There are more reports ranking the world’s health care systems than there are countries. They measure different stats and come at the problem from different angles—efficiency, money spent per capita, overall public health, and so on. One thing that emerges from all of these studies is that Canada is nowhere near the top in any of them. The best Canada did in a major study was to come in 10th out of 11 in a survey by the Commonwealth fund—which has a bias towards finding more money for Public health. The World Health Organization ranks Canada’s Health care system 30th in overall efficiency. Bloomburg published a study that showed Canada 21st on the same scale. So despite our universal health coverage, despite the fact that we spend around $5,000 per capita on health care, we lag behind countries like Morocco.
In an attempt to address the problem in Ontario, the government has turned to Dr. Kevin Smith President of St. Joseph’s Healthcare in Hamilton. With post graduate degrees in healthcare leadership from Britain and the prestigious Wharton School of Business in Philadelphia Dr. Smith has become the ‘go-to guy’ in trying to solve problems for the Ministry of Health in Ontario. In addition to managing a multi-hospital system in Hamilton, Guelph and Kitchener, Smith was asked to sort out a divisive hospital site selection controversy in Niagara and then became CEO of the new hospital there. Now the task he has been given is how to make the current multi-player, multi disciplinary system, as he puts it, “better, faster, cheaper.” It will be a challenge in a hydra-headed system. Kevin is serving as a special advisor to the minister on integration to help roll the concept out to 10 other health systems.
By March 18th proposals will be submitted and Smith will help select the best ones for wave one of the rollout.
It is generally conceded that if you come down with a serious illness in Ontario–cancer, heart disease or diabetes; that from the patient treatment perspective, the system works pretty well. You’ll get the CT Scan or MRI that is required, you will get surgery as required and you will get follow-up care. But this complex system lacks the kind of basic organizational efficiencies. that any private sector organization would have embraced decades ago or would now be extinct. It is a system that still makes extensive use of fax machines alongside some of the most sophisticated imaging and surgical equipment available. Medical records are not always accessible to everyone who is providing care. That’s one of the reasons why patients are repeatedly asked the same questions. Says Dr. Smith, “The system is siloed and disjointed… over and over we heard people say it doesn’t feel very smooth or very easy.” He is working on a coordination program that it is hoped will take the patient through the pre-hospital phase, the actual hospital stay and home follow-up. “What if we just kind of wrapped the care around you and gave you one number to call and we coordinated and we made sure that everyone who touched you was integrated into the team,” he asked. “Then it should make the care a lot better for the patient and for the provider.” That seems like a pretty basic premise, but health care in Ontario, while it has but one funding source, has many players who are accessing that money, and they often don’t communicate with each other as effectively as they should.
Dr Smith provides an example of how the system is getting more efficient using low cost technologies like I pad and Skype. “So I’m your home care worker, you have a concern, (with an I pad at the bedside)I would get the expert surgeon on an i pad and he or she could have a look at your incision or see what you’re concerned about…and not drag you back into an emergency room.” Health Minister Eric Hoskins and his predecessor, Deb Matthews got to try out the technology with a patient in a remote part of Haldimand county, (but still in the St. Jos catchment area), who received diagnosis and treatment via Skype, thus avoiding a hospital visit.
“At the end of the day it comes down to reducing waste in a system that will soon face an avalanche of aging baby boomers,” says Dr. Smith “ The auditor general is saying, show me value for money. I need to demonstrate to Ontarians that in spending this money we are getting the very best results possible.” He adds that in many ways Hamilton is ahead of the curve in coordinating the activities across the entire multi-player system. “We’re lucky in Hamilton because of the leadership McMaster School of Medicine has had in developing group-based models of care—so I think that’s is a real advantage. For many years we’ve had the highest concentration of group-based, team-based doctors.”