Very few reasons exist for hospital administrators, doctors, nurses, or the Ministry of Health to have patients seen and treated promptly.
This post summarizes Step 10, in No More Lethal Waits: 10 Steps to Transform Canada’s Emergency Departments.
High functioning teams play in the same direction, at the same time. Canadian hospitals have staff playing at cross-purposes:
- Hospitals lose money for seeing more patients.
- Doctors earn more for seeing more patients.
- Nurses get paid the same no matter how slow (or fast) they work.
- See blog on Canadian Chaos.
No one talks about incentives and control inside the system.
Deal With Unions
71% of public employees belong to a union versus 17% in the private sector. Unionization rates are over 90% for hospitals in Ontario.
Provider unions have grown imperious. Management fears them. See Are Unions Killing Healthcare?
There are 3 rules in healthcare:
- Always do what’s best for patients.
- Always do what’s best for providers.
- Never confuse #2 with #1.
Everybody has to work a little harder, and care for more patients today, than they did in the past.
Unionists are taught from the cradle that nurse to patient ratios take priority over patient needs.
Unions resists process change, if there is any chance that the change might negatively impact union members. Patient benefit is secondary.
Discuss Funding After Governance
People believe that our bloated healthcare system centres on debate about funding vs. spending, or supply versus demand. But it is neither of these.
Whether money comes from taxes collected by government, or taxes collected by insurance companies, the issue is not about money.
The debate must shift from how money comes in to who is control of how money gets spent.
Everyone demands accountability from the system, but no one gives the people inside the system the freedom or authority to truly control outcomes.
There too many self-interested stakeholders with narrow agendas.
The status quo survives on compromise consensus.
Problem With Salaried Administrators
Most administrators care more about losing their job than pursuing radical innovation for patients.
Administrators spend years working to get promotions into senior leadership. Hospitals give administrators little incentive to tackle the toughest problems.
In a bureaucracy-driven system, leaders focus on being slightly better than their peers, but never to be outstanding.
The risks of true innovation are too high.
Milton Friedman said that bureaucrats risk two choices with innovation:
- They can block something beneficial, but no one will ever know.
- They can approve something harmful. Then everybody knows, and the administrator loses his job.
Most bureaucrats choose #1.
Problem With Clinical Administrators
Just because you spent time as a clinician does not mean you understand how other clinicians think. We cannot lump all clinical training together.
When we look at healthcare with untrained eyes, we might think that nurses, respiratory therapists, and physicians do basically the same things.
They all see patients, travel around the hospital, and record their findings in charts, while discussing treatment plans.
This is like saying everyone in IT is basically the same. To the untrained eye, computer scientists, IT repairmen, and website developers basically do the same thing: they work in high-tech.
No one would ever fill a senior IT leadership team with only website developers. They would never assume that such an unbalanced team could champion IT excellence.
In health care, we assume anyone who spent time working with direct patient care should be able to run the hospital.
It’s simply not true.
CEOs who hang around the nursing station will never really know what it means to think like a nurse. CEOs who have watched physicians work will never understand how physicians think.
We Need Doctors in Leadership
See blog posts:
- How Doctors Can Fix Healthcare
- Healthcare’s Only Hope is Not Government
- Quality Care Requires Freedom
- Leadership in Medicare
- Myth: Physicians Lead Medicare
- Doctors Should Lead Medicine
And stop talking about engagement. We need true partnership.
What Our challenge Is Not
Conscientious providers get tied in knots worrying about the healthcare system.
We’ve done this for decades and it must stop. Until leaders focus solely on patient service, the system will not improve.
The time for political conscientiousness has passed. Emergency providers are on their own.
If government wants to decrease emergency department use, they need to redesign the system so patients are attracted to seek care elsewhere.
It is not for EM workers to bear the responsibility of rationing care for the whole system.
What Our Challenge Is
Patients need humanity and compassion with every clinical interaction.
The most important outcomes for patients are often qualitative, subjective, and impossible to measure.
We need to learn to articulate what medicine is. It must be hard. It needs to be tough and complicated to capture everything we do for patients.
Narrow-minded medicine makes patients secondary.
We need tough-minded leaders with diverse backgrounds and training who are committed to putting patients before budgets, politics, and ideology in order to sort out the Canadian chaos in healthcare.
This gives you a sense of the last chapter of No More Lethal Waits: 10 Steps to Transform Canada’s Emergency Departments. Thanks for checking it out!