2nd Curve Health Care Organizations

As part of IPAC's "Sustaining Transformation: Building a Resilient Organization" conference that we held on May 31st & June 1st, Dr. Marty Merry spoke about the opportunity to create 2nd curve health care organizations.

His premise is that the complexity of our health care system as outpaced its capacity to deliver safe patient care under the old "craft" model. What is required to move from a 4 sigma (6,210 defects/1 million = avoidable deaths) to a 6 sigma organization (3.4 defects/1 million) is a paradigm shift. Moving to a second curve system that imports the best of management science into the field of health care delivery would move an organization from 4 to 6 sigma. As Dr. Merry noted - what is the rate of preventable deaths that would be acceptable. If we say that we are satisfied with 95% success rate, that means that 50,000 people die from preventable deaths in our system. The only real answer that is acceptable is ZERO!

But how do we get there?

Dr Merry laid out "The Vision: 10 Rules of Performance in a Redesigned/2nd Curve Health Care System" (adapted from the Institute of Medicine, 2003):

1. Care is based on continuous  healing relationships;
2. Care is customized based on patient needs and values;
3. The patient is the source of control;
4. Knowledge is shared and information flows freely;
5. Decision making is evidence based;
6. Safety is a system property;
7. Transparency is necessary;
8. Needs are anticipated;
9. Waste is continuously decreased; and
10. Cooperation among clinicians is a priority.

Dr. Merry spoke about the characteristics of a second curve health care organization that is patient focused.  I could not do justice to his full talk, but have no fear as we will be posting the videos of his talk on teh IPAC website shortly.

Resilience Conference

As I wrote previously, on Monday & Tuesday, we organized a conference entitled “Sustaining Transformation: Building a Resilient Organization” that focused on health care.  We had an amazing array of speakers! The conference was videoed and will be posting the videos on our website in the next short while.

Among our keynote speakers was Saäd Rafi, DM of the Ministry of Health and Long Term Care who spoke to the delegates on the need for resilience and a focus on quality of care. He spoke of the need for health care organizations to act as a real system that is better aligned to quality health outcomes and that the future core business of the sector is a focus on quality care. There are some who equate the amount of funding to the level of quality. Saäd emphasized that more money does not result in better quality. Indeed there is an argument that true quality is less expensive as it focuses on the best practices for the delivery of care based on evidence. Saäd spoke about the Ontario government’s new legislation “Excellent Care for All” that is presently being debated in the Legislature. This legislation focuses on quality and patient outcomes and requires every hospital to develop an annual Quality Plan that includes regular surveys of patients, their families, and staff to gauge the level of quality being delivered.

Saäd also connected what the Ministry is doing to the 4 parts of resilience model- Responds, Monitors, Anticipates and Learns. He emphasized that the learn is the most difficult as it requires behavioral changes in the system as a whole. The delegates appreciated his take on the challenges and opportunities ahead and the need to build truly resilient organizations in order to be successful.

There were a number of other incredible speakers, such as Dr. Marty Merry and Dr. Josh Tepper on 2nd curve health care organizations that I will blog about in a future update.

Resilience, Reliability and Results

On Monday May 31st, and Tuesday June 1st, IPAC will be holding a conference focusing on health care entitled Sustainable Transformation: Building a Resilient Organization.

As part of IPAC's health care research project we will be releasing a study of five acute-care hospitals in the Waterloo-Wellington region that highlight the stories of these "high performers in the making" and their respective experiences with ED PIP – the Ontario Ministry of Health and Long-Term Care’s “Emergency Department Process Improvement Program.”

This 8 month initiative which ran from March – October 2009 engaged front-line staff from across these organizations in "quality by design" decision-making, planning, piloting and implementing of process improvement changes in Emergency Departments and across Inpatient Units. With Wave 2 just finishing and an additional 17 Ontario Hospital sites added to the roll-out, ED PIP may be one of the most significant transformational efforts to take place in Ontario hospitals in decades. In its early days PIP has clearly demonstrated success by enhancing the quality of the patient experience through improved access to care and flow through the system at the following Wave 1 sites:

• Groves Memorial Hospital, Fergus
• Guelph General Hospital, Guelph
• St. Mary’s General Hospital, Kitchener-Waterloo
• Grand River Hospital, Kitchener-Waterloo
• Cambridge Memorial Hospital, Cambridge

The case studies provide a context for specific process improvement strategies that could be adopted in other hospitals and outline the challenges or barriers that may prevent the adoption of these process improvements. This study considers:

• the significance of a learning culture that builds capacity and resilience in its people;
• the importance of process improvement designs that enhance system effectiveness and efficiencies and increase overall reliability in care delivery and patient outcomes; and
• the value of a management and performance measurement infrastructure that encourages and supports the desired results of the transformation.

With a spirit of persistent crafting and sustaining of robust strategies and improvements in care, these ‘stories’ and ‘lessons learned’ can influence, inspire and dare us to consider what is possible as we continue the journey of healthcare reform in the province of Ontario.

You can access these cases and much more on the IPAC Health Care Leaders Forum page of the IPAC website.

Next week I will be blogging from our Health care conference.  As I've written before on this blog, we must come to grips with the increased demands of our health care system if we are to ensure a longer term fiscally sustainable future and a society that invests in other important areas such as education, the arts and infrastructure.

Patient Safety & Quality Health Care

An interesting new report, published in April 2010, by the European Commission on the perceptions of patient safety and the quality of healthcare. The survey was conducted in 27 members states of the European Union. Nearly half the respondents feel that they could be harmed by healthcare in their country, and the majority of respondents feel hospital infections or incorrect, missed or delayed diagnoses are either fairly likely or very likely to occur.

• The majority of respondents feel hospital infections or incorrect, missed or delayed diagnoses are either fairly likely or very likely to occur when receiving healthcare in their own country.

• Over 25% of respondents claim that they or a member of their family have experienced an adverse event with healthcare. However, these events largely go unreported.

• Where adverse experiences were reported this was mainly to the hospital management or the relevant doctor, nurse or pharmacist.

• Nearly one third of respondents do not know which body is responsible for patient safety in their country. Others see the ministry of health or the healthcare providers (e.g. clinic, hospital, doctor, nurse) as the responsible bodies.

• Of the people who underwent surgery, 17% say written consent was never obtained, though great variance across the Member States is evident.

• Most respondents (73%) say television is their main source of information regarding adverse events in healthcare, followed by newspapers and magazines (44%) and friends or family (31%). Only 9% would seek information in official statistics or in hospital.

• Whether harm occurred in their own country, or another Member State, respondents expect that an investigation into the case or financial compensation would be the forms of redress.

• Should they be harmed in their own country, most respondents anticipate that they would seek help from a lawyer, or else the hospital management or ministry of health. If the harm occurs in another Member State, they claim they would first contact their embassy or consulate.

• When thinking of high quality healthcare, the most important criterion is well trained medical staff, followed by treatment that works. Thereafter, no waiting lists, modern medical equipment and respect of a patient’s dignity receive roughly equal responses.

• Most respondents rate the healthcare in their country as good, though the majority feel it is fairly good rather than very good. However, there is again great variance on a national level (from 97% to 25% of respondents rating quality of healthcare in their country as good).

• Respondents from 16 EU Member States consider the quality of healthcare in their country as worse than in other Member States, whereas respondents from 11 Member States consider it as better.

This is a fascinating report and Canadians should be aware that we have similar issues in this country.

After the Meltdown

On March 24th I had the opportunity to attend an interesting session entitled "After the Meltdown: The limits and possibilities of economics" that was organized by the Centre for Global Challenges of the Glendon School of Public & International Affairs.

After introductions by Alex Himelfarb and words of welcome by Mamdouh Shoukri (President of York University), the microphone was turned over to Chaviva Hosek, President of the Canadian Institute for Advanced Research to introduce the illustrious panelists.

The panelists were George Akerlof, Nobel Laureate & Professor of Economics at the University of California at Berkeley; Tim Besley, Professor of Economics & Political Science at the London School of Economics; and Pierre Fortin, Professor of Economics at the University of Québec at Montreal.

George Akerlof spoke about "animal spirits" and how they impact the economy (this is from his recent book entitled "Animal Spirits: How Human Psychology Drives the Economy, and Why It Matters for Global Capitalism". The term "animal spirits" is derived from Keynes and relates to the confidence and gut feelings in determining business decisions.

"Most, probably, of our decisions to do something positive, the full consequences of which will be drawn out over many days to come, can only be taken as the result of animal spirits - a spontaneous urge to action rather than inaction, and not as the outcome of a weighted average of quantitative benefits multiplied by quantitative probabilities." (161-162) - J.M.Keynes, General Theory.

By this he meant that data alone (profit/loss, eps, etc) are not enough to explain business decisions and that psychology has a role to play in it. Prof. Akerlof talked about the five animal spirits, with a special emphasis on "snake oil" to explain the meltdown.

In his talk, Prof Fortin outlined the three economic tasks that governments will have to respond to in the next decade: namely, drawing lessons from the recession, responding to the demographic forces  that will impact western countries and accelerating economic growth.

On demographics, he quoted David Foot who said "Demographics explain about two-thirds of everything".  This is especially true if you look at the demographics facing western industrialized countries like Canada.  I have previously written and spoken about this (In fact I gave a speech which contained some of this information and my analysis a couple of days before this session). The combination of demographics and ever increasing health care costs will impose a squeeze on public finances over the medium term according to Prof Fortin.  There are only two possible solutions: 1) radical change to our health care sector , and 2) accelerate economic growth.

It was an interesting discussion and I will post my remarks on the demographic challenges to either this blog (if I can figure out how) or to the IPAC website.

If Air Travel Worked Like Health Care

I recently received a link to a great video that is based on an article written by Jonathan Roach of the National Journal magazine in the US entitled If Air Travel Worked Like Health Care. The article is based on the US Health Care system and its fragmented nature. It is very funny but so true! Some of the issues that the protagonist goes through in the US applies to Canada also.




Hope you enjoy!

Resilience, Reliability & Results

A “resilient” organization, team, or individual has the ability to bounce back from a hard hit, to deal with adversity and return to a high level of performance. This idea has been gaining prominence in several fields in the last few years. In safety in high-consequence industries (aviation, chemical, nuclear, and healthcare), it means the ability to recover from accidents and also to prevent them before they happen. In human and social development, it means the ability of individuals and communities to rise above their circumstances and better themselves despite misfortunes or difficult conditions. In organizational terms, in means the capacity of a government, healthcare system, or private-sector company to recover from environmental shocks, adapt to the new situation, and return to a well-performing equilibrium point.

Why is resilience an important capacity for organizations, groups, and individuals to develop? In 1988, in a report for the Office of the Auditor General, Federal Government of Canada, Otto Brodtrick wrote:

“Well-performing organizations encourage risk taking. They are willing to try new methods when common sense dictates that better results can be achieved by following the spirit of a regulation, instead of the letter. However, staff must hold the values of stewardship, service and results, and they must consult with each other. When their people are governed by these values, the well-performing organizations encourage risk taking as a matter of strategy.”

Strategic risk-taking and risk management, toward optimizing performance, are hallmarks of the Resilient Organization. Given budget shortfalls, aging populations, and increasing demands for targeted, high-quality services, governments and healthcare systems must develop their capacity for resilience if they hope to accomplish their mandates. The same thing is true, in different ways, for high-consequence industries and the private sector. Achieving good performance in pockets seems more attainable than maintaining and sustaining it over large segments of a system or organization. Building organizational resilience is a necessary performance platform in today’s environment.

This is even more true today than it was ten or twenty years ago. Many governments, hospitals, school boards are facing budget crises and severe fiscal constraints across Canada, Europe, and the U.S. Take the healthcare sector as a further illustration. In many Canadian provinces spending on health care is fast approaching half of the provincial budget and is growing at a rate of 5-8% per annum. This is at the same time as governments are running significant deficits and demand for health services are climbing. This is also at the same time when government should be focusing more of their scare resources on investing for the future. Departments/Ministries of Health and Finance can only meet their fiscal accountabilities if they adopt the Resilient Organization perspective. Otherwise, their strategies will be limited to broad-brush cuts in service which do not change the basic dynamics of the system. Resilience can achieve both: steadily bending the cost curve, while increasing the quality of care and access to service. How? By improving alignment across the sector, enabling organizations to adapt, flex, and anticipate to environmental shocks, and (in general) reducing the costs of coordination by improving system-wide teamwork and situational awareness. All of these are characteristics of a highly-reliable, resilient healthcare system.

There are a number of studies that show that by only focusing on results, organizational improvement is temporary and not embedded in the culture of the organization. Using the same resources, one can focus on creating a resilient organization that will achieve the desired results over the long term.

In a future post I will write about a new paper by some leading US Healthcare thinkers on "Transforming Healthcare: A Safety Imperative". It is a fascinating paper and I think hits the nail on the head in terms of how to transform health care.

New Study from the US: 45,000 excess deaths annually linked to lack of health coverage

More evidence that the lack of universal health care in the USA has a direct impact on health outcomes. A recent study from Harvard has highlighted that there are approximately 45,000 excess deaths in the US due to lack of universal coverage. Read on.......

A study published online on Sept 17th estimates nearly 45,000 annual deaths are associated with lack of health insurance. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.

The new study, "Health Insurance and Mortality in U.S. Adults," appears in the online edition of the American Journal of Public Health.

The Harvard-based researchers found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

Lead author Dr. Andrew Wilper, who worked at Harvard Medical School when the study was done and who now teaches at the University of Washington Medical School, said, "The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors and baseline health. We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease - but only if patients can get into our offices and afford their medications."

The study, which analyzed data from national surveys carried out by the Centers for Disease Control and Prevention (CDC), assessed death rates after taking education, income and many other factors including smoking, drinking and obesity into account. It estimated that lack of health insurance causes 44,789 excess deaths annually.
Previous estimates from the IOM and others had put that figure near 18,000. The methods used in the current study were similar to those employed by the IOM in 2002, which in turn were based on a pioneering 1993 study of health insurance and mortality.

Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease. An increase in the number of uninsured and an eroding medical safety net for the disadvantaged likely explain the substantial increase in the number of deaths associated with lack of insurance. The uninsured are more likely to go without needed care.

Another factor contributing to the widening gap in the risk of death between those who have insurance and those who don't is the improved quality of care for those who can get it.

The research, carried out at the Cambridge Health Alliance and Harvard Medical School, analyzed U.S. adults under age 65 who participated in the annual National Health and Nutrition Examination Surveys (NHANES) between 1986 and 1994. Respondents first answered detailed questions about their socioeconomic status and health and were then examined by physicians. The CDC tracked study participants to see who died by 2000.

The study found a 40 percent increased risk of death among the uninsured. As expected, death rates were also higher for males (37 percent increase), current or former smokers (102 percent and 42 percent increases), people who said that their health was fair or poor (126 percent increase), and those that examining physicians said were in fair or poor health (222 percent increase).

Dr. Steffie Woolhandler, study co-author, professor of medicine at Harvard and a primary care physician in Cambridge, Mass., noted: "Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance. Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives."

Dr. David Himmelstein, study co-author and an associate professor of medicine at Harvard, remarked, "The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance. Even this grim figure is an underestimate - now one dies every 12 minutes."

Health Care - US

I usually don't comment on politics on this blog, but in this case I will make an exception, especially as it relates to Health Care, President Obama and the opposition to health care reform in the USA.

I have been astounded by the level of so-called debate in the US over the proposed reforms to the US health care system and the vitriol of those opposing the public option. When debate descends to the level where President Obama is compared to Hitler, you have to wonder what these critics have been smokin'! Then you have people like Sarah Palin who have said that the Obama plan includes "death panels" of bureaucrats who would decide who lives or dies. Where did she get that? There is no such thing, and yet she makes headlines "by being economical with the truth" as Sir Humphrey would say.

After our annual conference in Fredericton, I took some time off and stayed for a couple of days at the Algonquin Hotel in St. Andrew's. It is a wonderful Gatsbyesque place. At night, on the front lawn, they have a fire pit going with a number of Muskoka chairs around the fire. We were sitting there one night and talking to some of the other guests. A few of them where from the USA, so we asked them about Health Care reform. One was from Massachusetts and the other one was from Connecticut. They were both against the "public option" as they felt that people should take individual responsibility and that they did not want to pay for people who do not take care of themselves. We continued the debate, though when they stated that the fair news in the US was Fox news, we knew where they were coming from. Mind you it was a civilized debate, not the overexcited, screaming & yelling that one has seen at US town hall meetings. Must have been the effect of being in Canada that calmed them.

Whatever your position is on the public option in the US, you should at least have a civilized discourse!

Back to the substance of the debate - tonight Barack Obama addresses Congress to try to get his message across. We will see if he will be successful. I have my doubts, given that they have let the anti-reform side frame the debate. Whatever comes out of Congress will be watered down and the winners will be the special interest groups (US insurance companies) and the losers will be those with out coverage or with inadequate coverage.

You have to wonder why a society as individually generous as the US (compare their charitable donations per capita to other countries) would be against the concept of putting in place a universally accessible health care system. It is not as if the US system produces better health outcomes or costs less than other "socialized" health care systems. Some of the opposition is based on not wanting a government health bureaucracy and the assumption that government can't run anything (the example they give is Hurricane Katrina). But is it better to have multiple private health insurance bureaucracies that result in a huge administrative overhead (some estimates are that this overhead is 30% of the health care bill in the US).

I could go on, but I think I will stop here - there is much on this topic in cyberspace...check it out.

Stay tuned and see what happens with this interesting debate.

Deaths due to Medical Errors

A new study was released today detailing the death of patients due to preventable medical mistakes and hospital infections in the USA. There are similar studies about preventable deaths in Canada. One of the ways to reduce the exponential growth in health care costs is to reduce preventable mistakes and infections. There are numerous studies that show that over-prescription are one of the causes and can be reduced through electronic patient records.

This latest study from the Hearst News is quite comprehensive. I have copied the synopsis below and you can find the full study by clicking here.


An estimated 200,000 Americans will die needlessly from preventable medical mistakes and hospital infections this year, according to “Dead By Mistake,” a wide-ranging Hearst national investigation, which began reporting the findings today [www.deadbymistake.com]. Despite an authoritative federal report 10 years ago that laid out the scope of the problem and urged the federal and state governments and the medical community to take clear and tangible steps to reduce the number of fatal medical errors, a staggering 98,000 Americans die from preventable medical errors each year and just as many from hospital-acquired infections.

“Dead By Mistake” is the result of an investigation conducted by Hearst newspaper and television journalists.

Eric Nalder, senior enterprise reporter for Hearst Newspapers, and David McCumber, editor of two of Hearst’s Connecticut newspapers, The Advocate of Stamford and the Greenwich Time, are available in New York City and San Francisco, respectively, for interviews on this groundbreaking Hearst investigation.

Ten years ago, the highly-publicized federal report, “To Err Is Human,” highlighted the alarming death toll from preventable medical injuries and called on the medical community to cut it in half—in five years. Its authors and patient safety advocates believed that its release would spur a revolution in patient safety. But Hearst’s “Dead By Mistake” reveals that the federal government and most states have made little or no progress in improving patient safety through accountability mechanisms or other measures. According to the Hearst investigation, special interests worked to ensure that the key recommendations in the report—most notably a mandatory national reporting system for medical errors—were never implemented.

Among the key findings of the Hearst investigation:

· 20 states have no medical error reporting at all, five states have voluntary reporting systems and five are developing reporting systems;

· Of the 20 states that require medical error reporting, hospitals report only a tiny percentage of their mistakes, standards vary wildly and enforcement is often nonexistent;

· In terms of public disclosure, 45 states currently do not release hospital-specific information;

· Only 17 states have systematic adverse-event reporting systems that are transparent enough to be useful to consumers;

· The national patient-safety center is underfunded and has fallen far short of expectations;

· Congress approved legislation for “Patient Safety Organizations” as a voluntary system for hospitals to report and learn from errors, but the new organizations are devoid of meaningful oversight and further exclude the public;

· Hearst journalists interviewed 20 of the 21 living authors of “To Err is Human”—16 believe that the U.S. hasn’t come close to reducing medical errors by half, the primary stated goal of the report;

· New York’s reporting system has run out of money and staff—its last public report is four years old;

· The law mandating reporting in Texas expired in 2007, and funding ran out—a new reporting law has been passed, but no funds have been allocated;

· Washington State requires reporting, but doesn’t enforce that requirement—and the legislature failed to provide funds to analyze the results.

“Dead By Mistake” includes profiles of more than 30 people who died or were injured while seeking medical care. Most lost their lives, some in lingering pain. Others lived on, with paralysis, amputation, burns and emotional distress. Families suffered in the aftermath. In some cases, paperwork was lost, or mischaracterized the cause. “Ranging in age from newborn to 91, these Americans are a small sample of a huge and poorly accounted for population,” said Hearst Newspapers Editor-at-Large Phil Bronstein, who oversaw the project. “To the families, each case is a unique and compelling argument as to why a system that allows such preventable mistakes is intolerable.”

In addition to investigative reporting and case profiles, DeadByMistake.com features an interactive map that provides a state-by-state snapshot of reporting systems and two interactive databases created as part of this investigation. One database tracks hospitals’ participation in three prominent national safety programs. The second brings together the millions of anonymous patient discharge records that Hearst reporters collected from California, Texas, New York and Washington. Hearst worked with expert statisticians at the Niagara Health Quality Coalition, a not-for-profit think tank, to analyze this data to produce never-before published patient safety ratings from medical details buried in hospital records. The results appear on five searchable databases with interactive maps.

“More people die each month of preventable medical injuries than died in the terrorist attacks of September 11, 2001,” Bronstein added. “The annual medical error death toll is higher than that for fatal car crashes.”

Bronstein continued, “‘Dead By Mistake’ is the result of two things converging: a critical and neglected health-care issue that dramatically affects hundreds of thousands of Americans every year and the tireless work of a team of skilled and dedicated journalists.”

The investigation utilized the reporting resources of seven Hearst newspapers—the San Francisco Chronicle, Albany Times Union, San Antonio Express-News, Houston Chronicle, Greenwich Time, Stamford Advocate and the Connecticut Post—as well as SeattlePI.com and Hearst Television. In addition to contributing to the national television, print and Web stories, these Hearst journalists also produced market-specific reports highlighting the results of local investigations. Students, faculty and graduates of the Stabile Center for Investigative Journalism at Columbia University Graduate School of Journalism also contributed research, stories, photos, audio, video and Web content to the report.

“This comprehensive investigation allowed us to draw on the unique journalistic resources of our various Hearst properties and platforms, and enabled us to broaden the breadth and depth of the reporting,” Bronstein said. “This investigation is a new, collaborative way of reporting, but, more importantly, it is a public service focusing on the plague of fatal and preventable hospital errors.”

Health Care - the battle continues

I'm sure that you have all seen those commercials opposing health care reform in the United States from the Americans for Prosperity Foundation that includes a clip of Shona Holmes from Canada. In this commercial, Ms. Holmes makes that claim that if she relied on governments in Canada for treatment she would be dead.

There has been much ink spilled on her illness and the treatment she paid for in the US. Some of the opponents of health care reform in the US have used the "socialized" medicine bogeyman to try to defeat the public health option being discussed in Congress. They have said that they do not want to have a government "bureaucrat" decide on treatment. Unless the treatment is not covered by the provincial health plan, the government "bureaucrat" has nothing to say about the treatment prescribed by your physician. In the US, insurance company representatives can refuse treatment or payment after treatment on a number of grounds. The most recent example is of a women with brain tumors who was refused treatment by her insurance company. Read about it here.

There are many studies that show that a single payer system, as in Canada, is much more efficient that multiple payer systems as in the US. This is on top of providing universal coverage to the population. In the US, 50 million people are not insured and a significant number have inadequate coverage. The US spends almost 20% of its GDP on health care and yet have worse health outcomes than Canada and Western European countries who spend much less through universal programs.

Canada's system is by no means perfect and we still have work to do to ensure better efficiency, effectiveness and affordability of our system.

Health Care - the battle is on

Well it seems that our friends to the south are in the midst of another Health care battle. The President wants health care reform that would provide coverage to the 50 million American citizens without coverage and also wants to make health care more affordable. Some of those who have come out against his proposals have once again decided to use the Canadian system as the whipping boy.

And then there are the illogical ones such as this so-called pundit...click here Did you understand that????

I will be posting some more on the US Health Care debate in the near future...stay tuned.

Health Care - Electronic Patient Records

I received a press release today from the National Governors Association in the US about the innovative strategies that many US States are using to achieve integrated health records. There could be some lessons for Canada in this as Electronic Health Records are key to reducing medical errors as well as reducing duplicate & triplicate tests. The brief came from the NGA Center for Best Practices.

Accelerating the Adoption of Electronic Prescribing examines electronic prescribing, or e-prescribing-the computer-based electronic generation and transmission of a prescription. E-prescribing improves patient safety and quality of care, increases prescribing accuracy and efficiency and reduces health care costs by making critical information available to health care providers. The use of e-prescribing will grow as states and others provide support for e-prescribing. In recent years, states annually have doubled the number of prescriptions sent electronically. If states stay the course, this rate of adoption will reach at least 50 percent by 2012, according to State Alliance for e-Health Call to Action for NGA.

Developing and implementing plans to promote e-prescribing can help governors achieve critical health reform goals: achieving higher quality care and enhancing the delivery of health care services. Several strategies are available to states to promote an e-prescribing agenda. These include:

* Developing e-prescribing policies;
* Incorporating e-prescribing into state publicly funded health programs; and
* Implementing financial incentive programs for e-prescribing.

This is very interesting development in the US. I recall a Rand Corporation study from 2005 that estimated the savings from EPR implementation in the USA in the billions of dollars. I will write more about this in the near future.

With the demographic trends and with health care making up close to 50% of provincial budgets, we must find all the efficiencies we can in the delivery of quality and accessible health care.

Health Governance

It’s been over 10 days since I last blogged – time to catch up a little.

On January 16, 2008 we held a very successful conference on Health Care Governance renewal that focussed on the changes being implemented in Ontario. Ontario is in the process of implementing a “made in Ontario” regional model that integrates health services by region under what are called Local Health Integration Networks or LHINs in acronym. The job of the LHIN is to integrate all health services in a given geographic region – home care, long-term care, hospitals, mental health, etc. Unlike BC or Alberta, the model in Ontario has meant the elimination of the local level of governance (health provider Boards). The model therefore includes local governance, a LHIN governance structure (there are 14 LHINS in Ontario) and the Ministry of Health and Long-term Care at the apex.

These changes in structure mean that there is a tremendous amount of transformation of the system that has to occur – changes in the management of the system; in the governance of the system; in the interaction between the players; in the way that the Ministry of Health interacts with the system; etc. A lot of change!! The conference brought together Board members and senior management from a wide variety of health care providers, LHINs, Community Care Access Centres, etc to talk about how to start changing governance and management to ensure the integration of the system and the strategic alignment of the system.

We have created a new section on the IPAC website that is dedicated to health care – by health care I mean the management and governance issues related to health care (not clinical issues!). We will be expanding this section over the next few years as we continue to work in helping ameliorate health care management and governance in Canada. Check out this new section – there are two ways to get there: Look under “Key Initiatives” or look for Health Care under the “Research” section of the website.

All aBoard

I along with three other people, including Senator Hugh Segal, were appointed to the Board of the Institute for Clinical Evaluative Sciences (www.ices.on.ca). Since its inception in 1992, ICES has played a key role in providing unique scientific insights to help policymakers, managers, planners, practitioners and other researchers shape the future direction of the Ontario health care system. Their unbiased, evidence-based knowledge and recommendations, profiled in atlases, investigative reports, and peer-reviewed journals, are used to guide decision-making and inform changes in health care delivery.

Given my interest in Health Care - from both my work in the scientific field (my first degree was in Biology - Human Genetics) and my work at the Ontario Ministry of Finance, this appointment is a natural fit. I'm looking forward to my fisrt Board meeting next week and will let you know about any interesting developments. In a future blog I might even relate my past research on osteporosis using beagles to public management & administration (might be a stretch, but I'll find some link!)