As we absorb the day to day headlines of the latest sovereign nation to be invaded, we see nebulous infrastructure coming apart . The poignancy of young babes moved to basement shelters and nurses supporting their breathing efforts with bag-mask-ventilation. Communities function in a complex interplay of services provided i.e., water, sanitation, garbage pick up and essential services including police, fire, paramedics, and health care providers. The magnitude of the disruptions, exodus of citizens to neighbouring countries, the diplomatic efforts, yet people are dying and the tragedy continues to unfold.
In our own land in North America we are also affected by world affairs, as gas prices climb rapidly, supply chain issues affect industries and consumers. In health care we learned early in the pandemic that much of our medical care supplies come from outside the country. Masks manufactured overseas to contain costs; assumptions on how long supplies can be stored were overly optimistic, as N95 masks’ straps disintegrated when unboxed. The pandemic has been two years in our midst and the wish that it just be over now is perhaps not a sure thing. The Chief Medical Officer in the federal level of government cautions the virus is not gone yet. As capacity limits recede, it is surmised that mask guidelines may also be lifted.
The pandemic has revealed that we have many vulnerable groups in our communities and it is clear we need to improve determinants of health and the environmental factors to minimize the growing demands of care needed. The redesign of our health care system has some big ticket items to be considered; quality of life and dignity of death that need to contain the elements of efficiency, effectiveness, value to individuals, improved outcomes for the money and resources invested into health systems. Cutting costs, a pursuit expertly pursued by administrators, has not necessarily resulted in better health for many. It could be we have improved the delivery of questionable practices, seen the growth of big pharma, what we don’t always see is that by not applying evidence, by not investing in evidence; we do not end up where we want to go–best health outcomes (Teisberg & Wallace, 2019).
We have in the business of health care smart, caring, and hard-working professionals; we also have highly variable practices, increasing costs, treatment disconnects, and slow to innovate. Teisberg & Wallace (2019) outlined the following:
High Value, Relationship-Centred Care Results From Extraordinary Effort, Rather Than Usual Process
What does this all mean? Health care does not improve health enough. Outcomes are not the focus, yet it’s outcomes that will lead to reduced costs. The prevention of lifestyle diseases is less costly than treating poor health outcomes. Smoking cessation was a process that occurred over a generation to change personal habits, advertising, access, environmental regulations i.e. no smoking areas, no smoking at all in restaurants, airplanes. If you’re paying attention in health care a shift is occurring a key question how are you? Not how were we? There are gaps that occur in patient care when we don’t listen to the individual and/or family, lack of standardized protocols that are evidence-based, when we reduce the disparities of care we ensure there is a focus on quality of life and if suffering is unbearable. Palliative care needs to be considered appropriate care and coordinated with input from all stakeholders.
It’s no small project to redesign a care delivery framework. There are some elements to be considered; Teisberg & Wallace (2019) described a framework
- People with shared health needs
- Design solutions that draw from evidence and creativity
- Measure results: outcomes and costs. Measurement enables improvement
- Build integrated teams that have the characteristics i.e., trust, resilience, collaborative
- Align resources and partnerships; anything is possible when silos are eliminated, culture evolves and sets aspirations, accelerates learning
- Rationalize systems and networks; anticipate services needed, patient centred, relationship centred, seamless care; strategy focuses and aligns activity, builds on learning
- Grow based on value; patients want solutions not services; principles of capability, comfort, calm
A key point; we hear a lot about mission, vision, values—respect, safety, dignity are the ground floor. To aspire to excellence, value based outcomes we need to create with patients and families care experiences to achieve better health outcomes during care. Holistic care, multi-sectoral, quality, and building on what patients are capable of, let’s also give thought to the professionals who need to know their purpose and can access the resources needed when needed. Namaste.
Teisberg, Elizabeth. (2019) “Designing healthcare services for excellence and empathy” Technology to the Power of Compassion Equals Transformative Healthcare. AMS Healthcare, November 4, 2019, Toronto.
Registered Nurse Storyteller, Healer, Scribe, Transformational Leader