We are now early into 2017 and at a time when it is tradition to reflect on what was significant during the past year and what is expected and hoped to be accomplished in the upcoming year.
For us, looking back, there are some significant highlights from what we saw and experienced in 2016:
- Met twice with Deputy Premier and Health Minister Hoffman (January 13 & November 22, 2016)
During our first meeting, Deputy Premier Hoffman asked us what our top three priorities for the health system would be and we provided them to her and later shared our thoughts in subsequent posts: Vision & Culture, the Electronic Medical Record, and Purposefully learning from failure
- Release of the Health Quality Council of Alberta (HQCA) progress report titled Improving Continuity of Care: Key Opportunities and a Status Report on Recommendations from the 2013 Continuity of Patient Care Study (July 13, 2016)
We were looking forward to the completion of the work done by the HQCA to produce a progress report requested by Deputy Minister Dr. Amrhein. His request was to the review of the status of the recommendations made in the 2013 Continuity of Patient Care Report, which was based on the investigation of events that occurred outside the AHS leading up to Greg’s death.
- Update of the College of Physicians and Surgeons of Alberta’s Standard of Practice for Referrals
The College of Physicians and Surgeons of Alberta (CPSA) have led in their response to the recommendations assigned to them in the HQCA Continuity of Patient Care report. The CPSA updated the Continuity of Care standard in 2015 and this past year they continued to act with the update of the Standard of Practice for Referrals in 2016
- Showed our support for the Airdrie & Area Health Coop initiative (May 11, 2016)
Members of the community are working together on the creation of a citizen-centred entity in partnership with Alberta Health, Alberta Health Services (AHS), local physicians and the City of Airdrie. This model has a tremendous amount of potential because it has the necessary local decision-making and accountability structure to insure that the needs of their community are well known and responded to and that this translates into properly planning for their future. They made significant progress in 2016 in developing the base support and structure and we hope to see accelerated progress in 2017 with real tangible steps toward its establishment as the operational reality that the community believes in.
- Attended the Global Health Innovation Academy’s event
The event included some inspiring Keynote speakers along with a long list of health innovators who reinforce our belief that innovation, entrepreneurship are going to play a key role in the future of healthcare. The videos of keynotes and pitches by all of the competitors are available online and we encourage you to take a look.
- Presented at the Legalities in Nursing conference (November 24, 2016)
- Gave the opening keynote at the Canadian Association of Oncology Nurses (CANO) national conference (October 20, 2016)
- Participated in Alberta’s first Change Day & our pledge to establish Greg’s Army
- Part of the selection committee for this year’s CPSI’s Patient Safety Champion award winners
- The IMAGINE Citizens group continued their valuable work and to establish themselves as a valuable organization and resource for Albertans
Our 3 Priorities
Early in 2016 we shared what we consider to be our 3 priorities for improvements to our health system. Here is a quick summary of what we observed in relation to each priority throughout last year.
Vision & Culture
We hoped that there would continue to be increasing willingness by everyone involved in the system to be open to look at and learn from the challenges in the health treatment system. We also hoped that the general public, especially the healthy public, would gradually become more engaged in supporting real improvements in how the system provides the right care, effectively and efficiently, for patents and families in this province. We have seen some development by individuals and small groups within the system and in the public but know that there is much more that needs to take place. Momentum needs to build to support improvements and to break down the command and control culture, replacing it with genuine teamwork throughout.
On November 27, 2015, the government appointed a new AHS board (absent since former Health Minister Dr. Fred Horne fired the board June 12, 2013). In turn on June 3, 2016, Dr. Vera Yiu, who was acting President and CEO of AHS (from January 11, 2015) was promoted to become the current President and CEO. Dr. Francois Belanger filled Dr. Yiu’s previously held position of AHS Vice President of Quality and Chief Medical Officer.
While there has been much said about the Patient Centred initiative and associated adjustments, it has been difficult for us to see real improvements in the core issues of transparency and moving toward a true team based culture through out the system, horizontally and vertically.
Electronic Medical Records
The Provincial Clinical Information System and Patient Portal
We were hopeful that the on-going talk about Electronic Health Records and access to them by patients and families would translate into some real action, bringing Alberta’s system closer to what is being made available in some other Canadian provinces and in other systems around the world.
Last year’s provincial government’s budget set aside $400 million over the next 4 years for a provincial Clinical Information System. Some patient information will be available through a patient portal early this year and we continue to look forward to the important next steps of making these records available so patients and families can be more informed and engaged in their health care efforts. A recent 660 news poll showed that over 70% of respondents feel that it is a fantastic or good idea.
We continue to believe that Electronic Medical Records are a foundational block for improved health care. It also must be combined with the patient’s ability, as is their legal right, to full and complete access and ownership of this information. The patient and their family are by their very nature, the single connection point between the different and often disconnected parts of the health system. If patients and families are well informed they can contribute to the critical continuity of care as well as the advantages of greater teamwork of all involved.
Learning from failure
We know that in some instances, and by some individual parts of the system, change has come by learning from failure and by making improvements by closing the gaps found. Some have worked from the recommendations made following the study of the events that led up to Greg’s premature death and we are very thankful for that.
At the same time, this past year there were public reports that clearly showed gaps that put patients’ health at risk. As our readers know, we are concerned with the gaps in system oversight shown in the start up and operation of Edmonton North Clinic where patients were exposed to some unnecessary risks. The time that it took for the investigation to be done, affected patients informed by mail, and the reports to come out was far too long. While we have seen nothing reported publicly, we expect that this individual clinic situation has been addressed now but the question still remains about whether necessary adjustments in responsibility, accountability and communication across the system have been taken. We believe if this could happen in one instance it certainly could again, if it hasn’t already. This is the kind of learning and action that we believe must be taken decisively and transparently. We look forward to seeing what has actually been done and when.
Other significant events and announcements
In October 2015, Premier Notley confirmed the government’s commitment of $2.2 billion over the next 5 years for health infrastructure. The Premier spoke in Calgary about the government’s commitment to build the long overdue Calgary Cancer Centre with $650 million allocated and construction to begin in 2017. Of course, we are into the timeframe where the provincial budget is being considered and developed for the next fiscal year. We believe that Albertans need to go beyond the simple analysis of whether the total amount of money spent in the health system is too little or too much for us as taxpayers. It is more important for people inside and outside the system to listen to and learn from each other. We must understand and support potential efficiencies that can be gained in all aspects of health care and its delivery. Some improvements may save money quickly; others may require investment now to gain efficiencies over the longer term. Advocating for spending increases or cuts without this level of public understanding is very dangerous and likely will cause more harm to both the quality of care and the cost of it. The necessary public understanding can only come from genuine conversations between those working inside the system and those of us that do not. Online surveys with leading questions do not qualify as a meaningful conversation and are a disservice to the public and the committed care providers of the system. There is no question that we must start a new path away from continuing down the historical path and now insure the healthy public’s deeper understanding of the system’s challenges and where the working people inside the system believe significant improvements can be made. This will mean more effective and efficient decisions will be made.
From a personal perspective, our family’s experience in Alberta’s health system included the palliative care of Greg’s Grandmother until she passed away last January. We had worked with the doctors, nurses and support staff through the months before and found that process to be very sensitive and well coordinated. Everyone was open, frank and willing to listen to and act according to her wishes and that of the family.
Greg’s older brother also went through an experience that again demonstrated the lack of coordination and responsiveness of the “system”. This included multiple wrong diagnoses one of these involving a specialist that more interested in attempting to demonstrate his assumed superior intellect than listening to us or his colleagues. Fortunately other fine doctors and specialists did their best to mitigate what had been done before and work with us to get on a path of recovery. We also know that our experiences are not unique, either on the positive or the negative end of the spectrum and we would like to hear from anyone that would like to contribute to our efforts to help improve the system and its culture.
We are looking forward to 2017 and are excited by some of the early developments that already are taking shape. We want to continue to learn from experiences in the system and to support improvements for all involved, including the great people who are genuinely dedicated to working with each other and the patients in their care. As patients and also those of us who are members the “healthy public” we must be the real supporters of the right kind of change and to drive it.