auditor General also says:
“More money is not the solution. Albertans already pay for the most expensive health system of any province in Canada (based on 2015 per capita adjusted for age and gender), yet they are not receiving the level of care being provided by the best-performing health systems in other jurisdictions.”
Why then, in Alberta’s consolidated system, with its highly centralized management structure, are we not leading in the delivery of truly integrated care?
We believe that there is far too much internal politics, both nested in the various segments of the health treatment system and between these parts, and that as the public we have allowed provincial political agendas to override what needs to happen to make the improvements in the system that are needed and have been for many years. The solutions are not new, as Better Healthcare For Albertans notes.
The Auditor General talks about the need “to move purposefully” toward the goal of truly integrated care. This has not been happening in the distant or recent past. We believe that, given our politician managed and monopolistic system, we the public must now purposefully set the political priorities to ensure movement in this direction. No one else is able to do this. Great people who work inside the system have tried, and while some individual initiatives have succeeded, the larger and overall changes have met resistance. We each need to talk to those that we know who work in the “system” and learn from them. We need to understand what they believe will make the system better. Those that work inside the system must also have conversations with those they know, to help us, the members of the public, to help them. It is important for all of us to set the right priorities for those that have been elected to represent us.
It is not easy to be informed in a world where there is a significant lack of transparency or willingness to engage with the public. It is very important for the public to learn and become meaningfully engaged. We must ensure and accelerate improvement in the healthcare system that we depend on. History has shown that without our strong engagement the politics of a few will bog the down the process or take it in a direction that is not in the best interest of the population.
The Auditor General has done a very good job of setting out what has not been done and what needs to happen in order to turn the system here in the right direction for the future. Their independent view is refreshing. It is important for all of us, as the public, including both the people inside and outside the system, use their work to “move purposefully” toward an “integrated healthcare model”. This will only happen if we make it clear that we want and will only accept political priorities that reflect this new course. We cannot continue to allow or default to what others, often with vested interests of their own, choose as their own (taking us with them) direction.